Acetaminophen safety and hepatotoxicity – where do we go from here?

@article{Amar2007AcetaminophenSA,
  title={Acetaminophen safety and hepatotoxicity – where do we go from here?},
  author={P. Amar and Eugene R Schiff},
  journal={Expert Opinion on Drug Safety},
  year={2007},
  volume={6},
  pages={341 - 355}
}
Acetaminophen has been widely used for > 50 years in the treatment of pain and fever and provides for the safe and effective relief of these symptoms. In a small minority of patients, however, acetaminophen is responsible for life-threatening liver injury and accounts for up to 50% of all adult cases of acute liver failure in the US. Although approximately two-thirds of adult overdoses are associated with suicide attempts, many are inadvertent, often due to the use of multiple acetaminophen… 
PharmGKB summary: pathways of acetaminophen metabolism at the therapeutic versus toxic doses
TLDR
To reduce the risk of hepatotoxicity, the FDA requires that manufacturers limit the amount of acetaminophen in a pill to 325 mg, and that all the formulations containing the drug have a black box warning for potential liver damage.
Patterns of acetaminophen use exceeding 4 grams daily in a hospitalized population at a tertiary care center.
TLDR
This cohort of patients may represent an ideal population for further prospective study with more intensive and longer-term biochemical monitoring to assess for evidence of liver injury, and the use of multiple acetaminophen-containing medication formulations contributed to excessive dosing.
Effects of Acetaminophen or Ibuprofen Monotherapy in Febrile Children: A Meta-Analysis of Randomized Controlled Trials
TLDR
Assessing the efficacy and safety of acetaminophen and ibuprofen in febrile children through a systematic review with meta-analysis of randomized controlled trials concluded that acetamine is safer than ib uprofen, particularly in children approximately 5 years old.
Hepatotoxicity in a child following an accidental overdose of liquid paracetamol
TLDR
This uncommon case of hepatotoxicity in a child following accidental liquid paracetamol ingestion may have been due to increased susceptibility from a recent viral illness with decreased oral intake, as evidenced by the higher proportion of CYP metabolites.
Review on Chemistry, Pharmacology and Toxicity of Paracetamol
TLDR
One of the most commonly used antipyretic and analgesic drug in the world, which has no adverse effect when used at the therapeutic dose, paracetamol is associated with both intentional and unintentional poisoning.
Drug-induced liver injury in 2007
TLDR
The year 2007 brought with it several reminders of the importance of drug-induced liver injury in the clinical trial as well as the clinical practice setting, and there is additional evidence that statin drugs may be used safely in patients with chronic liver disease.
Paracetamol (Acetaminophen) Use in Infants and Children was Never Shown to be Safe for Neurodevelopment: A Systematic Review
Although widely believed to be safe for use in infants and children when used as directed, increasing evidence indicates that early life exposure to paracetamol (acetaminophen) may cause long-term
Acetaminophen Induces Apoptosis in Rat Cortical Neurons
TLDR
A direct neurotoxic action by AAP is established both in vivo and in vitro in rats at doses below those required to produce hepatotoxicity and this neurotoxicity might be involved in the general toxic syndrome observed during patient APP overdose and, possibly, also when AAP doses in the upper dosing schedule are used, especially if other risk factors are present.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 100 REFERENCES
Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug therapy for tuberculosis.
TLDR
Cases plus similar reports in the literature suggest that isoniazid or rifampin, or both, may potentiate the hepatotoxicity of acetaminophen, perhaps by induction of cytochrome P450 isozymes that oxidize acetamine to its toxic metabolites.
Unintentional Acetaminophen Ingestion in Children and the Potential For Hepatotoxicity
  • E. Caravati
  • Medicine
    Journal of toxicology. Clinical toxicology
  • 2000
TLDR
Children who ingest between 140–200 mg/kg of acetaminophen and demonstrate ipecac-induced emesis within 60 minutes may be safely managed at home and more clearly define referral criteria for these patients are defined.
Acetaminophen toxicity in an urban county hospital.
TLDR
In an urban county hospital, patients hospitalized with acetaminophen toxicity related to accidental misuse had higher rates of morbidity and mortality than those who attempted suicide, even though the latter had taken more acetamine.
Acetaminophen poisoning and toxicity.
TLDR
Although toxicity and fatalities have occurred in the adolescent age group, only one death in younger children has been recorded and the question must be raised as to how many cases of "jaundice of unknown etiology" are actually due to this drug.
Acetaminophen in chronic liver disease
  • G. Benson
  • Medicine
    Clinical pharmacology and therapeutics
  • 1983
TLDR
There is no contraindication to the use of acetaminophen in therapeutic doses in the presence of stable chronic liver disease and one subject developed symptoms, which worsened and were associated with deterioration in the results of laboratory studies, while taking acetamophen.
Acetaminophen hepatotoxicity in alcoholics. A therapeutic misadventure.
TLDR
Despite the low frequency of ethanol-potentiatedacetaminophen hepatotoxicity, alcoholics should be cautioned about the use of acetaminophen while they persist in heavy consumption of alcohol.
Association of acetaminophen hepatotoxicity with fasting and ethanol use.
TLDR
Acetaminophen hepatotoxicity after an overdose appears to be enhanced by fasting in addition to alcohol ingestion, and was associated with fasting and less commonly with alcohol use.
Acetaminophen‐induced acute liver failure: Results of a United States multicenter, prospective study
TLDR
In conclusion, acetaminophen hepatotoxicity far exceeds other causes of acute liver failure in the United States, and education of patients, physicians, and pharmacies to limit high‐risk use settings is recommended.
...
1
2
3
4
5
...