Hepatotoxicity-free pharmaceutical composition containing acetaminophen drugs

Abstract

A new compound composition that is free of a side effect to a liver and used for alleviating the toxicity of an acetaminophen (APAP) medicament to the liver. The compound composition comprises (a) a pharmaceutically effective amount of acetaminophen and (b) a frequently-used safe and pharmaceutically acceptable excipient that can be combined with one or more than two medicaments that can reduce the toxicity of a drug via liver enzyme CYP2E1 metabolism to the liver. The compound is selected from the following group: Tween 20, microcrystalline cellulose, dicalcium phosphate, polyoxyethylene 23 lauryl ether, saccharin, mannitol, polyoxyethylene alkyl ether, sucralose, pyrrolidone, sodium starch glycolate, acrylic resin S100, carboxymethyl cellulose sodium, polyoxyethylene polyoxypropylene, menthol, low-substituted hydrocarbon propyl cellulose, pregelatinized starch, Dextrates NF hydrated, citric acid, polyoxyethylene castor oil, colloidal silica, polyethylene glycol monostearate aliphatic ester, sorbic acid, lemon oil, hydroxypropyl cellulose, sorbitol, acesulfame potassium, hypromellose phthalate, lactose monohydrate, maltodextrin, Brij 58, Brij 76, Tween 80, Tween 40, PEG 400, PEG 4000, PEG 2000, and the like, so as to reduce the side effect of the toxicity caused by acetaminophen to the liver.

Claims

1. A method for reducing liver damage caused by acetaminophen (APAP), comprising administering to a subject in need thereof at least mannitol and sucralose and optionally menthol, in an amount effective in reducing liver damage caused by APAP, wherein mannitol is administered in an amount of 10-250 mg and sucralose is administered in an amount of 10-250 mg.

2. The method of claim 1, wherein the liver damage includes necrosis or vacuolization occurred in the liver of the subject.

3. The method of claim 1, wherein mannitol and sucralose are administered at a weight ratio of 1:1.

4. A method for administering acetaminophen (APAP) to a subject in need thereof, comprising administering to the subject acetaminophen, and at least mannitol and sucralose and optionally menthol in an amount effective in reducing liver damage caused by APAP, wherein mannitol is administered in an amount of 10-250 mg and sucralose is administered in an amount of 10-250 mg.

5. The method of claim 4, wherein the liver damage includes necrosis or vacuolization occurred in the liver of the subject.

6. The method of claim 4, wherein the acetaminophen, mannitol, sucralose and optionally menthol are administered separately, simultaneously or sequentially.

7. The method of claim 4, wherein the acetaminophen, mannitol, sucralose and optionally menthol are formulated in a pharmaceutical composition.

8. The method of claim 7, wherein the pharmaceutical composition is in a form of gel, solution, capsule, torches, or tablets, in a pharmaceutically acceptable dosage form.

9. The method of claim 4, wherein the acetaminophen, mannitol, sucralose and optionally menthol are included in pharmaceutical kits, pharmaceutical packs or patient packs and acceptable container.

10. The method of claim 7, wherein the pharmaceutical composition is a formulation consisting essentially of acetaminophen, mannitol and sucralose.

11. The method of claim 4, wherein mannitol and sucralose are administered at a weight ratio of 1:1.

12. A method for reducing liver damage caused by acetaminophen (APAP), comprising administering to a subject in need thereof at least mannitol and sucralose and optionally at least one compound selected from the group consisting of Menthol, Eudragit S100, Pluronic F68, and Microcrystalline cellulose, in an amount effective in reducing liver damage caused by APAP, wherein mannitol is administered in an amount of 10-250 mg and sucralose is administered in an amount of 10-250 mg.

13. A method for administering acetaminophen (APAP) to a subject in need thereof, comprising administering to the subject acetaminophen and a compound as an inhibitor in an amount effective in reducing liver damage caused by APAP, wherein the compound is at least mannitol and sucralose and optionally at least one compound selected from the group consisting of Menthol, Eudragit S100, Pluronic F68, and Microcrystalline cellulose.

14. The method of claim 1, wherein mannitol and sucralose are administered in an amount effective to reduce the formation of N-acetyl-p-benzoquinone imine (NAPQI) from APAP.

15. The method of claim 4, wherein mannitol and sucralose are administered in an amount effective to reduce the formation of N-acetyl-p-benzoquinone imine (NAPQI) from APAP.

16. The method of claim 12, wherein mannitol and sucralose are administered in an amount effective to reduce the formation of N-acetyl-p-benzoquinone imine (NAPQI) from APAP.

17. The method of claim 13, wherein mannitol and sucralose are administered in an amount effective to reduce the formation of N-acetyl-p-benzoquinone imine (NAPQI) from APAP.

