Raised liver enzymes on the maximum dose did not mean liver damage
At 4 g a day, 31% to 44% had a raised liver enzyme, against none of the 39 people on placebo. Nobody in either trial developed liver disease.
What the study found
At 4 g of paracetamol a day, a third or more had raised liver enzymes
That is a laboratory signal and not an injury: nobody in either trial developed liver disease. The 4 g figure ran from 31% to 44%, against none of the 39 people on placebo. At 3 g for 28 days, nearly half of those affected saw the enzyme fall back while still taking it.
The caveat · Hospital stays, not home use
Fourteen days in hospital with every meal provided is not ordinary home use, and 145 people is a small sample for a safety question. The 28-day study used 3 g rather than 4 g, so the two rates are not measuring the same exposure. Its placebo group had an 11% rate of its own, a reminder that this enzyme moves without any drug at all. The 4 g trial ran inside a hydrocodone product development programme, with several industry-affiliated authors.