Alcohol and paracetamol are both processed through the liver. Paracetamol can form a toxic metabolite called NAPQI, which the body usually neutralises safely. But factors like heavy alcohol use, repeated dosing, fasting, GSH reduces NAPQI, the metabolite responsible for hepatotoxicity in acetaminophen toxicity. Toxic doses increase oxidation into NAPQI, overwhelming glutathione. How does ethanol interfere with acetaminophen metabolism? Image: https: t.co 6EY9dIwLXY Acetaminophen (Paracetamol) Toxicity A common and potentially fatal cause of acute liver failure due to toxic accumulation of the metabolite NAPQI when glutathione stores are depleted. Early recognition and timely administration Napqi hi res stock photography and images Alamy