For the use only of Registered Medical Practitioners or a Hospital or a Laboratory

CALPOL
TABLETS / SUSPENSION / PAEDIATRIC DROPS
Paracetamol Tablets IP / Paracetamol Paediatric Oral Suspension IP
WARNING: Taking more than daily dose may cause serious liver damage
or allergic reactions (e.g. swelling of the face, mouth and throat, difficulty
in breathing, itching or rash)

QUALITATIVE AND QUANTITATIVE COMPOSITION

Tablets:

CALPOL TABLETS 500 mg (Paracetamol Tablets IP 500 mg)

Each uncoated tablet contains Paracetamol IP 500 mg.

CALPOL TABLETS 650 mg (Paracetamol Tablets IP 650 mg)

Each uncoated tablet contains Paracetamol IP 650 mg.

Suspension:

CALPOL SUSPENSION 120 mg/5 ml (Paracetamol Paediatric Oral Suspension IP 120mg)

Each 5 ml contains:

Paracetamol IP 120 mg in a flavoured syrup base.

Colour : Carmoisine

CALPOL SUSPENSION 250 mg/5 ml (Paracetamol Paediatric Oral Suspension IP 250mg)

Each 5 ml contains:

Paracetamol IP 250 mg in a flavoured syrup base.

Colour : Carmoisine.

Paediatric Drops:

CALPOL PAEDIATRIC DROPS 100 mg/ml (Paracetamol Paediatric Oral Suspension IP 100
mg)

Each ml (approx. 20 drops) contains:

Paracetamol IP 100 mg.

Colour: Sunset Yellow FCF.
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PHARMACEUTICAL FORM

Tablets
Suspension

CLINICAL PARTICULARS

Therapeutic Indications

Paracetamol is an analgesic and an antipyretic.

• Treatment of mild-to-moderate pain and treatment of fever including: Headache, Migraine,

Muscle ache, Dysmennorhoea, Sore throat, Musculoskeletal pain, Fever and pain
associated with vaccination/immunisation, Pain after dental procedures / tooth extraction,
Toothache, Earache / otalgia, Respiratory tract infections including cold and flu,
Osteoarthritis pain.

Posology and Method of Administration

Do not exceed the stated dose. The lowest dose necessary to achieve efficacy should be used
for the shortest duration of treatment.

Tablets

Oral administration only.

Minimum dosing interval: 4 hours.

Maximum daily dose: 4000 mg.

Adults (including the elderly) and children aged 12 years and over:

CALPOL TABLETS 500 mg: 1 to 2 tablets taken every 4 to 6 hours as required.

CALPOL TABLETS 650 mg: 1 tablet taken every 4 to 6 hours as required.

Children, 6 to 11 years:

No more than four doses in any 24-hour period.

Maximum duration of continued use without medical advice: 3 days.

Maximum daily dose: 60mg/kg presented in divided doses of 10 - 15 mg/kg throughout the 24-
hour period.

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Children, 6 to 8 years:

250mg (½ tablet)

Children, 9 to 11 years:

500mg paracetamol (1 tablet)

Children under 6 years:

Not recommended for children under the age of 6 years.

Suspension

Do not exceed the stated dose. The lowest dose necessary to achieve efficacy should be used
for the shortest duration of treatment.

Oral administration only.

Minimum dosing interval: 4 hours.

No more than four doses in any 24-hour period.

Maximum duration of continued use without medical advice: 3 days.

Maximum daily dosage: 60mg/kg presented in divided doses of 10 - 15 mg/kg throughout the
24-hour period.

Children aged 1 month and above:

Fever

Treatment of fever in children 1 month - 3 months:

If fever persists for >24 hours (4 doses) seek medical advice to exclude a serious infectious
cause.

Post Vaccination guidance

Post-vaccination fever in children 1 month - 3 months:

A single dose of 10 - 15 mg/kg for symptomatic relief of fever following vaccination. If a

second dose is required, leave at least 4 hours between doses. Medical advice should be sought
if fever persists after a second dose.

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Special populations

• Children

See Posology and Method of Administration section for product specific information.

