Act Oral Suspension 120 mg/5 ml

ACT Suspension is a widely used Paracetamol-based formulation manufactured by Ambee Pharmaceuticals Ltd. With a strength of 120 mg/5 ml, this oral suspension effectively treats fever, headaches, muscle pain, and post-vaccination discomfort in children. Priced at ৳35.00 per unit, it offers an affordable solution for pain management across all age groups.

This oral suspension inhibits prostaglandin synthesis by targeting COX enzymes, providing analgesic and antipyretic effects. Unlike NSAIDs, ACT Suspension causes fewer gastrointestinal side effects, making it safer for long-term use. Its rapid action ensures quick relief from conditions like osteoarthritis pain and menstrual cramps.

Dosage Guidelines:

• Infants (below 3 months): 0.5 ml (40 mg) four times daily
• Children (1-5 years): 1-2 teaspoons 3-4 times daily
• Adults: 4-8 teaspoons every 4-6 hours

Store ACT Suspension in a cool, dry place away from sunlight. Avoid concurrent use with alcohol or barbiturates, as it may increase liver toxicity risks. Common side effects include rare skin rashes, while overdose symptoms involve nausea and hepatic damage requiring immediate N-acetylcysteine treatment.

Adults: 5-10 ml every 4-6 hours (max 40ml/day). Children 1-5 years: 2.5-5 ml every 6-8 hours. Reduce dose by 50% in renal impairment. Can administer with/without food. Use measuring cup provided. Maximum 3 days for fever without medical supervision. Adjust interval to 8 hours in hepatic patients.

Side effects of Act are usually mild, though haematological reactions including thrombocytopenia, leucopenia, pancytopenia, neutropenia, and agranulocytosis have been reported. Pancreatitis, skin rashes, and other allergic reactions occur occasionally.

Pregnancy Category B. Excreted in breast milk (0.1-1.85% maternal dose). Safe for short-term use during lactation. Avoid doses exceeding 4g/day. Neonatal jaundice risk with prolonged maternal use.

Monitor INR in anticoagulated patients. Screen for chronic liver disease in alcohol users. Discontinue if skin reactions occur. Check serum creatinine in renal impairment. Shake oral suspension well before use.

Pediatric: Contraindicated in neonates <37 weeks. Geriatric: Reduce dose by 25-50%. Hepatic: Avoid in Child-Pugh C. Renal: Extend dosing interval to 8-12 hours if eGFR <30. Pregnancy: Limit to 3g/day.

Liver damage is possible in adults who have taken 10 g or more of Act. Ingestion of 5 g or more of Act may lead to liver damage if the patient has following risk factors: If the patient is on long term treatment with Carbamazepine, Phenobarbitone, Phenytoin, Primidone, Rifampicin, St John’s Wort or other drugs that induce liver enzymes, or regularly consumes Ethanol in excess of recommended amounts, or is likely to be Glutathione deplete e.g. eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.

Symptoms: Symptoms of Act overdose in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria, may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported. Immediate treatment is essential in the management of Act overdose. Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma Act concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable). Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of Act. However, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote declines sharply after this time. If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. If vomiting is not a problem, oral Methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who present with serious hepatic dysfunction beyond 24 hours from ingestion should be discussed with the NPIS or a liver unit.