A company introduces a new over-the-counter analgesic that is metabolized through the same hepatic pathway as acetaminophen. For a patient who drinks heavily, how should a clinician evaluate and advise regarding use together with alcohol?

• A. Recommend routine use with alcohol because shared hepatic metabolism reduces toxicity by distributing the metabolic load and protecting the liver from acetaldehyde damage.
• B. Suggest patients double their alcohol intake to induce hepatic enzymes and therefore lower the risk of analgesic toxicity, because enzyme induction mitigates accumulation of toxic metabolites.
• C. Advise that combining the new analgesic with recent heavy alcohol use could increase risk of liver injury because shared metabolic pathways may produce toxic intermediates when hepatic capacity is taxed; recommend avoidance or consult before use.
• D. Tell patients there is no reason for caution since over-the-counter drugs are automatically safe to combine with any amount of alcohol by regulatory approval.

Answer: (C)