Question

A patient is taking a herb that is supposed to be an antidepressant, this compound also greatly increases the levels of CYP-2E1. He broke his leg and the doctor gave him a pain medication with acetaminophen. What problems might this herbal supplement cause him? What if he is a heavy drinker?

Answer 1

When the person is on anti-depressants which helps in increase in the production of CYP-2E1, the use of pain killer with acetaminophen tends to increase the toxicity. Since he is a heavy drinker, there is high amount of ethanol in his body and hence the higher is the production of the CYP-2E1, it tends to increase the metabolizing of the ethanol and hence increases further toxicity in presence of the acetaminophen. It tend to the metabolic conversion of the anti-depressant drug in a form which tends to increase the hepatotoxic metabolite increasing the toxicity of the liver. When there is high amount of alcohol like ethanol present in the body, the CYP2E1 is able to metabolize it and adds to the toxicity. Hence with the high concentration of CYP2E1, it tends to activate the acetaminophen and is likely to cause hepatotoxicity at low frequency.