Should a Lower Treatment Line Be Used When Treating Paracetamol Poisoning in Patients with Chronic Alcoholism?

  title={Should a Lower Treatment Line Be Used When Treating Paracetamol Poisoning in Patients with Chronic Alcoholism?},
  author={Paul I Dargan and Alison Linda Jones},
  journal={Drug Safety},
The widespread practice of using a lower plasma paracetamol (acetaminophen) concentration threshold for the treatment of paracetamol poisoning in patients with chronic alcoholism has been introduced on the basis of anecdotal case reports.In animals, acute alcohol loading inhibits toxic metabolic activation of paracetamol whilst chronic alcohol administration results in cytochrome P450 (CYP) 2E1 induction with increased toxic metabolic activation of paracetamol by CYP2E1 and increased… 
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Comment on "Acute ethanol coingestion confers a lower risk of hepatotoxicity after deliberate acetaminophen overdose".

Investigation into the effect of acute ethanol coingestion on risk of hepatotoxicity among patients admitted to hospital for N-acetylcysteine (NAC) therapy after deliberate acetaminophen overdose finds an apparent protective effect, but further work is required to establish mechanisms by which ethanol might confer protection against hepatot toxicity.

Over-the-Counter Pain Management Gone Awry

It is essential for all health care providers to be familiar with the etiology and progression of this poisoning, as well as the necessary steps in treatment, to provide the highest level of care for this often-treatable condition.

Management of paracetamol poisoning.

Treating acetaminophen overdose: thresholds, costs and uncertainties

The United Kingdom's Medicines and Healthcare Products Regulatory Agency (MHRA) modified the indications for N-acetylcysteine therapy of acetaminophen (paracetamol) overdose in September 2012. The



Paracetamol, alcohol and the liver.

  • L. Prescott
  • Medicine
    British journal of clinical pharmacology
  • 2000
Although the possibility remains that chronic consumption of alcohol does increase the risk of paracetamol hepatotoxicity in man (perhaps by impairing glutathione synthesis), there is insufficient evidence to support the alleged major toxic interaction.

Paracetamol medication and alcohol abuse: a dangerous combination for the liver and the kidney.

It seems reasonable to recommend that paracetamol should be prescribed with great caution to alcoholics, and absolutely not for continuous use.

Lesson of the week: Deaths from low dose paracetamol poisoning

Protocols and guidelines for treating patients with an antidote before referral to specialist care have been drawn up and suggest that acetylcysteine given after 16 hours can reduce the frequency of multiorgan failure and improve survival.

Paracetamol hepatotoxicity and alcohol consumption in deliberate and accidental overdose.

It was unable to demonstrate that heavy drinkers develop more severe hepatotoxicity following paracetamol overdose than non-drinkers, and from the material reported in this study, accidental overdose is a better defining term than therapeutic misadventure.

Adverse reactions to N‐acetylcysteine during treatment for paracetamol poisoning

N-acetylcysteine is an effective antidote and its toxicity is acceptable if patients are selected carefully for treatment on the basis of the time that has elapsed since the poisoning, and the blood concentrations of paracetamol.

The effect of mild alcohol consumption on the metabolism of acetaminophen in man.

  • P. BandaB. Quart
  • Medicine
    Research communications in chemical pathology and pharmacology
  • 1982
It is observed that a small dose of alcohol, consumed over a period of one hour prior to the ingestion of APAP, leads to a reduction in APAP-mercapturic acid excretion, and the reduction in the excretion extends for up to 12 hours after APAP ingestion, which is longer than the half-life of the alcohol consumed.

Metabolic basis for high paracetamol dosage without hepatic injury: a case study

A combination of slow par acetamol absorption, enhanced detoxication of paracetamol (by sulphation) and reduced metabolism to potentially cytotoxic metabolites may have reduced the risk of liver damage in this patient.

The effect of alcohol on the toxicity of acetaminophen in mice.

Alcohol appears to be an effective antidote for acetaminophen overdose in the mouse model, when given at an appropriate time and dose.

The Effect of Chronic Alcohol Intake on Prognosis and Outcome in Paracetamol Overdose

Chronic alcohol intake above suggested limits is an adverse prognostic feature in cases of severe paracetamol overdose and is partly related to increased nephrotoxicity.

Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985)

It is concluded that N-acetylcysteine treatment should be started within eight hours of an acetaminophen overdose, but that treatment is still indicated at least as late as 24 hours after ingestion, and it may be superior when treatment is delayed.