Drug General Information (ID: DDIHASD1RZ)
Drug Name			Acetaminophen		Drug Info		Ethanol		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Analgesics				Analgesics
Structure

Mechanism of Acetaminophen-Ethanol Interaction (Severity Level: Major)
Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Acetaminophen				Ethanol
Mechanism		Hepatotoxicity				Hepatotoxicity
Key Mechanism Factor 1
		Factor Name		Hepatotoxicity
		Factor Description		Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
Mechanism Description		Increased risk of hepatotoxicity by the combination of Acetaminophen and Ethanol

Recommended Action
Management		In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day. However, if acetaminophen is used, these patients should be cautioned not to exceed the recommended dosage (maximum 4 g/day in adults and children 12 years of age or older).

References
1	Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301. [PMID: 7609254]
2	Kartsonis A, Reddy KR, Schiff ER "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med 105 (1986): 138-9. [PMID: 3717790]
3	Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23. [PMID: 4062453]
4	McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA 244 (1980): 251-3. [PMID: 7382090]
5	Nelson EB, Temple AR "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301. [PMID: 7609255]
6	O'Dell JR, Zetterman RK, Burnett DA "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA 255 (1986): 2636-7. [PMID: 3701979]
7	Prescott LF, Critchley JA "Drug interactions affecting analgesic toxicity." Am J Med 75 (1983): 113-6. [PMID: 6359860]
8	Product Information. Tylenol (acetaminophen). McNeil Pharmaceutical, Raritan, NJ.
9	Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med 104 (1986): 399-404. [PMID: 3511825]
10	Thummel KE, Slattery JT, Nelson SD "Mechanism by which ethanol diminishes the hepatotoxicity of acetaminophen." J Pharmacol Exp Ther 245 (1988): 129-36. [PMID: 3361439]
11	Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50. [PMID: 7990219]
12	Zimmerman HJ, Maddrey WC "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology 22 (1995): 767-73. [PMID: 7657281]