An automated flow injection (FI) manifold based on iterative change of the flow direction has been designed to carry out continuous liquid–liquid extraction without phase separation and hydrolysis both with ultrasound-assistance. The dynamic approach has been applied to suppositories from which paracetamol has been extracted in this way into an aqueous phase and hydrolysed prior to reaction with o-cresol in the alkaline medium used as extractant. The three linked reactions, extraction–hydrolysis–derivatisation, cause displacement of the balance to completeness. The strategic location of the photometric flow-cell in the flow-injection manifold enables monitoring of the overall process and the obtaining of a characteristic multipeak recording. The influence of ultrasounds on the different steps was investigated. The indophenol blue dye formed was monitored at 620 nm. The limits of detection (LOD) and quantification (LOQ) of the method are 0.38 and 0.64 μg ml−1, respectively, with a linear range from 0.64 to 50 μg ml−1; a within-laboratory reproducibility between 2.07 and 4.66% and repeatability from 2.01 to 4.63%, both expressed as relative standard deviation. The results obtained with the proposed method are in excellent agreement with those provided by the official method, but with a shorter analysis time, lower sample and reagent consumption and less analyst involvement.