How does acetaminophen damage the liver?
As with so many medications, acetaminophen is processed by the body in the liver. There, the drug undergoes two processes, one called sulphation and one called glucuronidation. These take place along two pathways, one for each process, and once they are finished, the actual acetaminophen and the sulphation and glucuronidation compounds that the liver has made from the drug are eliminated from the body. This whole process typically happens without harming the liver. But if there is too much acetaminophen, the two pathways that help break down the drug become flooded and stop working. This forces the drug down another “breakdown” pathway in the liver called the cytochrome P-450 system. This is where the problem starts for the liver, because when acetaminophen goes down this pathway, it produces a toxic compound called NAPQI. This poisonous substance builds up in the liver and causes serious damage. Even worse, if a person is taking other medications, including phenobarbital, an anti-seiz