18. A method for reducing liver damage caused by acetaminophen (APAP), comprising administering to a subject in need thereof a compound selected from the group consisting of Mannitol, Sucralose, Menthol, and any combination thereof, in an amount effective in reducing liver damage caused by APAP, wherein mannitol is administered in an amount of 10-250 mg and sucralose is administered in an amount of 10-250 mg, provided that when sucralose is administered in an amount of 10 mg, it is administered in combination with mannitol in an amount of 10-250 mg.

19. A method for administering acetaminophen (APAP) to a subject in need thereof, comprising administering to the subject acetaminophen and a compound as an inhibitor in an amount effective in reducing liver damage caused by APAP, wherein the compound is selected from the group consisting of Mannitol, Sucralose, Menthol, and any combination thereof, wherein mannitol is administered in an amount of 10-250 mg and sucralose is administered in an amount of 10-250 mg, provided that when sucralose is administered in an amount of 10 mg, it is administered in combination with mannitol in an amount of 10-250 mg.

20. A method for reducing liver damage caused by acetaminophen (APAP), comprising administering to a subject in need thereof a compound selected from the group consisting of Mannitol, Sucralose, Menthol, Eudragit S100, Pluronic F68, Microcrystalline cellulose, and any combination thereof, in an amount effective in reducing liver damage caused by APAP, wherein mannitol is administered in an amount of 10-250 mg and sucralose is administered in an amount of 10-250 mg, provided that when sucralose is administered in an amount of 10 mg, it is administered in combination with mannitol in an amount of 10-250 mg.

21. A method for administering acetaminophen (APAP) to a subject in need thereof, comprising administering to the subject acetaminophen and a compound as an inhibitor in an amount effective in reducing liver damage caused by APAP, wherein the compound is selected from the group consisting of Mannitol, Sucralose, Menthol, Eudragit S100, Pluronic F68, Microcrystalline cellulose, and any combination thereof, wherein mannitol is administered in an amount of 10-250 mg and sucralose is administered in an amount of 10-250 mg, provided that when sucralose is administered in an amount of 10 mg, it is administered in combination with mannitol in an amount of 10-250 mg.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 shows the metabolic pathway of acetaminophen (APAP) in liver.

(2) FIG. 2 shows tissue sections of rat liver from (A)normal control group, (B)APAP hepatotoxicity group, (C)dicalcium phosphate, (D) mannitol, (E)menthol, (F) sucralose, (G) mannitol+ sucralose (1.67+1.67 mg/kg) and (H) mannitol+sucralose (0.83+0.83 mg/kg) liver protection group, tissue sections of rat liver after oral administration of a single dose of the compound (A) liver tissue morphology of normal control group, (B) the hepatocytes around the central vein (V) are broken and infiltrated with inflammatory cells and necrosis and vacuolization are present. When compared with the APAP hepatotoxicity groups, all hepatocytes of the rats in the liver protection groups are more intact around the central vein and have a apparent nucleus with less vacuolization (D, E, F, G and H) except for the dicalcium phosphate group and among which (F) and (G) are most similar to the liver tissue sections of normal rats (H&E stain, 200X).

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

(3) The present invention is further illustrated by the following examples, which are provided for the purpose of demonstration rather than limitation.

(4) In view of the aforesaid disadvantages of side effects such as hepatotoxicity caused by the above-mentioned conventional uses of acetaminophen, the inventor of the present invention desirably wants to improve and innovate, and after many years of research, has finally succeeded in researching and developing the new acetaminophenol having no side effects to the liver.

(5) According to the invention, the new acetaminophen pharmaceutical composition induced hepatotoxicity in rats and this is used as an animal model to investigate the effect of hepatotoxicity caused by acetaminophen in rats by combining acetaminophen with one or any combination of CYP2E1 inhibitors. In addition to the use of common markers of hepatotoxicity and histological tissue sections, GSP is also used to quantify residual liver function of the rats for further assessment.

(6) Unless defined otherwise, all technical and scientific terms used herein have the meaning commonly understood by a person skilled in the art to which this invention belongs.

(7) In the invention, when used in two or more compounds and/or pharmaceutical formulations, the term “combination” refers to the materials that containing said two or more compounds and/or pharmaceutical formulations. As used herein, the term “combined” and “combining” used in the invention have the meanings ascribed to them unless specified otherwise.

(8) Pharmaceutical kits, pharmaceutical packs or patient packs, wherein two or more compounds/pharmaceutical formulations are co-packed or co-present (if the compound(s) is packaged as the dosage unit in a batch).

(9) Present invention will be better elucidated when read in conjunction with the following examples; however, it should be understood that the invention is not limited to the preferred embodiments shown. Unless otherwise specified, all materials used herein are commercially available materials and can be easily acquired.

Example 1

(10) Animal studies of combination use of acetaminophen and one pharmaceutically acceptable excipient or its combinations thereof to reduce hepatotoxicity induced by drugs.

