Paracetamol has been associated with liver toxicity in association with massive overdose or chronic unintentional overdose in patients with a history of chronic alcohol abuse, malnutrition, and prolonged starvation and it is one of the most common causes of acute liver failure in the USA.109[III] Patients consuming more than three units of alcohol per day should consult with their physician before taking any analgesic.95,109[III]

There is no evidence that preexisting chronic liver disease increases the risk of hepatotoxicity after administration of paracetamol in therapeutic doses for short periods of time (up to five days). Cytochrome P-450 enzyme levels are not increased and excretion of various conjugates (including cysteine and mercapturic acid conjugates) remains unchanged in the presence of liver disease.109,79, 110,111,112 The elimination half-life of paracetamol is statistically prolonged, but clinically unimportant.

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