• Renal Impairment

Patients who have been diagnosed with renal impairment must seek medical advice before
taking this medication. The restrictions related to the use of paracetamol products in
patients with renal impairment are primarily a consequence of the paracetamol content of
the drug (see Special Warnings and Special Precautions for Use).

• Hepatic Impairment

Patients who have been diagnosed with liver impairment must seek medical advice before
taking this medication. The restrictions related to the use of paracetamol products in
patients with hepatic impairment are primarily a consequence of the paracetamol content
of the drug (see Special Warnings and Special Precautions for Use).

Contraindications

This product is contraindicated in patients with a previous history of hypersensitivity to

paracetamol or excipients.

Special Warnings and Special Precautions for Use

All formulations:

Contains paracetamol. Do not use with any other paracetamol-containing products. The
concomitant use with other products containing paracetamol may lead to an overdose.

Paracetamol overdose may cause liver failure which may require liver transplant or lead to
death.

Underlying liver disease increases the risk of paracetamol related liver damage. Patients who
have been diagnosed with liver or kidney impairment must seek medical advice before taking
this medication.

Cases of hepatic dysfunction/failure have been reported in patients with depleted glutathione
levels, such as those who are severely malnourished, anorexic, have a low body mass index are
chronic heavy users of alcohol or have sepsis.

In patients with glutathione depleted states the use of paracetamol may increase the risk of
metabolic acidosis.

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If symptoms persist, medical advice must be sought.
Keep out of sight and reach of children.

In addition the following apply to specific presentations:

Suspension 120mg/5 ml and 250mg/5ml:

Contains Sorbitol solution – Patients with rare hereditary problems of fructose intolerance
should not take this medicine.

Contains Methyl-, propyl- hydroxybenzoates may cause allergic reactions (possibly delayed).

Paediatric Drops 100 mg/ml:

Contains Methyl-, propyl- hydroxybenzoates may cause allergic reactions (possibly delayed).

Interaction with Other Medicaments and Other Forms of Interaction

The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged
regular daily use of paracetamol with increased risk of bleeding; occasional doses have no
significant effect.

Pregnancy and Lactation

Pregnancy

As with the use of any medicine during pregnancy, pregnant women should seek medical
advice before taking paracetamol. The lowest effective dose and shortest duration of treatment
should be considered.

Lactation

Paracetamol is excreted in breast milk but not in a clinically significant amount at

recommended dosages. Available published data do not contraindicate breast feeding.

Effects on Ability to Drive and Use Machines

Unlikely to cause an effect on ability to drive and use machines.

Undesirable Effects

Adverse events from historical clinical trial data are both infrequent and from small patient
exposure. Accordingly, events reported from extensive post-marketing experience at
therapeutic/labelled dose and considered attributable are tabulated below by System Organ
Class and frequency.

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The following convention has been utilised for the classification of undesirable effects: very
common (≥1/10), common (≥1/100, <1/10), uncommon (≥1/1,000, <1/100), rare (≥1/10,000,
<1/1000), very rare (<1/10,000), not known (cannot be estimated from available data).

Adverse event frequencies have been estimated from spontaneous reports received through
post-marketing data.

Post marketing data

Body System Undesirable effect Frequency

Blood and lymphatic system Thrombocytopaenia Very rare
disorders
Immune System disorders Anaphylaxis cutaneous Very rare
hypersensitivity reactions
including, among others, skin
rashes, angioedema, Stevens-
Johnson syndrome and Toxic
Epidermal Necrolysis.
Respiratory, thoracic and Bronchospasm in patients Very rare
mediastinal disorders sensitive to aspirin and other
NSAIDs
Hepatobiliary disorders Hepatic dysfunction Very rare

Overdose

Signs and Symptoms

PARACETAMOL OVERDOSE MAY BE INJURIOUS TO LIVER.

Experience following overdose with paracetamol indicates that the clinical signs of liver injury
occur usually after 24 to 48 hours and have peaked after 4 to 6 days.

Paracetamol overdose may cause liver failure which may require liver transplant or lead to
death. Acute pancreatitis has been observed, usually with hepatic dysfunction and liver toxicity.

