title: Acetaminophen usage patterns and concentrations of glutathione and gamma-glutamyl transferase in alcoholic subjects.
abstract: OBJECTIVE
  To determine if subjects with chronic alcoholism are predisposed to acetaminophen-induced hepatotoxicity, and to determine the contributing factors.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Community-based crisis intervention center.
  
  
  METHODS
  One hundred eighty-eight subjects who answered "yes" to at least one of the four questions on the CAGE (Cut down-Annoyed-Guilty-Eye-opener) questionnaire for identifying alcoholism, and 10 healthy volunteers (controls).
  
  
  METHODS
  A history, physical examination, urine toxicologic analysis, ethanol and drug therapy history, and venous blood samples were collected on all subjects.
  
  
  RESULTS
  Venous blood was analyzed for a liver profile, prothrombin time, and total and oxidized glutathione concentrations. A significantly higher proportion of daily drinkers were regular daily users (29.2% [45/154] vs 11.8% [4/34], p=0.0497) as well as abusers (35.7% [55/154] vs 14.7% [5/34], p=0.0237) of acetaminophen compared with non daily drinkers. Alcoholic subjects with elevated gamma-glutamyl transferase (GGT >or= 51 U/L) levels had significantly lower median plasma glutathione concentrations (2.33 micromol/L, 95% confidence interval [CI] 1.74-2.69 micromol/L) compared with those of alcoholic subjects with normal GGT concentrations (5.97 micromol/L, 95% CI 4.39-7.03 micromol/L, p<0.0001) and healthy volunteers (6.59 micromol/L, 95% CI 4.79-9.65 micromol/L, p=0.0002). A significant inverse correlation was also noted between the GGT concentration and the plasma total glutathione concentration (r = -0.62, p<0.0001). None of the 188 subjects met all preset criteria for hepatotoxicity.
  
  
  CONCLUSIONS
  Daily drinkers were more than twice as likely as non daily drinkers to be regular daily acetaminophen users and abusers. Alcoholic subjects with elevated GGT concentrations had significantly lower plasma total glutathione concentrations, and plasma total glutathione concentrations inversely correlated with GGT concentrations. Elevated GGT concentrations may be a clinical marker of depleted glutathione in alcoholic subjects. Acetaminophen-induced hepatotoxicity appears to be uncommon in alcoholic subjects, despite the 31.9% (60/188 patients) who took doses that are potentially hepatotoxic.
authors.affiliation: School of Pharmacy, Texas Tech University Health Sciences Center, 3601 4th Street, MS 8162, Lubbock, TX 79430-8162, USA. charles.seifert@ttuhsc.edu
authors.forename: Charles F
authors.initials: CF
authors.lastname: Seifert
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Anderson
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D000437:Alcoholism / Q000150:complications*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects*; D054316:Biomarkers, Pharmacological; D056486:Chemical and Drug Induced Liver Injury; D015331:Cohort Studies; D003151:Community Health Centers; D004305:Dose-Response Relationship, Drug; D005260:Female; D005978:Glutathione / Q000097:blood; D006801:Humans; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000453:epidemiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019966:Substance-Related Disorders; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D018712:Analgesics, Non-Narcotic; D054316:Biomarkers, Pharmacological; D000082:Acetaminophen; D005723:gamma-Glutamyltransferase; D005978:Glutathione