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Editor's Correspondence
May 27, 2002

Alcohol, Acetaminophen, and Toxic Effects on the Liver

Author Affiliations

Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

Arch Intern Med. 2002;162(10):1194-1195. doi:

Although we do not dispute the factual results of the recently published study by Kuffner et al,1 "Effect of Maximum Daily Doses of Acetaminophen on the Liver of Alcoholic Patients," the conclusions reached by the authors, as well as their recommendations concerning alcohol consumption and acetaminophen, are of great concern and might pose a potential public health hazard. It is well known that acetaminophen possesses a narrow therapeutic index, and the potential for hepatoxicity can vary greatly among individuals, depending upon the clinical environmental situation. For example, persons with chronic alcoholism or persons with low caloric intake could become glutathione deficient and as a result be potentially more susceptible to acetaminophen-related hepatotoxicity. While doubling the 4-g maximum daily therapeutic dose is known to cause liver injury, in some individuals predisposed to hepatotoxicity, the tolerable dose may actually be significantly lower.2,3

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