(11) Materials and Methods

(12) 1. Materials

(13) All organic solvents are HPLC grade and are purchased from Tedia (Fairfield, Ohio, USA). APAP is purchased from Sigma (St. Louis, Mo. USA), galactose injectable solution is manufactured by Southern Photochemical Co. and is prepared by dissolving 400 g of galactose (Sigma) in 1 L of buffer solution containing isotonic salts for injections.

(14) 2. Animals

(15) Male SD (Sprague-Dawley) rats weighing 175-280 g were purchased from the National Laboratory Animal Center (NLAC), Taiwan. The study was conducted in accordance with the Guidelines for Conducting Animal Studies of the National Health Research Institute and all rats were placed in the air/humidity controlled environment under the 12 hours of day/12 hours of night cycle and with unlimited water and food supply. During the course of the study, the weights of rats were monitored continuously with normal water supply.

(16) 3. Treatments

(17) In vitro selection of effective CYP2E1 inhibitors and conduct animal studies to examine APAP-induced hepatotoxicity by combination use or no combination use of APAP. For hepatotoxicity test, rats were fed with a single dose of APAP in the amount of 1000 mg per kilogram of body weight to induce hepatotoxicity. Rats in the liver protection groups were fed with 1.67 mg of dicalcium phosphate per kilogram of body weight, or 1.67 mg of mannitol per kilogram of body weight, or 1.67 mg of menthol per kilogram of body weight, or 1.67 mg of HUEXC041 per kilogram of body weight, or 1.67 mg of mannitol and 1.67 mg of sucralose per kilogram of body weight, or 0.83 mg of mannitol and 0.83 mg of sucralose per kilogram of body weight, or 0.42 mg of mannitol and 0.42 mg of sucralose per kilogram of body weight, or 0.17 mg of mannitol and 0.17 mg of sucralose per kilogram of body weight, and combined with oral administration of a single dose of 1000 mg APAP per kilogram of body weight through tube feeding. Measurements of the serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are used as indicators of liver inflammation. GSP was performed 16 hours before and after administration of the drugs to analyze the residual liver function of rats. Meanwhile, pathological changes of each test group were analyzed using histological tissue sections to assess the mechanism(s) of liver damage or liver protection.

(18) 4. Blood Samples

(19) After completion of the treatments, rats were sacrificed under ether anesthesia, and blood was collected from the tail artery of the rats and placed in a test tube containing EDTA. The plasma was centrifuged at 13,000 at 4° C. for 15 minutes and the isolated plasma was transferred to Eppendorf tubes in aliquots and stored at −80° C.

(20) 5. Biochemical Analysis

(21) Liver damage is quantified by measuring plasma AST and ALT activity. AST and ALT are common indicators of hepatotoxicity and are measured by using the Synchron LXi 725 system (Beckman Instruments, U.S.).

(22) 6. Optic Microscope

(23) Following scarification of the rats, histological analysis was performed. Liver samples were fixed with 10% phosphate-buffered formalin, dehydrated an embedded in paraffin, Sections were prepared in 5 μm thickness and then stained with hematoxylin and eosin and subjected to Periodic acid Schiff stain (PAS). The stained sections were observed under the optic microscope.

(24) 7. Quantitative Tests of Liver Function

(25) After the study was completed, all rats were subjected to GSP test. Rats were i.v. injected with 0.4 g/ml BW galactose solution 0.5 g/kg within 30 seconds and one blood sample was collected at 5, 10, 15, 30, 45 and 60 minutes post injection from the tail vein. Colorimetric galactose dehydrogenase is used to quantify the concentration of galactose and the test concentration ranges from 50 to 1,000 μg/ml. The within-day variation of each concentration is calculated using standard deviation and coefficient of variation (CV) and the maximum allowable coefficient of variation is 10% CV, whereas day-to-day variation is examined by comparing the slope and intercept of calibration curves. The GSP is the blood galactose concentration obtained 60 seconds after stopping the 30-second injection.

(26) 8. Statistical Analysis

(27) All data are represented in mean±standard deviation(SD) and the results are calculated using ANOVA to determine the significance. Statistical Package of the Social Science program (Version 13, SPSS Inc.) is used for calculations followed by post hoc test to examine the least significant difference for multiple comparisons so as to confirm the significant differences between groups and the average difference between groups was significant p<0.05.

(28) Results

(29) 1. Results of Biochemical Analysis

(30) At the time of completion the study, the weight and relative liver weight of the test animals were measured and no significant difference was found when compared with the animals in the normal control group. The results of blood biochemical analysis are shown in Table 1. Except for the activity of plasma AST and ALT in the APAP hepatotoxicity group was significantly higher than control group (the plasma AST level of the control and APAP group was 202±34 IU/L and 499±112 IU/L, respectively, p<0.005; the plasma ALT level of the control and APAP group was 56±14 IU/L and 368±71 IU/L, respectively, p<0.005), indicating liver damage has occurred in the APAP hepatotoxicity group. Except the results of the dicalcium phosphate group are not as expected, said liver damage can be improved by combined use of the safe recipients such as mannitol, menthol, sucralose and the measured liver inflammatory indicators AST, ALT and GSP as well as the Total HAI-score assessment based on the histological tissue sections all showed significant decrease. The results are shown in FIG. 1 and among which the combination of mannitol and sucralose showed the best protection effect and the result is similar to the control group.

