Drug/Small Molecule:
acetaminophen

2D structure

Overview

Generic Names: APAP; Acetaminofen; Paracetamol; Paracetamolo; Paracetanol
Trade Names: Abenol; Abensanil; Acamol; Accu-Tap; Acephen; Aceta Elixir; Aceta Tablets; Acetagesic; Acetalgin; Actamin; Actimol; Algotropyl; Allay; Alpiny; Alpinyl; Alvedon; Amadil; Aminofen; Anacin; Anacin-3; Anaflon; Anapap; Anelix; Anhiba; Apacet; Apadon; Apamid; Apamide; Atasol; Banesin; Bayer Select; Bickie-mol; Bucet; Butapap; Calpol; Captin; Cetadol; Clixodyne; Co-Gesic; Conacetol; Dafalgan; Dapa; Dapa X-S; Darvocet; Datril; Dimindol; Dirox; Disprol; Dolene AP-65; Doliprane; Dolprone; Drixoral Plus; Dularin; Dymadon; Dypap; Elixodyne; Enelfa; Eneril; Eu-Med; Excedrin; Exdol; Febridol; Febrilix; Febrinol; Febro-Gesic; Febrolin; Fendon; Feverall; Fevor; Finimal; Gelocatil; Genapap; Genebs; Hedex; Homoolan; Hy-Phen; Injectapap; Janupap; Korum; Lestemp; Liquagesic; Liquiprin; Lonarid; Lyteca; Momentum; Multin; NAPA; Napafen; Napap; Naprinol; Nealgyl; Nebs; Neopap; Neotrend; Nobedon; Norco; Oraphen-PD; Ortensan; Pacemo; Painex; Paldesic; Panadol; Panaleve; Panasorb; Panets; Panex; Panofen; Papa-Deine; Paracet; Parapan; Paraspen; Parelan; Parmol; Pasolind; Pasolind N; Pedric; Phenaphen; Phenaphen Caplets; Phendon; Phrenilin; Phrenilin Forte; Prompt; Propacet 100; Proval #3; Pyrinazine; Redutemp; Rivalgyl; Robigesic; Rounox; SK-Apap; Salzone; Sedapap; Servigesic; Snaplets-FR; St. Joseph Fever Reducer; Suppap; Synalgos-Dc-A; Tabalgin; Talacen; Tapanol; Tapar; Tavist Allergy/Sinus/Headache; Temlo; Tempanal; Tempra; Tencon; Tibinide; Tibizide; Tisin; Tisiodrazida; Tizide; Tralgon; Triaprin; Tussapap; Tycolet; Tylenol; Ultracet; Valadol; Valgesic; Valorin; Valorin Extra; Wygesic
Brand Mixtures: Amacodone (acetaminophen + hydrocodone bitartrate); Anexsia (acetaminophen + hydrocodone bitartrate); Anodynos (acetaminophen + hydrocodone bitartrate); Anolor (acetaminophen + butalbital + caffeine); Bancap (acetaminophen + hydrocodone bitartrate); CoGesic (acetaminophen + hydrocodone bitartrate); Dolacet (acetaminophen + hydrocodone bitartrate); Duradyne (acetaminophen + hydrocodone bitartrate); Endolor (acetaminophen + butalbital + caffeine); Esgic (acetaminophen + butalbital + caffeine); Fioricet (acetaminophen + butalbital + caffeine); Hydrocet (acetaminophen + hydrocodone bitartrate); Hydrogesic (acetaminophen + hydrocodone bitartrate); Lorcet (acetaminophen + hydrocodone bitartrate); Lortab (acetaminophen + hydrocodone bitartrate); Margesic (acetaminophen + hydrocodone bitartrate); Norcet (acetaminophen + hydrocodone bitartrate); Oxycet (acetaminophen + oxycodone hydrochloride); Percocet (acetaminophen + oxycodone hydrochloride); Roxicet (acetaminophen + oxycodone hydrochloride); Roxilox (acetaminophen + oxycodone hydrochloride); Stagesic (acetaminophen + hydrocodone bitartrate); TGesic (acetaminophen + hydrocodone bitartrate); Tylox (acetaminophen + oxycodone hydrochloride); Vicodin (acetaminophen + hydrocodone bitartrate); Zebutal (acetaminophen + butalbital + caffeine); Zydone (acetaminophen + hydrocodone bitartrate)
PharmGKB Accession Id: PA448015

