[4] Clinical assessment should focus on identifying the cause of elevated levels rather than assuming toxicity from supplementation alone
doi:10.1016/j.jchf.2022.07.013
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For increased patient safety in APAP consumption, the FDA has worked to mitigate APAP hepatotoxicity by legislating regulations to limit prescription combination drug products to have no more than 325 mg of APAP per dosage unit and have urged healthcare providers to cease prescribing combination drug products with more than 325 mg of APAP per tablet.31 One study reported that ingestion of the recommended maximum amount of 4000 mg of APAP for 2 weeks resulted in the asymptomatic elevation of alanine transaminase, up to three times normal, in 40% of patients.19 These transaminase elevations did not amount to any clinical significance, and after the APAP was discontinued the transaminase levels returned to normal.19 Yet, while asymptomatic, chronically elevated aminotransferases may be of concern to healthcare providers, leading to further costly diagnostic studies or changes/restrictions in necessary medications
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