(31) TABLE-US-00001 TABLE 1 Mice in the control group, APAP hepatotoxicity group, and liver protection groups including dicalcium phosphate, mannitol, menthol, sucralose were administered with a single dose by tube feeding and GSP, AST level, ALT level and the Total HAI-score obtained from histological tissue sections were measured. Calculations of the values are shown in mean ± SD. Liver function parameters GSP (mg/L) AST (IU/L) ALT (IU/L) Total HAI-score 1. normal control 289 ± 38   202 ± 34   56 ± 14   0.0 ± 0.0   (n = 6) 2. APAP 848 ± 123  499 ± 112  368 ± 71   4.9 ± 1.8   hepatotoxicity group (n = 6) 3. dicalcium 444 ± 60*** 315 ± 42*  196 ± 65*   3.1 ± 1.1*  phosphate (1.67 mg/kg) group (n = 6) 4. mannitol (1.67 253 ± 29*** 201 ± 30*** 79 ± 34*** 0.8 ± 0 3*** mg/kg) group (n = 6) 5. menthol (1.67 289 ± 20*** 187 ± 2***  109 ± 23***  1.1 ± 1.2**  mg/kg) group (n = 6) 6. sucralose (1.67 218 ± 31***  199 ± 24* * * 83 ± 23*** 0.6 ± 0 4*** mg/kg) group (n = 6) 7. mannitol + 236 ± 33***  198 ± 37* * * 59 ± 13*** 0.5 ± 0 4*** sucralose (1.67 + 1.67 mg/kg) group (n = 6) 8. mannitol + 244 ± 19*** 190 ± 23*** 65 ± 19*** 0.7 ± 0.5*** sucralose (0.83 + 0.83 mg/kg) group (n = 4) 9. mannitol + 281 ± 58*** 187 ± 41*** 96 ± 14*** 1.4 ± 1.7*  sucralose (0.42 + 0.42 mg/kg) group (n = 4) 10. mannitol + 371 ± 49*** 298 ± 49*  101 ± 24***  2.1 ± 1.2*  sucralose(0.17 + 0.17 mg/kg) group (n = 4)

(32) 2. Histopathology

(33) The improved results are also reflected in the corresponding liver tissues. Rats fed with a single oral dose of 1000 mg/kg APAP successfully produced hepatotoxicity in vivo. The liver tissue sections from the rats in the APAP hepatotoxicity group showed that hepatocytes surrounding the central vein are broken with visible vacuolization and reduced number of nucleuses, some hepatocytes even showed the signs of necrosis and liver damage is more severe when compared with the hepatocytes from rats in the normal control group (as shown in FIG. 2B). On the contrary, liver structure of rats in the control group are normal, the hepatocytes are intact and arranged in order with no vacuolization (as shown in FIG. 2A). As for the liver sections from the liver protection groups such as mannitol, menthol and sucralose, the hepatocytes are relatively intact with visible nucleus and less vacuolization (as shown in FIGS. 2C, D, F, G and H), indicating the liver tissues from the mannitol, menthol and sucralose protection groups are similar to the liver tissues from the normal control group and among which mannitol and sucralose provide the best protection and said protection is positively correlated with dose, the higher the dose the better the protection.

(34) 3. Measurement of Residual Liver Function

(35) As shown in FIG. 1, the GSP values of the control and APAP hepatotoxicity group shows significant differences (the GSP of control and hepatotoxicity group was 289±38 mg/L and 848±123 mg/L, respectively, p<0.005). In addition, the GSP values of the protection group dicalcium phosphate, mannitol, menthol and sucralose were 444±60 mg/L, 253±29 mg/L, 289±20 mg/L and 218±31 mg/L, respectively and the differences between the GSP values of the protection groups and the hepatotoxicity group were significant when compared the APAP hepatotoxicity group (p<0.005). The GSP values increased significantly in the rats with hepatotoxicity after a single administration of APAP; however, combination use of APAP with excipients like mannitol, menthol and sucralose in the liver protection group can help against such change.

Example 2

(36) Screening of the Cytochrome P450 2E1 (CYP2E1) inhibitors—rat liver microsomes and human liver microsomes.