Description

Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. PubChem (source: Drug Bank)

Indication

For temporary relief of fever and minor aches and pains. (source: Drug Bank)

ATC Therapeutic Category

  • N02BE:Anilides

Pharmacology, Interactions, and Contraindications

Mechanism Of Action

Acetaminophen is thought to act primarily in the CNS, increasing the pain threshold by inhibiting both isoforms of cyclooxygenase, COX-1 and COX-2, enzymes involved in prostaglandin (PG) synthesis. Unlike NSAIDs, acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, thus, has no peripheral anti-inflammatory affects. While aspirin acts as an irreversible inhibitor of COX and directly blocks the enzyme's active site, studies have found that acetaminophen indirectly blocks COX, and that this blockade is ineffective in the presence of peroxides. This might explain why acetaminophen is effective in the central nervous system and in endothelial cells but not in platelets and immune cells which have high levels of peroxides. Studies also report data suggesting that acetaminophen selectively blocks a variant of the COX enzyme that is different from the known variants COX-1 and COX-2. This enzyme is now referred to as COX-3. Its exact mechanism of action is still poorly understood, but future research may provide further insight into how it works. (source: Drug Bank)

Pharmacology

Acetaminophen (USAN) or Paracetamol (INN) is a popular analgesic and antipyretic drug that is used for the relief of fever, headaches, and other minor aches and pains. It is a major ingredient in numerous cold and flu medications and many prescription analgesics. It is extremely safe in standard doses, but because of its wide availability, deliberate or accidental overdoses are not uncommon. Acetaminophen, unlike other common analgesics such as aspirin and ibuprofen, has no anti-inflammatory properties or effects on platelet function, and so it is not a member of the class of drugs known as non-steroidal anti-inflammatory drugs or NSAIDs. In normal doses acetaminophen does not irritate the lining of the stomach nor affect blood coagulation, the kidneys, or the fetal ductus arteriosus (as NSAIDs can). Like NSAIDs and unlike opioid analgesics, acetaminophen does not cause euphoria or alter mood in any way. Acetaminophen and NSAIDs have the benefit of being completely free of problems with addiction, dependence, tolerance and withdrawal. Acetaminophen is used on its own or in combination with pseudoephedrine, dextromethorphan, chlorpheniramine, diphenhydramine, doxylamine, codeine, hydrocodone, or oxycodone. (source: Drug Bank)

Food Interactions

Avoid alcohol (may increase risk of hepatotoxicity).
Take without regard to meals. (source: Drug Bank)

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Approximately 90 to 95% of a dose is metabolized in the liver via the cytochrome P450 enzyme pathways (primarily by conjugation with glucuronic acid, sulfuric acid, and cysteine). An intermediate metabolite is hepatotoxic and most likely nephrotoxic and can accumulate after the primary metabolic pathways have been saturated. (source: Drug Bank)

Protein Binding

25% (source: Drug Bank)

Absorption

Rapid and almost complete (source: Drug Bank)

Toxicity

Oral, mouse: LD<sub>50</sub> = 338 mg/kg; Oral, rat: LD<sub>50</sub> = 1944 mg/kg. Acetaminophen is metabolized primarily in the liver, where most of it is converted to inactive compounds by conjugation with sulfate and glucuronide, and then excreted by the kidneys. Only a small portion is metabolized via the hepatic cytochrome P450 enzyme system. The toxic effects of acetaminophen are due to a minor alkylating metabolite (N-acetyl-p-benzo-quinone imine), not acetaminophen itself nor any of the major metabolites. This toxic metabolite reacts with sulfhydryl groups. At usual doses, it is quickly detoxified by combining irreversibly with the sulfhydryl group of glutathione to produce a non-toxic conjugate that is eventually excreted by the kidneys. The toxic dose of paracetamol is highly variable. In adults, single doses above 10 grams or 140 mg/kg have a reasonable likelihood of causing toxicity. In adults, single doses of more than 25 grams have a high risk of lethality. (source: Drug Bank)

