Paracetamol for pain in palliative care

If paracetamol is indicated to manage pain in palliative care (see Principles of pharmacological management of pain in palliative care for indications), use:

There is anecdotal evidence that liver toxicity can occur when therapeutic doses of paracetamol (4 g in 24 hours) are used in adults with intrahepatic glutathione depletion (ie those who are malnourished, cachectic or frail, or have alcoholism or decompensated cirrhosis). Liver toxicity is more likely in patients with decompensated cirrhosis¹ or when multiple conditions associated with glutathione depletion are present. For patients with decompensated cirrhosis, reduce the maximum daily dose of paracetamol to 2 to 3 g in 24 hours. Consider dose reduction in patients with multiple conditions associated with glutathione depletion.

Monitor therapy for effectiveness and tolerability—see Monitoring analgesic therapy in palliative care.

For further information on paracetamol, including advice on route of administration and how to support safe use, see the Pain and Analgesia guidelines.