(37) Materials and Methods

(38) 1. Materials

(39) This example is preparation of microsomes from rat and human liver for in vitro screening of CYP2E1 inhibitors. A total of 55 safe and edible excipients are included in the screening for cytochrome P450 2E1 (CYP2E1) inhibitors. Effective rat or human hepatic CYP2E1 inhibitors were screened and the principle for screening the CYP2E1 inhibitors is based on the reaction of microsomal CYP2E1 prepared from the liver of different origin and its specific substrate Chlorzoxazone (CZX). After addition of the test sample, the amount of CYP2E1 metabolite standard 6-OH-CZX (6-Hydroxy-Chlorzoxazone) is used for calculation of the CYP2E1 inhibition ratio of the test sample by using the amount of 6-OH-CZX of the control group as the baseline.

(40) All test samples were dissolved in 10% methanol or distilled water and CYP 2E1 inhibition ratios were measured by adding excipients at different concentrations (66 uM, 33 uM, 16.5 uM; 0.167%, 0.08%, 0.042%, w/v). The results are shown in Table 2.

(41) The reagents required for screening of the cytochrome CYP2E1 inhibitors from rat or human liver microsomes are as follows: (1) CYP2E1: 100 mM potassium phosphate (pH 7.4) contains 10 mg/mL P450 protein concentration. (2) Control Protein: 10 mg/mL P450 Protein was dissolved in 100 mM Potassium Phosphate (pH 7.4). (3) Buffer Solution: 0.5 M Potassium Phosphate (pH 7.4). (4) Stop Solution: ice-acetonitrile. (5) Cofactors: contain 100 mM NADP+ and 10 mM Glucose 6-Phosphate. (6) Glucose 6-Phosphate Dehydrogenase: 2000 units/ml was dissolved in sterile water. (7) Chlorzoxazone: the substrate 16 mM Chlorzoxazone was dissolved in 10% methanol. (8) DDTC (Diethyldithiocarbamic acid): CYP2E1 selective inhibitors (positive control group), 20 mM DDTC was dissolved in 10% methanol. (9) NADPH-regenerating System: in 3.42 in, add 530 uL Cofactors, 40 uL G6PDH (Glucose 6-Phosphate Dehydrogenase Solution) and 100 uL Control Protein.

(42) 2. Screening of Cytochrome P450 2E1 (CYP2E1) Inhibitors

(43) The procedures of screening for cytochrome P450 2E1 (CYP2E1) inhibitors from rat or human liver microsomes are as follows: (1) In a water bath at 4° C., 0.1 M phosphate buffered saline (pH 7.4) containing 0.5 mg/mL rat or human liver microsomes and 5 mM MgCl.sub.2 were incubated for 15 minutes. (2) add P450 2E1 substrate drug, 16 mM Chlorzoxazone, and the screened compound to the experimental groups and methanol:sterile water=1:1 and DDTC was added to the control groups and positive control group, respectively. (3) Add cofactors 1 mM NADP.sup.+, 10 mM G6P and 2 IU G6PD in the last. Transfer to and pre-incubate the reaction mixture in a water bath at 37° C. for 1 minute. The reaction time for testing activity is 30 minutes. (4) After the reaction is completed, add 500 μL acetonitrile to stop the reaction. Incubate the sample for 1 minute and add internal standard (5 ug/mL 4-hydroxy-tobutamide). Collect 20 uL of the supernatant after centrifugation and diluted 10 fold using methanol:sterile water and take 5 uL of the resuspended solution and inject into the LC/MS/MS for analysis. (5) Analysis of the results: convert the detected signal values obtained from LC/MS/MS into the amount (pmol) of CYP2E1 metabolite standard 6-Hydroxy-Chlorzoxazone using the control group as the baseline, i.e. the CYP2E1 inhibition ratio of the control group is 0%, and calculate the CYP 2E1 inhibition ratio of the positive control group using the follow formula:

(44) $\mathrm{CYP}2E1\mathrm{inhibition}\mathrm{rate}\left(\%\right)=\hspace{1em}\left[1-\frac{\mathrm{Experimental}\mathrm{Group}6\text{-}\mathrm{OH}\text{-}\mathrm{CZX}\mathrm{amount}}{\mathrm{Control}\mathrm{Group}6\text{-}\mathrm{OH}\text{-}\mathrm{CZX}\mathrm{amount}}\right]\times 100\%$

(45) Results

(46) 1. Positive Control Group

(47) CYP2E1 inhibition ratios of the positive control group (DDTC) are shown in Table 2. From Table 2, CYP2E1 inhibition can reach 89.2% when the concentration of DDTC is at 100 μM.

(48) 2. CYP2E1 Inhibition Ratios of the Experimental Groups

(49) CYP2E1 inhibition ratios of the excipients in the rat liver microsomes are shown in Table 2. From the results, excipients at different concentrations (66 μM, 33 μM, 16.5 μM; 0.167%, 0.08%, 0.042%, w/v) have different effects on P450 2E1 inhibition and among which 0.167% Brij 58 showed the best inhibition effect (100.0±0.00%).

