Liver injury induced by paracetamol and challenges associated with intentional and unintentional use

Table 1 Drugs and substances that affect cytochrome P450 2E1 activity and can interfere with paracetamol metabolism

Cytochrome P450	Inducers	Inhibitors
CYP2E1	Ethanol	Disulfram
	Isoniazid
	St. John’s wort
	Garlic, Germander

CYP2E1: Cytochrome P450 2E1.

Table 2 Outcomes of acute liver failure from paracetamol among selected countries

Country	Acute liver failure from paracetamol	Hepatic failure resulting in death or transplant	Concomitant medication use/ suicide attempts
Australia[81]	Not disclosed	Death in 8.8% of cases (39 deaths total)	79% of cases with co-ingestion of opioids or benzodiazepines
United Kingdom[83]	2163 cases (65% of total ALF cases)	Death in 36% of cases (778 deaths total), 147 transplant cases	Not disclosed
United States[5]	120 cases (39% of total ALF cases)	Transplantation in 6% of cases, mortality in 27% of cases	44 cases (37%) were suicide attempts
Portugal[84]	5 cases over 3 years (11% of total ALF cases)	1 liver transplant case	Not disclosed
Germany[85]	10 cases (9.2% of total ALF cases)	3 liver transplant cases, 1 death	Not disclosed