Treatment

Immediate medical management is required in the event of overdose, even if symptoms of

overdose are not present.

Administration of N acetylcysteine or methionine may be required.

PHARMACOLOGICAL PROPERTIES

Pharmacodynamic Properties

Pharmacotherapeutic group: Anilides, ATC code: N02B E01.

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Mechanism of Action

Paracetamol is an analgesic and antipyretic. Its mechanism of action is believed to include

inhibition of prostaglandin synthesis, primarily within the central nervous system.

Pharmacodynamic Effects

The lack of peripheral prostaglandin inhibition confers important pharmacological properties

such as the maintenance of the protective prostaglandins within the gastrointestinal tract.
Paracetamol is, therefore, particularly suitable for: patients with a history of disease or patients
taking concomitant medication, where peripheral prostaglandin inhibition would be
undesirable (such as, for example, those with a history of gastrointestinal bleeding or the
elderly).

Pharmacokinetic Properties

All formulations:

Absorption

Paracetamol is rapidly and almost completely absorbed from the gastrointestinal tract.

Distribution

Binding to the plasma proteins is minimal at therapeutic concentrations.

Metabolism

Paracetamol is metabolised in the liver and excreted in the urine mainly as glucuronide and
sulphate conjugates.

Elimination

Less than 5% is excreted as unmodified paracetamol.

In addition the following apply to specific formulations:

Tablets:

Paracetamol is rapidly absorbed from the gastrointestinal tract and is distributed into most body
tissues. Binding to plasma proteins is minimal at therapeutic concentrations. Paracetamol is
metabolised in the liver and excreted in the urine mainly as glucuronide and sulphate
conjugates; less than 5% is excreted as unmodified paracetamol. The mean plasma half life is
about 2.3 hours.

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Clinical Studies

Sore throat

A double blind, single-dose parallel study in 120 patients with upper respiratory tract infection
with acute sore throat and objective evidence of tonsillopharyngitis demonstrated statistically
and clinically significant efficacy of a single 1000 mg dose of paracetamol tablet in reducing
pain intensity and providing pain relief in sore throat over at hourly intervals 6 hour period,
compared with placebo. This study used validated measures and differences were clinically
relevant.

Headache

Three large, randomised, double-blind studies assessing the efficacy of paracetamol in tension
headache have been reported, comparing several doses of paracetamol with other analgesics
and placebo. Two studies demonstrated statistically significant superior cumulative pain relief
values and cumulative sums of pain intensity differences over 6 hours for paracetamol 1000
mg compared with placebo. Significant differences compared with placebo were observed from
one hour after dosing, although separation of benefit commenced as early as 30 minutes after
dosing. The third study demonstrated that paracetamol 1000 mg gave statistically significant
superior pain relief compared to placebo.

Muscle Ache

A randomised, double-blind, placebo-controlled study investigated the effect of treatments

including paracetamol (1000 mg) in combination with pseudoephedrine in patients with the
common cold. General muscular ache was assessed during the study and a significant
superiority over placebo (p<0.05) was demonstrated for the paracetamol combination.

Migraine

A large parallel group study assessed the efficacy of paracetamol 1000 mg compared with
placebo in a single migraine attack. The paracetamol was significantly superior to placebo at 2
hours post-dose for headache response rate, pain-free rate and for other migraine headache
symptoms such as photophobia, phonophobia and functional disability.

A large cross-over study assessed the efficacy of paracetamol 1000 mg compared with
dihydroergotamine, paracetamol/dihydroergotamine combination and placebo in four
consecutive migraine attacks. All active treatments were significantly superior to placebo in
reducing intensity of pain at 1 and 2 hours, and brought a significantly faster abatement of pain.
A second crossover study compared paracetamol 900 mg with ibuprofen 400 mg in the
treatment of classical migraine. Both treatments significantly reduced severity of pain
compared with baseline.