Isomeric SMILES Code:

CC(=O)Nc1ccc(cc1)O (source: Drug Bank)

The following genes are in curated knowledge about this drug.

  Gene Relationship Evidence
Phenotype data available Genotype Data Available Literature annotations available Has annotations
ABCB1
  •   
  • PD
  • PK
  •   
  • GN
Publications
No phenotype data Genotype Data Available Literature annotations available Not annotated
BHMT2
  •   
  •   
  •   
  • FA
  • GN
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP2D6
  • CO
  • PD
  • PK
  •   
  • GN
Publications
No phenotype data Genotype Data Available Literature annotations available Not annotated
CYP2E1
  •   
  • PD
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
CYP3A
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP3A4
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP3A5
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
SULT1A1
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
SULT1A3
  •   
  •   
  • PK
  •   
  •   
Publications
No phenotype data Genotype Data Available Literature annotations available Not annotated
SULT1A4
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
UGT1A1
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
UGT1A6
  •   
  •   
  • PK
  •   
  • GN
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
UGT1A9
  •   
  •   
  • PK
  •   
  •   
Publications

A list of non-curated publications that mention this drug along with other genes is available.

Drug Targets

Gene Description
PTGS1 Uncurated Annotation (source: Drug Bank)
PTGS2 Uncurated Annotation (source: Drug Bank)

PharmGKB Curated Pathways

BioCarta Pathways

External pathways not curated by PharmGKB.

The following drugs are in curated knowledge about this drug.

  Drug Relationship Evidence
No phenotype data No genotype data Literature annotations available Not annotated
acetylcysteine
  • CO
  •   
  •   
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
tropisetron
  •   
  • PD
  •   
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
warfarin
  •   
  •   
  •   
  •   
  •   
Publications

A list of non-curated publications that mention this drug along with other drugs is available.

Drug Interactions

Drug Description
acenocoumarol Uncurated Annotation Increases the anticoagulant effect (source: Drug Bank)
dicumarol Uncurated Annotation Increases the anticoagulant effect (source: Drug Bank)
imatinib Uncurated Annotation Increased hepatic toxicity of both agents (source: Drug Bank)
isoniazid Uncurated Annotation Risk of hepatotoxicity (source: Drug Bank)
warfarin Uncurated Annotation Acetaminophen increases the anticoagulant effect (source: Drug Bank)

Curated Information

The following diseases are in curated knowledge about this drug.

  Disease Relationship Evidence
No phenotype data No genotype data Literature annotations available Not annotated
Bradycardia
  • CO
  •   
  • PK
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Drug interaction with drug
  •   
  • PD
  • PK
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Drug Toxicity
  •   
  • PD
  • PK
  • FA
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Gastroschisis
  •   
  •   
  • PK
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Liver Failure, Acute
  •   
  •   
  • PK
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Pain
  •   
  • PD
  • PK
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Toxic liver disease
  •   
  • PD
  • PK
  • FA
  • GN
Publications

Non-Curated Information

A list of non-curated publications that mention this drug along with other diseases is available.

Additional Datasets

These datasets are minimally curated and are sorted alphabetically by title.

  1. Physicochemical determinants of human renal clearance

LinkOuts

Web Resource:
Wikipedia
DrugBank:
DB00316
ChEBI ID:
2386
KEGG Compound ID:
C06804
KEGG Drug ID:
D00217
PubChem Compound ID:
1983
PubChem Substance ID:
7847284

Common Searches

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Non-Curated Publications

A list of non-curated publications that mention this drug is available.

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