Many case reports describe severe liver damage, fatal in some instances, in some alcoholics and persistent heavy drinkers who take only moderate doses of paracetamol. However, controlled studies have found no association between alcoholism and paracetamol-induced hepatotoxicity. There is controversy about the use of paracetamol in alcoholics. Some consider standard therapeutic doses can be used, whereas others recommend the dose of paracetamol should be reduced, or paracetamol avoided. Occasional and moderate drinkers do not seem to be at any extra risk.
There seems to be no way of identifying those alcoholics at risk. The combination need not be avoided, but caution patients against long-term regular use without close monitoring.
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