Intravenous paracetamol (Prodafalgan) causes hypotension in critically ill patients

Introduction

Some critically ill patients cannot absorb enteral medications. We noted that intravenous (IV) Prodafalgan (PRDFG), a recently introduced parenteral bioprecursor of paracetamol, caused hypotension. A prospective study was conducted.

Methods

The population was ICU patients requiring IV PRDFG (rectal temperature ≥ 38°C, no enteral route). PRDFG (2 g) was infused over 15–20 min. The temperature, heart rate, systolic/diastolic blood pressure and mean blood pressure (MAP) were recorded before, during and 15–120 min following infusion. Interventions to correct hypotension were recorded.

Results

Seventy-two events, in 14 patients, of PRDFG administration were recorded. MAP dropped significantly 15 min following PRDFG infusion. Initiation or increase of noradrenaline occurred in 25% of the events and fluid bolus was given in 8%.

Conclusions

PRDFG caused significant hypotension, requiring active intervention in 33% of the events. This data substantiated the anecdotal knowledge on the relationship between paracetamol (acetaminophen) and hypotension in the critically ill and associated it with the IV preparation.

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