Le paracétamol à dose thérapeutique : quelles populations à risque d'hépatotoxicité ?

The risk to develop hepatotoxicity following the ingestion of a single paracetamol overdose is currently adequately assessed, even though some individual risk factors may still be identified. They are usually due to toxic or nutritional factors. By contrast, the factors predisposing to hepatotoxicity after therapeutic doses of paracetamol are still debated. They belong to the following main categories: alcohol consumption, either acute or chronic, nutritional status, obesity, non-alcoholic hepatic steatosis and concomitant use of drugs sharing some common metabolic pathways. For these different factors, they may be some discrepancy between animal experimental data and human findings. This can be partly explained by the simultaneous involvement of different factors: difficulty of defining a supratherapeutic dose or concentration of paracetamol, accurate history of paracetamol and alcohol consumption, link between alcohol consumption and nutritional status, … However, experimental data lead to consider chronic alcohol consumption, poor nutritional status or fasting, and non-alcoholic hepatic steatosis as risk factors for hepatoxicity following therapeutic dosage regimens of paracetamol.