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• W1514729713 abstract "Sirs, Watelet et al. discuss a case of liver cirrhosis probably related to chronic use of paracetamol. The liver toxicity of paracetamol is usually associated with short term use of high-doses, but the effect of chronic ingestion of therapeutic doses on the liver are less well known.1 In our study, of the 17 cases of acute liver injury exposed to paracetamol and without concomitant exposure to other well known hepatotoxic drugs, three had taken the drug for more than 2 weeks.2 All three cases presented a hepatocellular pattern.3 A 58-year-old woman had taken 650 mg of paracetamol 1 day per week for several years for osteoarthritis. She also drank 40 g of alcohol per day. She underwent liver transplant. An 85-year-old woman had taken 1950 mg of paracetamol per day for 23 days for osteoarthritis. Her alcohol consumption was less than 10 g per day. Four months before admission she had been diagnosed with idiopathic thrombocytopenia, for which she received corticosteroids for the last month. The liver tests were still abnormal after nearly 1 year of follow-up. A 58-year-old woman had taken 650 mg of paracetamol per day, 4 days a week for 4 years for osteoarthritis. She also took paroxetine during the last 8 months, lorazepam and atenolol during the last 4 years, hydroxyzine for 10 years, and valeriana for 3 months. Her alcohol consumption was less than 10 g per day. All drugs were stopped during hospital admission and she recovered within 6 months. Use of paracetamol at therapeutic doses (up to 4 g per day) has rarely been associated with acute liver injury.4, 5 The three patients described above had taken less than 4 g per day for longer than 15 days. Two of them developed a chronic clinical evolution which is unusual in hepatocellular drug-induced liver injury, and the first one underwent a liver transplant. Causality assessment in drug-related hepatic damage is often difficult, because its clinical and biological pattern is indistinguishable from other causes of liver injury, and because several drugs are often used concomitantly.1 Only one case took a drug occasionally reported to cause liver injury (paroxetine),6 and we cannot discard that either drug potentially damaged the liver. Alcohol could also have contributed to the development and evolution of liver injury in the first of our patients. We suggest that paracetamol could have played a role in the development of acute liver injury in the three patients. The risk of hepatotoxicity should be considered when using paracetamol in therapeutic dosages for long periods, particularly if associated with other hepatotoxic drugs or alcohol, specially in patients with reported risk factors for paracetamol toxicity.1 Declaration of personal interests: None. Declaration of funding interests: The study was supported by grants from: CIRIT (Comisionat per a Universitats I Recerca, Generalitat de Catalunya) Accions Mobilitzadores (1995XT 00030) and Boehringer-Ingelheim, Barcelona." @default.
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• W1514729713 date "2007-10-06" @default.
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• W1514729713 title "Toxicity of chronic paracetamol ingestion: authors’ reply" @default.
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• W1514729713 doi "https://doi.org/10.1111/j.1365-2036.2007.03543.x" @default.
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