Acetaminophen and BP

Q: Intravenous (IV) acetaminophen may decrease the blood pressure (BP) up to the point that it may require pressor? 

A) True 

B) False

Answer: A

Acetaminophen has different effects with oral and IV routes. Chronic oral ingestion of acetaminophen has been shown to increase the baseline blood pressure and risk for chronic kidney disease. In contrast, IV acetaminophen has been shown to decrease BP in ICU patients up to the point where pressor may be required to salvage the drop in BP. 

This acetaminophen-induced hypotension can be seen within 30 minutes of administration and may last up to an hour. This effect is reproducible in non-ICU relatively healthy patients. This decrease in BP is both due to analgesic as well as a direct effect.

#hemodynamic

#pharmacology

References:

1. Cantais A, Schnell D, Vincent F, et al. Acetaminophen-Induced Changes in Systemic Blood Pressure in Critically Ill Patients: Results of a Multicenter Cohort Study. Crit Care Med 2016; 44:2192. 

2. Chiam E, Weinberg L, Bailey M, et al. The haemodynamic effects of intravenous paracetamol (acetaminophen) in healthy volunteers: a double-blind, randomized, triple crossover trial. Br J Clin Pharmacol 2016; 81:605. 

3. Maxwell EN, Johnson B, Cammilleri J, Ferreira JA. Intravenous Acetaminophen-Induced Hypotension: A Review of the Current Literature. Ann Pharmacother 2019; 53:1033.