Patterns of acetaminophen use in alcoholic patients

Alcoholics may be predisposed to the hepatotoxicity of acetaminophen due to increased activity of the cytochrome P-450 system and decreased hepatic glutathione. To date, scattered case reports provide only a brief sketch of the frequency and pattern of acetaminophen use by alcoholics. To determine these variables, we obtained a detailed ethanol and drug history from patients answering yes to at least one of four questions on the CAGE questionnaire. Patients were classified in terms of their acetaminophen use as nonusers, users as necessary, or regular users. Regular users were further classified as nondaily or daily users, or abusers (> 4 g/day). A total of 64 patients were enrolled in the study. The average number of positive responses to the CAGE questionnaire was 3.27 +/- 0.91. Of the 64 patients, 34 (53.1%) were continuous daily drinkers, 28 (43.8%) binge drinkers, and 2 (3.1%) had completely discontinued using alcohol. By history, 32 (50)% were nonusers of acetaminophen. Of the 32 users, 12 (37.5%) stated they took it as needed and 20 (62.5%) took it regularly. Of the 20 regular users, 7 (35%) were nondaily users, 11 (55%) were daily users, and 2 (10%) were abusers. Approximately 31% of alcoholics used acetaminophen regularly, most on a daily basis, with 1 of every 10 abusing the drug. Of the 64 alcoholics interviewed, 3 (4.7%) fit the drinking and acetaminophen use patterns theoretically associated with hepatotoxicity.