Acetaminophen-related hepatotoxicity

Clin Liver Dis. 2013 Nov;17(4):587-607, viii. doi: 10.1016/j.cld.2013.07.005. Epub 2013 Sep 4.


Acetaminophen (APAP) is the leading worldwide cause of drug overdose and acute liver failure (ALF). Single overdose ingestion and therapeutic misadventure may cause hepatotoxicity. Several factors, such as concomitant alcohol use or abuse, concurrent medications, genetic factors, and nutritional status, can influence the susceptibility and severity of APAP hepatotoxicity. Early manifestations of APAP hepatotoxicity are nonspecific, but require prompt recognition by physicians. Patients with repeated overdose tend to present late, and in such hepatotoxicity may have already evolved. N-acetylcysteine is a very effective antidote when giving within 8 hours, and is also recommended after a presentation of hepatotoxicity and ALF. The prognosis of patients with APAP-induced ALF is better than other causes of ALF. Liver transplantation should be offered to those who are unlikely to survive.

Keywords: Acetaminophen; Acute liver failure; Drug-induced liver injury; Hepatotoxicity; Liver transplantation; N-acetylcysteine; Overdose.

Publication types

  • Review

MeSH terms

  • Acetaminophen / adverse effects*
  • Acetylcysteine / therapeutic use
  • Analgesics, Non-Narcotic / adverse effects
  • Antipyretics / adverse effects
  • Chemical and Drug Induced Liver Injury / drug therapy
  • Chemical and Drug Induced Liver Injury / etiology*
  • Humans
  • Liver Failure, Acute / chemically induced*
  • Liver Failure, Acute / drug therapy
  • Risk Factors


  • Analgesics, Non-Narcotic
  • Antipyretics
  • Acetaminophen
  • Acetylcysteine