(50) TABLE-US-00002 TABLE 2 The inhibition ratios of CYP 2E1 inhibitors from in-vitro screening of rat liver microsomes Excipient CYP 2E1 inhibition ratio (%) Test concentration 66 μM 33 μM 16.5 μM Control group 0 Positive control group (100 μM) (50 μM) (10 μM) (DDTC) 89.2 ± 2.2 50.4 ± 1.1  8.6 ± 1.1 Brij 58 100.0 ± 0.0  98.6 ± 0.2 96.5 ± 0.3 (0.167%) (0.084%) (0.042%) Brij 76 100.0 ± 0.0  98.5 ± 0.1 97.5 ± 0.3 (0.167%) (0.084%) (0.042%) Tween 20 95.9 ± 0.4 92.5 ± 0.7 80.6 ± 1.9 (0.167%) (0.084%) (0.042%) Tween 80 85.1 ± 0.4 79.4 ± 1.4 68.2 ± 1.3 (0.167%) (0.084%) (0.042%) Microcrystalline 78.7 ± 2.8 75.0 ± 5.2 73.9 ± 1.8 cellulose (0.025%) (0.013%) (0.006%) Tween 40 78.1 ± 1.4 71.5 ± 0.5 54.0 ± 3.2 (0.167%) (0.084%) (0.042%) Dicalcium phosphate 76.7 ± 0.8 62.0 ± 2.6 55.0 ± 4.6 dihydrate Saccharin 67.4 ± 3.9 59.6 ± 3.3 35.3 ± 2.0 Brij 35 67.2 ± 1.4 59.3 ± 2.5 45.9 ± 2.6 (0.025%) (0.013%) (0.006%) Mannitol 60.6 ± 3.3 51.0 ± 2.7 40.9 ± 2.8 Cremophor RH40 57.4 ± 3.2 49.4 ± 2.9 48.0 ± 2.1 Sucralose 54.0 ± 4.2 46.8 ± 0.8 41.1 ± 2.7 PEG 400 52.5 ± 4.6 43.4 ± 3.0 35.1 ± 2.2 (0.167%) (0.084%) (0.042%) Crospovidone 48.7 ± 0.4 43.2 ± 3.6 41.1 ± 2.7 PEG 4000 48.1 ± 2.4 39.4 ± 1.8 32.7 ± 0.8 (0.167%) (0.084%) (0.042%) Sodium starch 41.2 ± 4.9 37.6 ± 2.5 34.1 ± 0.8 glycolate (0.167%) (0.084%) (0.042%) S100 39.7 ± 4.9 33.5 ± 4.0 12.7 ± 1.9 Eudragit S100 (0.167%) (0.084%) (0.042%) Croscarmellose 38.8 ± 2.4 35.9 ± 2.8 10.7 ± 4.0 sodium (0.167%) (0.084%) (0.024%) Pluronic F68 37.3 ± 3.0 18.9 ± 1.4 14.9 ± 0.9 (0.167%) (0.084%) (0.024%) Menthol 36.4 ± 0.3 15.3 ± 7.9  7.2 ± 2.9 Low-substituted 36.2 ± 6.0 33.8 ± 1.4 28.7 ± 2.2 hydroxypropyl (0.025%) (0.013%) (0.006%) cellulose Pregelatinized starch 33.6 ± 2.0 26.2 ± 2.8 14.0 ± 2.5 (0.167%) (0.084%) (0.024%) Dextrates, NF hydrate 32.9 ± 2.0 27.0 ± 3.0 13.2 ± 0.6 (0.167%) (0.084%) (0.024%) Citric acid 27.6 ± 3.6 12.4 ± 2.2  7.5 ± 2.3 Cremophor EL 25.2 ± 2.7 12.9 ± 2.2  5.9 ± 0.3 (0.167%) (0.084%) (0.024%) Aerosil 200 23.8 ± 2.4 22.8 ± 1.7  4.7 ± 1.2 (0.167%) (0.084%) (0.024%) Myrj 52 20.5 ± 0.3 18.5 ± 0.6 17.5 ± 1.5 (0.167%) (0.084%) (0.024%) PEG 8000 19.2 ± 2.0 15.1 ± 0.6  9.9 ± 0.3 (0.167%) (0.084%) (0.024%) Sorbic acid 19.0 ± 5.6 13.2 ± 4.4 12.1 ± 5.7 Lemon oil 18.2 ± 3.7 13.9 ± 2.9  9.7 ± 3.8 (0.167%) (0.084%) (0.024%) Hydroxypropyl 18.0 ± 2.2 12.7 ± 1.9  6.7 ± 0.7 cellulose (0.167%) (0.084%) (0.024%) Span 60 17.1 ± 0.8 15.2 ± 2.1 15.1 ± 1.4 (0.167%) (0.084%) (0.024%) Sorbitol 16.1 ± 0.7  5.6 ± 0.5  6.4 ± 0.5 (0.167%) (0.084%) (0.024%) Sodium benzoate 15.8 ± 0.9  7.8 ± 4.1  7.1 ± 2.0 Acesulfame 14.5 ± 1.9  7.1 ± 2.3  3.9 ± 2.7 potassium Hydroxypropyl 13.9 ± 2.2 13.6 ± 2.6  6.7 ± 0.7 methylcellulose (0.167%) (0.084%) (0.024%) Hydroxy 11.6 ± 0.9 13.2 ± 0.6  5.6 ± 0.5 ethylmethylcellulose (0.167%) (0.084%) (0.024%) Methylcellulose 10.3 ± 1.7  5.2 ± 0.3  5.0 ± 1.1 (0.167%) (0.084%) (0.024%) Span 80  9.4 ± 0.6  8.5 ± 1.3 10.6 ± 1.9 (0.167%) (0.084%) (0.024%) Sodium cyclamate  9.1 ± 2.6  5.7 ± 4.7  9.4 ± 2.7 Lactose monohydrate  8.7 ± 3.8  7.8 ± 2.2  3.9 ± 2.3 Maltodextrin  8.5 ± 2.8  5.9 ± 2.1  9.7 ± 5.6 (0.167%) (0.084%) (0.024%) Glyceryl behenate  8.2 ± 2.0  3.1 ± 2.5  3.1 ± 0.2 Oxide red  8.5 ± 5.1 10.7 ± 4.1 10.3 ± 2.1 Glycerin  6.9 ± 1.8  7.4 ± 2.9  8.3 ± 5.7 monostearate (0.167%) (0.084%) (0.024%) Copovidone K28  6.1 ± 0.7  4.5 ± 0.5  4.3 ± 0.2 (0.167%) (0.084%) (0.024%) Starch acetate  5.3 ± 0.7  4.9 ± 1.2  5.5 ± 1.2 (0.167%) (0.084%) (0.024%) Magnesium stearate  5.0 ± 1.6  3.0 ± 0.7  2.0 ± 1.0 Sodium lauryl sulfate  4.8 ± 1.2  6.4 ± 0.9  4.6 ± 1.1 Providone K30  3.2 ± 0.2  2.2 ± 0.1  4.7 ± 1.0 Benzyl alcohol −10.3 ± 6.3   6.7 ± 1.0  8.2 ± 2.0 (0.167%) (0.084%) (0.024%) Methylparaben −21.5 ± 2.0  −14.6 ± 4.1   4.6 ± 3.2 Propylparaben −27.3 ± 3.7  −17.2 ± 2.4  −4.1 ± 1.2 Solutol H15 −35.5 ± 4.3  −21.0 ± 4.8  −9.3 ± 0.8 (0.167%) (0.084%) (0.042%) Butylated −85.5 ± 3.9  −47.1 ± 5.3  −16.8 ± 2.5  hydroxylanisol

