Doses of acetaminophen and nonsteroidal antiinflammatory drugs in children

Drug	Dose	Comments
Acetaminophen		Doses should be reduced for patients with hepatic or significant renal dysfunction.
Oral	15 mg/kg orally every 4 to 6 hours, as needed or scheduled, maximum 5 doses per day, maximum 4 g/day*	Usual dosing interval for pain management is every 6 hours.
Intravenous	15 mg/kg IV, as needed or scheduled, maximum 5 doses per day, maximum 4 g/day*	Usual dosing interval for pain management is every 6 hours.
Rectal	Intraoperative loading dose 30 to 40 mg/kg rectally, maximum 650 mg; subsequent dose of 15 mg/kg rectally no sooner than 6 hours after initial rectal dose only if subsequent IV and oral routes are not possible Without loading dose: 15 mg/kg rectally every 4 to 6 hours, maximum 5 doses per day, maximum 75 mg/kg/day	Rate of absorption and bioavailability of rectal administration are highly variable; safety of multiple rectal doses following a loading dose is unknown.
Ibuprofen
Oral	10 mg/kg orally every 6 hours, maximum 400 mg/dose, maximum daily dose 40 mg/kg/day or 2400 mg/day, whichever is less
Intravenous	10 mg/kg IV every 6 hours, maximum 400 mg/dose, maximum daily dose 40 mg/kg/day or 2400 mg/day, whichever is less	Not FDA approved for children <3 months of age. FDA approved for children 3 to 6 months of age as a single, one time only dose for acute pain or fever.
Ketorolac
6 months to 2 years of age	0.5 mg/kg IV every 6 to 8 hours, maximum 12 doses
2 to 16 years of age	0.5 mg/kg IV every 6 hours, maximum 30 mg/dose, maximum 20 doses	Some clinicians recommend a maximum of 12 doses.
>16 years of age and >50 kg	0.5 mg/kg every 6 hours, maximum 30 mg/dose, maximum 20 doses	Some clinicians recommend a maximum of 12 doses. For children in this age <50 kg, some sources recommend a maximum of 15 mg/dose and a maximum daily dose of 60 mg/day.

IV: intravenous; FDA: Food and Drug Administration.

* Hepatoxicity has occurred at manufacturer recommended maximum doses. Many experts recommend maximum doses of 3000 to 3250 mg/day, lower doses in patients with liver or kidney dysfunction. These maximum doses apply to short-term (eg, 3 to 5 days) administration.

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Doses of acetaminophen and nonsteroidal antiinflammatory drugs in children