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Although, it has been cited in the literature4 that the American Academy of Pediatrics (AAP) has discouraged the use of rectal acetaminophen because of concerns about the toxic effects as well as erratic absorption of the drug; this was not the recommendation for the use of rectal acetaminophen. The AAP did, in fact, publish that certain factors create the potential for inadequate therapeutic effect such as poor absorption and a cumulative toxic effect from excessive or too frequently repeated doses but the recommendation clearly stated that, for parents, rectal acetaminophen therapy should be avoided unless specifically discussed with the health care provider22. There was not a recommendation for discontinuing the use of rectal suppositories in hospitals or by physicians. The reason that parents need specific instructions is because the absorption of the acetaminophen varies depending on where in the rectum it is placed. When the suppository is placed in the distal rectum the drug by passes the liver, whereas with more proximal placement (oral), the drug will go through the first pass of the portal system that is drugs are metabolized in a single passage through the gut wall and (principally) liver, which reduces the bioavailability of the