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Dysmenorrhoea

Two placebo-controlled studies examined paracetamol efficacy in dysmenorrhoea. The first

study was part of a pooled analysis which compared paracetamol 1000 mg with naproxen
sodium 220 mg and placebo. The design was a randomised, double-blind, single dose, cross-
over study in patients with primary dysmenorrhoea of moderate to severe intensity. For
paracetamol, maximal pain relief was observed at 2 hours post-dose. Paracetamol showed
significant pain relief at 2, 3 and 4 hours after administration versus placebo (p<0.01) and
numerically superior pain relief at 5, 6 and 7 hours after administration. The second study
demonstrated that paracetamol 650 mg was superior to placebo in reducing menstrual pain.

Dental Pain

Six studies in dental pain are reviewed. All were large studies, randomised, group comparative
and double-blind in design. All except one were placebo controlled. The non-placebo
controlled study compared two doses of paracetamol with codeine 60 mg. One study was
performed in pre-operative pain, all others were post-operative assessments. In all studies
paracetamol 1000 mg was shown to be statistically superior to placebo or to codeine 60 mg. In
one study effervescent paracetamol was shown to have a faster onset of analgesia than standard
immediate release paracetamol tablets.

Osteoarthritis

A meta-analysis has of the efficacy of paracetamol in the treatment of osteoarthritis showed

that paracetamol was significantly more effective in relieving pain due to osteoarthritis than
placebo.

Musculoskeletal pain

A study has been performed in acute and chronic moderately severe musculoskeletal pain
(including ligament/bone pain, low back strain, osteoarthritis and 14 other conditions) in 90
patients. Pain was significantly reduced compared with baseline in the paracetamol group, but
comparisons with placebo were not performed.

Respiratory tract infections, including cold and flu symptoms

A large, well-designed study in adults with upper respiratory tract infection assessed the
efficacy of 500 mg and 1000 mg doses of paracetamol compared with aspirin (500 mg or 1000
mg) or placebo for 6 hours after treatment. Compared to placebo, significant reductions were
seen in the mean intensity of headache, aching and feverish discomfort (p<0.001) at 2, 4 and 6
hours after paracetamol 1000 mg. Compared to placebo, significant reductions were seen in the
mean intensity of headache (p<0.001) at 2, 4 and 6 hours after paracetamol 500 mg. Further,
with the 500 mg paracetamol dose, feverish discomfort (p<0.001 at 2 and 4 hours and p<0.025
at 6 hours) and achiness (p<0.01 at 1 and 4 hours) were significantly reduced as compared to
placebo.

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Two open-label, randomised comparative studies in children with upper respiratory tract
infections report significant (p<0.05) reductions in fever after the first dose of paracetamol.

In patients with an acute sore throat and at least one current symptom of upper respiratory tract
infection, 1000 mg paracetamol showed significantly greater total pain relief over 30 minutes,
1 hour, and 6 hours compared with matching placebo.

Earache / otalgia

In a small study (26 children, aged 18 month-13 years and 9 adults, aged 15-65 years) patients
with acute otalgia were randomised to receive oral paracetamol or aural choline salicylate
dosed every 3-4 hours until pain relief was achieved. All patients receiving paracetamol (n=17)
had reported pain relief within a time period of 10-90 minutes, 3 patients had mild pain, 9
patients had moderate pain and 5 had stronger pain.

A large, well-designed randomised controlled trial of 219 children (aged 1-6 years) with otitis
media assessed the efficacy of 2 days’ treatment with paracetamol (10 mg/kg three times daily,
[n=73]), ibuprofen (10 mg/kg three times daily) or placebo. Tympanic score was reduced in all
three groups at day 2; however there was no significant difference between the three treatment
groups.

A Cochrane review reports that at 48 hours, children in the paracetamol group had less pain
than those allocated to placebo. This data is based on the Cochrane authors’ analysis of the
results in the above-cited trial.

Fever

A large, well designed study in 392 adults with fever (associated with upper respiratory tract
infection) assessed the efficacy of 500 mg (n=79) and 1000 mg (n=79) doses of paracetamol
compared with placebo (n=78) for 6 hours after treatment. Both doses of paracetamol were
effective compared to placebo (p<0.001) over the 4 hour period and significant temperature
reduction for paracetamol persisted for a minimum of 6 hours. Another large, placebo-
controlled study in 154 adults assessed a single 650 mg dose of paracetamol in an endotoxin-
induced model of fever. This study showed a statistically significant and clinically relevant
change from baseline in temperature over 8 hours for paracetamol (n=30) compared with
placebo (n=30). Other controlled studies have demonstrated the antipyretic efficacy of
paracetamol in children.

