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Title Liver Toxicity In Patients Using Acetaminophen
Clinical Question In patients with Post-operative pain, does the use of acetaminophen cause hepatotoxicity versus other analgesics?
Clinical Bottom Line Use of acetaminophen has caused increased rates of hepatotoxicity. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21193765Guggenheimer/2011N/ASystematic Review
Key resultsIncreased use of acetaminophen has increased the number of cases of hepatotoxicity. Since acetaminophen is found in many analgesics, unintentional overdose can occur.
Evidence Search Liver toxicity and acetaminophen
Comments on
The Evidence
The study is a systematic review of articles. The authors reviewed the literature in which investigators examined data related to the epidemiology of APAP-related liver toxicity, studies in which the investigators evaluated the risk factors for its occurrence and case reports. They included articles that were used by the FDA as the basis for establishing the new labeling requirements. Overall, it was found that the use of acetaminophen has caused a substantial increase in the number of cases of acute liver failure.
Applicability When prescribing acetaminophen to patients with post-operative pain risk factors for hepatotoxicity should be considered.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Liver toxicity, Acetaminophen, N-acetyl-p-aminophenol
ID# 842
Date of submission: 04/28/2011spacer
E-mail Chandraa@livemail.uthscsa.edu
Author Aanchal Chandra
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail SPACKMAN@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments on the CAT
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by David Cox, Randy Demetter (San Antonio, TX) on 10/03/2014
A PubMed search was performed October 2014. More recent evidence was found to support the conclusion of the CAT. Notably expert opinion by McGill 2014, PubMed: 24836926 showing mechanism of action of APAP-related hepatotoxicity, and a literature review by Blieden 2014, PubMed: 24678654 support the 2011 review cited.

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