Acetaminophen misconceptions.
Examination of the pharmacokinetics of acetaminophen can decrease misconceptions involved in clinical evaluation. Enzyme patterns and acetaminophen levels must be related to time and known metabolic phenomena. A careful look at ethanol and nutrition, especially fasting demonstrates that therapeutic doses of acetaminophen do not place patients at a greater risk in either of these instances. An overdose of acetaminophen in a chronic alcohol abuser may result in more severe hepatotoxicity than in the nonalcoholic. CYP2E1 and glutathione must be evaluated simultaneously rather than in isolation. Glucuronidation capacity in humans is not a factor except in massively overdosed patients.
Rumack
Barry H
BH
University of Colorado School of Medicine, Greenwood Village, CO 80121, USA. barry@rumack.com
D000082:Acetaminophen / Q000009:adverse effects* / Q000378:metabolism* / Q000493:pharmacokinetics / Q000506:poisoning; D000428:Alcohol Drinking; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects* / Q000378:metabolism* / Q000493:pharmacokinetics / Q000506:poisoning; D004347:Drug Interactions; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D010634:Phenobarbital / Q000009:adverse effects; D010672:Phenytoin / Q000009:adverse effects
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D010672:Phenytoin; D010634:Phenobarbital