Sir, I read with interest the recent article 'Dental pain management – a cause of significant morbidity due to paracetamol overdose' (BDJ 2018; 224: 623–626). Working in secondary care I am continually surprised by the number of patients admitted to hospital with paracetamol overdoses related to toothache.

For dental colleagues working in secondary care managing inpatients, it is important to consider dose banding with regards to prescribing intravenous paracetamol. Within the trust in which I work this issue has been highlighted as a priority improvement for patient safety. This was implemented after a number of incidents in which patients were incorrectly prescribed intravenous doses of 1 g paracetamol. Unfortunately, some of these patients developed hepatic impairment and were admitted under critical care.

For patients who cannot take paracetamol orally and require intravenous paracetamol, it is important to consider a patients weight and hepatic condition when prescribing. The BNF currently states that patients under 50 kg or who have risk factors for hepatotoxicity should have 15 mg/kg every 4-6 hours to a maximum of 60 mg/kg per day.1

Preferably, paracetamol should be given orally whenever possible and patients should be weighed on admission to hospital to aid with dose banding. If intravenous paracetamol is prescribed then it should be switched back to oral at the earliest opportunity.