Acetaminophen (APAP) is the most commonly used drug for the treatment of pain and fever around the world. At the same time, APAP can cause dose-related hepatocellular necrosis, responsible for nearly 500 deaths annually in the United States (US) alone, as well as 100,000 calls to US Poison Control Centers, 50,000 emergency room visits and 10,000 hospitalisations per year. As an over-the-counter and prescription product (with opioids), APAP toxicity dwarfs all other prescription drugs as a cause of acute liver failure in the US and Europe, but it is not regulated in any significant way. In this review the ongoing controversy surrounding the proper role for this ubiquitous pain reliever: its history, pathogenesis, clinical challenges in recognition and management, and current regulatory status are highlighted. A new solution to a 50-year-old problem is proposed.

中文翻译：

---

公共卫生：对乙酰氨基酚 (APAP) 肝毒性——APAP 是不是该消失了？

对乙酰氨基酚 (APAP) 是世界上治疗疼痛和发烧最常用的药物。同时，APAP 可导致剂量相关的肝细胞坏死，仅在美国 (US) 每年就造成近 500 人死亡，以及每年向美国毒物控制中心拨打 100,000 次电话、50,000 次急诊室就诊和 10,000 次住院治疗。作为一种非处方药和处方药（含阿片类药物），APAP 的毒性使美国和欧洲引起急性肝功能衰竭的所有其他处方药相形见绌，但并未受到任何重大监管。在这篇综述中，围绕这种无处不在的止痛药的适当作用一直存在争议：它的历史、发病机制、识别和管理方面的临床挑战以及当前的监管状况。