Non-alcoholic Fatty Liver Disease (NAFLD) Clinical Trial
Official title:
The Effect of Daily Acetaminophen on Patients With Non-alcoholic Fatty Liver Disease (NAFLD) Compared to Healthy Controls
In this first pilot study, we will examine the effects of acetaminophen dosing in adult
patients with NAFLD in comparison to the effects in a healthy control group. Both groups
will receive 3 grams (g) of acetaminophen, the maximum recommended daily dose, daily for 14
days. We hypothesize that NAFLD patients are more prone to APAP toxicity than normal
controls.Treatment will be stopped after two weeks or in the following conditions:
Treatment with APAP will be stopped in healthy volunteers if ALT and/or AST reached three
times the ULN. In patients with NAFLD, treatment will be stopped if: ALT or AST reach ≥
three times the upper limit of entry value or ≥ 5 times the ULN; or if there is ALT or AST
>3 times ULN and TBili >2xULN or INR >1.5; or if there is ALT or AST >3 times ULN with the
appearance of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever,
rash, and/or eosinophilia (>5%). We follow a conservative approach derived from the FDA
guidelines for stopping medications expected to cause drug induced liver injury (DILI).
Indeed, the FDA allows continuation of the medication until ALT or AST are >8x ULN in the
absence of elevated Tbili or INR. Patients who have hepatotoxicity will have close
monitoring of their liver enzymes until they normalize. Taking acetaminophen up to 3g daily
has been shown to be safe and acceptable. We have followed very strict criteria for
monitoring and stopping rules however in the usually cases of toxicity the patient will be
admitted for monitoring.
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