acetaminophen rectal (Acephen, FeverAll, FeverAll Infants, FeverAll Junior Strength, Adults' FeverAll)
Classes: Analgesics, Other
Dosing and uses of Acephen, FeverAll (acetaminophen rectal)
Adult dosage forms and strengths
suppository
- 80mg
- 120mg
- 325mg
- 650mg
Antipyretic/Analgesic
325-650 mg PR q4-6hr PRn
Not to exceed 4 g/day
Administration
Patient should lie on left side with knees bent
Remove protective wrap before inserting
Gently insert tip into rectum with slight side-to-side movement (tip of suppository pointing toward navel)
Pediatric dosage forms and strengths
suppository
- 80mg
- 120mg
- 325mg
- 650mg
Antipyretic/Analgesic
3 months to 1 year: 80 mg PR q6hr PRn
1-3 years: 80 mg PR q4hr PRn
3-6 years: 120 mg PR q4-6hrPRn
6-12 years: 325 mg PR q4-6hr PRn
>12 years: As adults; 325-650 mg PR q4-6hr PRn
Maximum daily dose
- <12 years: Not to exceed 5 doses/24 hr
- ≥12 years: Not to exceed 4 g/day
Administration
Patient should lie on left side with knees bent
Remove protective wrap before inserting
Gently insert tip into rectum with slight side-to-side movement (tip of suppository pointing toward navel)
Acephen, FeverAll (acetaminophen rectal) adverse (side) effects
Frequency not defined
Pruritic maculopapular rash
Urticaria
Rectal discomfort
Angioedema
Increase in bilirubin, alkaline phosphatase
Nephrotoxicity (chronic overdose)
Analgesic nephropathy
Decrease in chloride, glucose, uric acid
Laryngeal edema
Agranulocytosis
Decrease in bicarbonate, sodium, calcium
Leukopenia
Neutropenia
Pancytopenia
Thrombocytopenia
Thrombocytopenic purpura
Anaphylactoid reaction
Warnings
Contraindications
Hypersensitivity
Cautions
Acetaminophen is available in many dosage forms and products, check label carefully to avoid overdose
Risk of hepatotoxicity is higher in alcoholics, chronic high dose, or use of more than one acetaminophen-containing product
G6PD deficiency
Risk for rare, but serious skin reactions that can be fatal; these reactions include Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP); symptoms may include skin redness, blisters and rash
Pregnancy and lactation
Pregnancy category: B; Crosses placenta, safe to use in all stages of pregnancy short term
Lactation: Excreted in breast milk; compatible w/ breastfeeding
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Acephen, FeverAll (acetaminophen rectal)
Mechanism of action
Inhibits prostaglandin synthesis in the CNS and works peripherally to block pain impulse generation; acts on hypothalamus to produce antipyresis
Pharmacokinetics
Onset: 1 hr
Duration: 4-6 hr (analgesia)
Half-life: 2.4 hr (adolescents); 2-3 hr (adults); 2-5 hr (children); 4-10 hr (neonates)
Plasma Time: 107-288 min
Peak Plasma Concentration: dose-dependent; (10 mg/kg) 5.5 mcg/mL, (20 mg/kg) 8.8 mcg/mL, (30 mg/kg) 14.2 mcg/mL
Protein Bound: 10-25% (therapeutic concentrations); 43% (toxic concentrations)
Distribution: 1 L/kg
Metabolism: Liver (microsomal enzyme systems); conjugation (glucuronic/sulfuric acid)
Metabolites: N-acetyl-p-benzoquinoneimine, N-acetylimidoquinone, NAPQI; further metabolized via conjugation with glutathione
Excretion: <5% is excreted in the urine as unconjugated (free) acetaminophen and 60-80% as glucuronide metabolites
Hemodialysis: Yes
