Paracetamol toxicity: is enzyme induction important?

A female patient receiving carbamazepine developed severe liver damage after an overdose of paracetamol. Antidotal therapy was not administered because her plasma paracetamol concentration was below that normally indicating the need for such therapy. Subsequently, carbamazepine was readministered and resulted in marked induction of the metabolism of a single dose of paracetamol. Antidotal therapy may be indicated if the plasma paracetamol concentrations are 70% or more of those shown in the conventional treatment line, if the patients are also receiving enzyme-inducing drugs.