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Normal acetaminophen dosage can trigger liver failure in alcoholics

HOUSTON -- (February 10, 2006) -- It only takes a few pain pills to do life-threatening damage to your liver if you drink too much alcohol, say liver experts at Baylor College of Medicine in Houston.

The equivalent of two or more alcoholic beverages daily, coupled with poor eating habits that reduce nutrition, greatly increases the risk of liver failure when the common pain reliever acetaminophen is used, according to Baylor Liver Health Director Dr. John Vierling.

"These people may have lesser ability to detoxify acetaminophen and a greater likelihood of producing toxic byproducts even if they take acetaminophen for the right indications and do not exceed the maximum recommended doses," said Vierling, also professor of medicine and surgery at BCM.

Acetaminophen, the active ingredient in hundreds of over-the-counter pain relief medications and fever reducers, can cause liver toxicity when daily doses exceed the maximum recommended four grams, or the equivalent of eight extra-strength Tylenol® tablets. Those who regularly consume alcohol or have a poor diet, however, should limit their acetaminophen intake to two-and-a-half grams per day, says Vierling.

According to Vierling, the best solution is prevention, which starts with improved public education about acetaminophen. Roughly half of all acute liver failure cases in the United States are now caused by acetaminophen overdoses, accounting for an alarming increase over the frequency a few years ago. Children are especially vulnerable to acetaminophen overdosage.

"One form of pediatric formulation may contain much higher amounts of acetaminophen than the next," said Vierling. "People must read the labels carefully to be sure the dose being given is safe. Adults also must be more aware that acetaminophen is often found in prescription pain killers and over-the-counter cold remedies, which can lead to unintentional consumption of excessive amounts."

In severe cases of liver failure caused by acetaminophen, liver transplantation may be the only life-saving hope, but even urgent transplantation is not always possible because the availability of donor livers is limited and some patients may become to ill to undergo transplantation.

Nevertheless, recent advances in intensive care of patients with acetaminophen liver failure have improved outcomes without transplantation by stabilizing the patient long enough for the liver to regenerate itself. Vierling says that many patients with acetaminophen-related liver failure who might have required transplantation in the past are now surviving without the operation because of these advances in care.

"Acetaminophen can kill a large portion of liver and place a patient on death's door, but with advanced intensive care, many, but not all, can be stabilized long enough to rebuild their liver without a transplant," said Vierling. "We hope that future advances will make it possible for all patients with acetaminophen liver failure to survive with transplantation."