Paracetamol Alcohol Hepatotoxicity — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyParacetamol Alcohol HepatotoxicityRACP Adult Medicine

A 60-year-old woman on paracetamol 4 g daily with 2 standard drinks alcohol daily develops ALT elevation. What is the concern?

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Correct answer: B — Chronic paracetamol + alcohol may cause hepatotoxicity at therapeutic doses via CYP2E1 induction

Alcohol induces CYP2E1, increasing NAPQI production while depleting glutathione. Reduce paracetamol to ≤3 g/day with regular alcohol use.

Reference: AMH – 2025; eTG – 2025