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Acetaminophen Usage Patterns and Concentrations of Glutathione and γ‐Glutamyl Transferase in Alcoholic Subjects
Author(s) -
Seifert Charles F,
Anderson Douglas C.
Publication year - 2007
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.27.11.1473
Subject(s) - medicine , glutathione , urine , gastroenterology , acetaminophen , venous blood , confidence interval , prospective cohort study , endocrinology , chemistry , anesthesia , biochemistry , enzyme
Study Objectives . To determine if subjects with chronic alcoholism are predisposed to acetaminophen‐induced hepatotoxicity, and to determine the contributing factors. Design . Prospective cohort study. Setting . Community‐based crisis intervention center. Subjects . One hundred eighty‐eight subjects who answered “yes” to at least one of the four questions on the CAGE (Cut down‐Annoyed‐Guilty‐Eye‐opener) questionnaire for identifying alcoholism, and 10 healthy volunteers (controls). Intervention . A history, physical examination, urine toxicologic analysis, ethanol and drug therapy history, and venous blood samples were collected on all subjects. Measurements and Main Results . Venous blood was analyzed for a liver profile, prothrombin time, and total and oxidized glutathione concentrations. A significantly higher proportion of daily drinkers were regular daily users (29.2% [45/154] vs 11.8% [4/34], p=0.0497) as well as abusers (35.7% [55/154] vs 14.7% [5/34], p=0.0237) of acetaminophen compared with nondaily drinkers. Alcoholic subjects with elevated γ‐glutamyl transferase (GGT ≥ 51 U/L) levels had significantly lower median plasma glutathione concentrations (2.33 μmol/L, 95% confidence interval [CI] 1.74‐2.69 μmol/L) compared with those of alcoholic subjects with normal GGT concentrations (5.97 μmol/L, 95% CI 4.39‐7.03 μmol/L, p<0.0001) and healthy volunteers (6.59 μmol/L, 95% CI 4.79‐9.65 μmol/L, p=0.0002). A significant inverse correlation was also noted between the GGT concentration and the plasma total glutathione concentration (r = −0.62, p<0.0001). None of the 188 subjects met all preset criteria for hepatotoxicity. Conclusions . Daily drinkers were more than twice as likely as nondaily drinkers to be regular daily acetaminophen users and abusers. Alcoholic subjects with elevated GGT concentrations had significantly lower plasma total glutathione concentrations, and plasma total glutathione concentrations inversely correlated with GGT concentrations. Elevated GGT concentrations may be a clinical marker of depleted glutathione in alcoholic subjects. Acetaminophen‐induced hepatotoxicity appears to be uncommon in alcoholic subjects, despite the 31.9% (60/188 patients) who took doses that are potentially hepatotoxic.