DARU Journal of Pharmaceutical Sciences

, Volume 27, Issue 2, pp 839–851 | Cite as

Acetaminophen poisoning-induced heart injury: a case-based review

  • Fatemeh KhabazianZadeh
  • Tooba Kazemi
  • Samaneh Nakhaee
  • Patrick C. Ng
  • Omid MehrpourEmail author
Review article



Acetaminophen (Paracetamol, APAP) poisoning is frequently implicated in self-harm. Cases of acetaminophen-associated cardiotoxicity are rare in relation to the number of patients with acetaminophen poisoning. A review of acetaminophen cardiotoxicity in 1996 concluded that there was no decisive evidence demonstrating that acetaminophen overdose has a cardiotoxic effect. This review study aimed to determine whether acetaminophen could induce heart injury.


We searched for keywords of acetaminophen, paracetamol, cardiotoxicity, heart injury, heart damage, myocarditis, pericarditis, myocardial infarction, and myocardial ischemia in Web of Science, PubMed, Scopus, Embase, Google Scholar, and Persian databases. The search included articles published from January 1950 to October 2018 with no language restrictions.


The search yielded 64 citations in English; 36 of the articles were excluded as they were not relevant; 5 articles were excluded since they were duplicates, leaving 23 articles. Full-text articles of the 23 citations were obtained and reviewed. Myocardial infarction, heart dysfunction and failure, cardiac arrhythmias, pericarditis, heart cell necrosis, and sudden cardiac death were reported in acetaminophen overdose.


Ddysrhythmias, heart failure, and various other cardiac effects could occur following acetaminophen induced hepatic failure. However, the evidence for direct injury on cardiac tissue is weak.

Graphical abstract

Potential mechanisms for cardiotoxicity of acetaminophen


Acetaminophen Acute poisoning Heart injury Cardiotoxicity Paracetamol Overdose 



The authors want to convey an appreciation for Dr. Barry H. Rumack, Dr. Kennon Heard, and Dr. Allister Vale for their nice comments in editing the manuscript.

Author contributions

FKZ, SN, TK, PCN, OM contributed to conceptualization, design, and preparation of the manuscript. FKZ, SN, TK, and OM conducted the data collection and contributed to acquisition and interpretation. FKZ, SN, PCN, and OM made substantial contributions to drafting the manuscript and revising it critically for important intellectual content. All authors have read and approved the final version of the manuscript.

Compliance with ethical standards

Competing interests

The authors declare no competing interests.


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Authors and Affiliations

  1. 1.Medical Toxicology and Drug Abuse Research Center (MTDRC)Birjand University of Medical Sciences (BUMS)BirjandIran
  2. 2.Cardiovascular Diseases Research CenterBirjand University of Medical SciencesBirjandIran
  3. 3.Rocky Mountain Poison and Drug CenterDenver Health and Hospital AuthorityDenverUSA
  4. 4.Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraUSA

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