Preclinical Safety Data

Non-clinical safety data for paracetamol have not revealed findings that are of relevance to the
recommended dosage and use of the product.

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PHARMACEUTICAL PARTICULARS

List of Excipients

CALPOL TABLETS 500 mg and 650 mg

Starch Maize, Pregelatinised Starch, Methylparaben, Magnesium Stearate, Purified Water.

CALPOL SUSPENSION 120 mg/5ml

Sucrose, Sorbitol Solution, Agar, Microcrystalline Cellulose, Methyl Hydroxybenzoate, Propyl

Hydroxybenzoate, Sodium Citrate, Citric Acid Monohydrate, Sodium Lauryl Sulphate,
Strawberry Flavour, Carmoisine, Purified Water.

CALPOL SUSPENSION 250 mg/5ml

Sucrose, Sorbitol solution 70%, Agar, Microcrystalline Cellulose, Methyl Hydroxybenzoate,

Propyl Hydroxybenzoate, Sodium Citrate, Citric Acid Monohydrate, Sodium Lauryl Sulphate,
Colour Carmoisine, Strawberry Flavour, Purified Water.

CALPOL PAEDIATRIC DROPS 100 mg/ml

Sucrose, Liquid Glucose, Xanthan Gum, Glycerin, Monoammonium Glycyrrhizinate, Methyl

Hydroxybenzoate, Propyl Hydroxybenzoate, Sodium Chloride, Sodium Citrate, Citric Acid
Monohydrate, Sunset Yellow FCF, Peppermint, Purified Water.

Incompatibilities

No data available.

Shelf Life

CALPOL TABLETS 500 mg and 650 mg

CALPOL SUSPENSION 120 mg/5ml and 250 mg/5ml

CALPOL PAEDIATRIC DROPS 100 mg/ml

The expiry dates are indicated on the label and packaging.

Special Precautions for Storage

CALPOL TABLETS 500 mg and 650 mg

Store at temperature not exceeding 30°C. Protect from light and moisture.

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CALPOL SUSPENSION 120 mg/5ml

Store in a well closed container at temperatures not exceeding 30ºC. Protect from direct
sunlight. Do not freeze.

CALPOL SUSPENSION 250 mg/5ml

Store in a well closed container at temperatures not exceeding 30ºC. Protect from direct
sunlight. Do not freeze.

CALPOL PAEDIATRIC DROPS 100 mg/ml

Store in a well closed container at temperatures not exceeding 30ºC. Protect from direct
sunlight. Do not freeze.

Keep out of reach of children.

Nature and Specification of Container

CALPOL TABLETS 500 mg and 650 mg

Blister strips in a carton

or
High density polyethylene (HDPE) container with induction sealing

CALPOL SUSPENSION 120 mg/5ml

Bottle with a measuring cup.

CALPOL SUSPENSION 250 mg/5ml

Bottle with a measuring cup.

CALPOL PAEDIATRIC DROPS 100 mg/ml

Bottle with a dropper in a carton.

All pack presentations may not be marketed in the country.

Instructions for Use / Handling

CALPOL TABLETS 500 mg and 650 mg

No special requirements.

CALPOL SUSPENSION 120 mg/5ml and 250 mg/5ml

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Shake well before use.

CALPOL PAEDIATRIC DROPS 100 mg/ml

Unscrew the cover on the dropper. Pull out the teat and screw the dropper on to the bottle after
removing the metal cap.

Shake well before use.

For further information please contact:

GlaxoSmithKline Pharmaceuticals Limited.
Registered Office
Dr. Annie Besant Road, Worli
Mumbai 400 030, India.

Trade marks are owned by or licensed to the GSK group of companies.

Version: CAL/PI/IN/2019/02 dated 8 April 2019.

Adapted from Paracetamol Consolidated GDS Version 7.0 dated 02-Aug-2017.

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