Background and importance Pain is highly prevalent in old, frail adults with paracetamol as the mainstay treatment. Pain management is regularly suboptimal and using different paracetamol formulations might improve pain control. It is not known whether faster dissolving formulations of paracetamol granulate result in improved exposure.
Aim and objectives Our objective was to determine the pharmacokinetics (PK) of two different formulations of oral paracetamol in old, frail adults.
Material and methods Geriatric inpatients aged 80 years or older were eligible for inclusion if they received 1000 mg of paracetamol as a tablet or a granulate formulation at 8am, 2pm and 8pm. Samples were collected at trough levels (T0) and at +0.5 (T0.5), +1 (T1), +2 (T2), +4 (T4), +5 (T5) and +6 hours (T6). PK parameters were evaluated for both paracetamol formulations.
Results 36 patients were included, with a mean age (±SD) of 86.78 (±4.20) years. Most of the patients (n=26/36, 72%) received the tablet; 10 patients (28%) were prescribed the granulate formulation. Seven (21%) patients achieved an average plasma concentration (Css) above the analgesic target of 10 mg/L. Median Css (IQR) for the tablet group was 7.76 (6.31–9.08) mg/L and 9.27 (4.94–11.03) mg/L for the granulate group. Tmax was 50.5 (31.50–92.50) min and 42.50 (33.75–106.75) min for the tablet and granulate formulation, respectively (p=1.00). Cmax for tablet users was 15.95 (12.38–21.19) mg/L and 15.59 (10.80–21.77) mg/L for the granulate users (p=0.698).
Conclusion and relevance Large interindividual differences in PK parameters were found in a very old patient sample. Absorption parameters such as Tmax and Cmax were not significantly different between the tablet and granulate formulation. A trend for a higher Css was observed for patients in the granulate group.
Conflict of interest No conflict of interest
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