Aminotransferase Trends During Prolonged Acetaminophen Dosing

Denver Health and Hospital Authority398 enrolled

Overview

The objective of this study is to monitor liver function tests (blood levels of an indicator of liver function) of healthy people taking the maximum labeled daily dose of acetaminophen compared to people taking placebo for 16 to 40 days. Those people that continue to have normal liver tests after 16 days will have completed their part of the study. People that develop abnormal liver function tests will continue taking acetaminophen or placebo, and have their liver tests monitored closely for up to an additional 24 days. This is to (1) make sure these tests return to normal and (2) determine when these tests return to normal while still taking acetaminophen or placebo. If at any time the liver tests indicate anything more than a minor increase, you would be immediately told to stop taking the study drug. Secondary objective is to determine the proportion of subjects that have detectable acetaminophen-protein adducts after daily dosing.

Acetaminophen use is common and many consumers take 4g/day for longer than 4 days. The use of 4g/day of acetaminophen for more than 4 days causes an asymptomatic ALT elevation in some people. This elevation most likely resolves while continuing treatment, but it is possible that some individuals may go on to develop clinical liver injury. By carefully following healthy subjects who are taking the maximal daily dose of acetaminophen, we can safely determine if the ALT elevation resolves or progresses to clinical liver injury. If a subject develops clinical liver injury we can intervene before irreversible injury occurs.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Masking

QUADRUPLE

Enrollment

398

Conditions

Drug Toxicity

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * age 18 or older Exclusion Criteria: 1. History of acetaminophen ingestion on any of the four days preceding study enrollment 2. Measurable serum acetaminophen level at time of enrollment 3. Viral markers of Hepatitis B or C, or viral markers of Hepatitis A with an ALT level greater than ULN during screening laboratory testing 4. Serum ALT or AST level greater than ULN at Screening or Day 0 5. Total bilirubin level greater than ULN at Screening or Day 0 6. INR level greater than ULN at Screening 7. Alkaline phosphatase level greater than ULN at Screening 8. Platelet count less than 125 10\^9/L at Screening 9. Known cholelithiasis 10. Positive pregnancy test at Screening (female participants only) 11. History of consuming more than an average of 3 alcohol containing drinks daily over the preceding 2 weeks 12. History of consuming 3 or more alcohol containing drinks on any given day during the 2 weeks prior to study enrollment 13. New prescription medication started within the previous 30 days 14. Currently taking isoniazid 15. Currently taking warfarin 16. Currently adheres to a fasting type diet as determined by self report 17. Currently has anorexia nervosa as determined by self report 18. Participant is clinically intoxicated, psychiatrically impaired or unable to give informed consent for any reason 19. Known hypersensitivity or allergy to acetaminophen

Outcomes

Primary Outcomes

The Proportion of Subjects Treated With Long-term Acetaminophen (4 g/Day) That Develops Persistent ALT Elevations.

ALT was measured on Day 0 and 16 for all study participants. Subjects with an elevated ALT at Day 16 continued dosing with study drug and continued to have their ALT measured every three days until the ALT elevation resolved or until Day 40. Persistent ALT elevation was defined as any subject with an unresolved ALT elevation at study Day 40.

Time frame: serial samples for 16-40 days

Secondary Outcomes

The Proportion of Subjects With Detectable Serum Acetaminophen-cysteine Adduct (APAP-cys) Concentrations 1, 2, and 3 Days After Starting the Maximal Recommended Dosing of Acetaminophen (4 g/Day).

Time frame: Days 1-3