To the Editor.
—The recent study by Drs Whitcomb and Block1 and the accompanying Editorial by Dr Strom2 are an instructive perspective on the adverse-events profile of acetaminophen. When viewed in the context of the long history of acetaminophen use by patients with a wide variety of medical problems, their results serve to emphasize the remarkable safety profile of acetaminophen when used within dosing instructions. The observations of Whitcomb and Block are consistent with those previously known. Patients at highest risk for an adverse experience to any drug are those who are severely ill or malnourished, who consume excess amounts of alcohol, and who either acutely or chronically exceed recommended doses of the drug. Various combinations of these can be particularly troublesome. Despite the millions of patients with a multitude of medical problems who are consuming acetaminophen daily, these events are rare.Strom provides a compelling discussion of
Nelson EB, Temple AR. Acetaminophen Hepatotoxicity, Fasting, and Ethanol. JAMA. 1995;274(4):301. doi:10.1001/jama.1995.03530040027025