The mechanism of paracetamol-induced hepatotoxicity: implications for therapy.

1 The reactive metabolite responsible for paracetamol-induced hepatotoxicity, postulated to be N-acetyl-p-benzoquinoneimine reacts with N-acetyl cysteine. 2 An adduct is formed by an SN2 mechanism and paracetamol is produced by a redox reaction. 3 The adduct produced is capable of further oxidation by N-acetyl-p-benzoquinoneimine. 4 Methionine does not react with the reactive metabolite to any great extent.