Preventing paracetamol overdose?

Question

Paracetamol overdose is one of the most common drug toxicities. It may be treated by intravenous N-acetylcysteine which replaces the glutathione that is used up in paracetamol metabolism to prevent the harmful effects of NAQBI. Why can glutathione, NAC nor an inhibitor of the alternate cytochrome metabolism be added to paracetamol to prevent the possibility of acute liver failure?

Answer 1

All of these play an important part in mitigating oxidative stress hence why they are known as antioxidants! This is particularly important in paracetamol (tylenol) overdose as this is the most common cause of drug-induced acute liver failure due to its availability in households.

Now the question is why do you need it to prevent acute liver failure, well these act as scavengers for reactive oxygen species which is commonly produced in the body. Normally, your body can maintain a balance between the production and elimination of the reactive oxygen species. When the system is overwhelmed and can no longer maintain that balance, then this leads way to damage as the oxidative stress encourages release of inflammatory cytokines that are indicated in multiple pathological processes - cancers, transplant rejection, alzheimers, ischemic cardiac events, and more.