Acetaminophen Use Concomitant with Long-Lasting Flucloxacillin Therapy: A Dangerous Combination

  • Luuk René van den Bersselaar Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
  • Judith Maria Dimphena van den Brule Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
  • Johannes Gerardus van der Hoeven Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
DOI: https://doi.org/10.12890/2020_001569

Keywords

5-oxoproline, acetaminophen, flucloxacillin, anion gap, metabolic acidosis

Abstract

Acetaminophen and flucloxacillin both interfere with the ?-glutamyl cycle. Long-lasting concomitant use of flucloxacillin and acetaminophen can lead to 5-oxoproline accumulation and severe high anion gap metabolic acidosis. Females and patients with sepsis, impaired kidney and/or liver function, malnutrition, advanced age, congenital 5-oxoprolinase deficiency and supratherapeutic acetaminophen and flucloxacillin dosage are associated with increased risk. Therefore, a critical attitude towards the prescription of acetaminophen concomitant with flucloxacillin in these patients is needed.
We present the case of a 79-year-old woman with severe 5-oxoprolinaemia after long-lasting treatment with flucloxacillin and acetaminophen, explaining the toxicological mechanism and risk factors, and we make recommendations for acetaminophen use in patients with long-lasting flucloxacillin treatment.

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    • Published: 2020-04-23

    Issue: Vol 7 No 7 (view)

    Section: Articles

    How to cite:
    1.
    van den Bersselaar LR, van den Brule JMD, van der Hoeven JG. Acetaminophen Use Concomitant with Long-Lasting Flucloxacillin Therapy: A Dangerous Combination. EJCRIM 2020;7 doi:10.12890/2020_001569.