(51) The CYP2E1 inhibition ratios of th excipients detected in the human liver microsomes are shown in Table 3. From the results, excipients at different concentrations (66 μM, 33 μM, 16.5 μM; 0.167%, 0.08%, 0.042%, w/v) have different effects on P450 2E1 inhibition and among which 0.167% Brij 58 showed the best inhibition effect (91.2±1.3%).

(52) TABLE-US-00003 TABLE 3 The inhibition ratios of CYP 2E1 inhibitors from in-vitro screening of human liver microsomes Excipient CYP 2E1 inhibition ratio (%) Test concentration 66 μM 33 μM 16.5 μM Control group 0 Positive control group (100 μM) (50 μM) (10 μM) (DDTC) 89.6 ± 0.9 49.8 ± 2.9  7.3 ± 1.0 Brij 58 91.2 ± 1.3 80.5 ± 1.1 62.6 ± 2.1 (0.167%) (0.084%) (0.042%) Brij 76 86.2 ± 1.3 75.7 ± 1.6 69.0 ± 3.8 (0.167%) (0.084%) (0.042%) Saccharin 78.5 ± 2.1 51.2 ± 0.9 29.4 ± 2.7 Brij 35 77.3 ± 1.0 73.0 ± 1.7 42.4 ± 1.8 (0.025%) (0.013%) (0.006%) Tween 20 75.4 ± 3.6 70.4 ± 0.9 55.4 ± 1.9 (0.167%) (0.084%) (0.042%) PEG 400 64.2 ± 1.5 54.8 ± 3.5 26.4 ± 1.8 (0.167%) (0.084%) (0.042%) Microcrystalline 60.2 ± 4.1 54.4 ± 3.8 48.8 ± 0.2 cellulose (0.025%) (0.013%) (0.006%) Dicalcium phosphate 60.1 ± 0.3 56.8 ± 2.2 31.2 ± 2.9 dihydrat Sucralose 55.8 ± 2.0 45.8 ± 4.0 37.1 ± 2.8 Mannitol 54.5 ± 4.2 51.2 ± 2.1 44.8 ± 1.8 Cremophor RH40 50.4 ± 1.1 43.2 ± 3.1 30.2 ± 2.8 Sodium starch 49.1 ± 2.9 31.4 ± 5.2 38.9 ± 1.3 glycolate (0.167%) (0.084%) (0.042%) PEG 2000 47.5 ± 1.5 41.4 ± 1.6 22.3 ± 1.9 (0.167%) (0.084%) (0.042%) PEG 4000 47.1 ± 0.9 23.9 ± 2.9  8.7 ± 1.8 (0.167%) (0.084%) (0.042%) Tween 40 46.3 ± 3.1 33.4 ± 2.7 16.9 ± 1.2 (0.167%) (0.084%) (0.042%) Crospovidone 44.1 ± 0.9 40.3 ± 3.3 35.6 ± 1.8 (0.167%) (0.084%) (0.042%) Tween 80 39.1 ± 2.4 40.6 ± 3.8 29.0 ± 1.7 (0.167%) (0.084%) (0.042%) S100 38.3 ± 0.1 35.6 ± 2.4 23.2 ± 3.5 Eudragit S100 (0.167%) (0.084%) (0.042%) Croscarmellose 35.4 ± 4.8 30.3 ± 5.4  8.1 ± 2.3 sodium (0.025%) (0.013%) (0.006%) Pluronic F68 31.5 ± 1.6 17.4 ± 4.2  7.9 ± 0.8 (0.025%) (0.013%) (0.006%) Menthol 30.8 ± 0.3 20.8 ± 2.1 10.5 ± 0.4 Low-substituted 22.1 ± 3.7 20.3 ± 1.8 17.5 ± 2.9 hydroxypropyl (0.025%) (0.013%) (0.006%) cellulose PEG 8000 21.1 ± 4.4 14.2 ± 3.6  9.4 ± 0.2 (0.167%) (0.084%) (0.024%) Citric acid 20.5 ± 1.8 15.5 ± 1.5  9.9 ± 3.1 Cremophor EL 19.2 ± 0.5 15.1 ± 2.2  8.1 ± 0.6 (0.167%) (0.084%) (0.024%) Dextrates, NF hydrate 19.2 ± 1.1 14.4 ± 3.2 12.9 ± 0.6 (0.167%) (0.084%) (0.024%) Pregelatinized starch 18.3 ± 2.4 12.8 ± 0.8  9.9 ± 0.1 (0.167%) (0.084%) (0.024%) Myrj 52 18.1 ± 2.6 15.7 ± 2.8 14.6 ± 1.7 (0.167%) (0.084%) (0.024%) Span 60 17.4 ± 0.9 13.9 ± 0.7 12.4 ± 2.3 (0.167%) (0.084%) (0.024%) Aerosil 200 15.7 ± 3.4 17.8 ± 2.1  7.8 ± 0.4 (0.167%) (0.084%) (0.024%) Sorbic acid 14.8 ± 0.1 10.9 ± 2.7  8.4 ± 1.6 Span 80 10.1 ± 2.1  5.7 ± 4.7  9.4 ± 2.7 (0.167%) (0.084%) (0.024%) Lemon oil  7.8 ± 0.3  9.8 ± 0.4  8.8 ± 1.1 (0.167%) (0.084%) (0.024%)

(53) The effective dose range of the excipients at different concentrations (66 μM, 33 μM, 16.5 μM) for the new hepatotoxicity-free pharmaceutical composition for improving hepatotoxicity induced by Acetaminophen (APAP) drugs is: 0.17-5.5 g polyethylene glycol sorbitan monolaurate (Tween 20), 100˜1000 mg microcrystalline cellulose, 10-250 mg dicalcium phosphate dihydrate, 100-1000 mg Brij 35, 10-40 mg saccharin, 10-250 mg mannitol, 0.17-5.5 g cremophor RH40, 10-250 mg sucralose, 0.17-5.5 g crospovidone, 0.17-5.5 g sodium starch glycolate, 0.17-5.5 g Eudragit S100, 0.17-5.5 g croscarmellose sodium, 1.4-5.5 g Pluronic F68, 8-34 mg menthol, 0.19-0.82 g low-substituted hydroxypropyl cellulos, 1.7-5.5 g pregelatinized starch, 0.17-5.5 g dextrates NF hydrated, 10-42 mg citric acid, 1.7-5.5 g cremophor EL, 0.17-5.5 g Aerosil 200, 1.4-5.5 g Myrj 52, 6-24 mg sorbic acid, 0.17-5.5 g lemon oil, 0.17-5.5 g hydroxypropyl cellulose, 0.17-5.5 g sorbitol, 1.4-5.5 g acesulfame potassium, 0.17-5.5 g hydroxypropyl methylcellulose, 6-24 mg lactose monohydrate, 0.17-5.5 g maltodextrin, 0.17-5.5 g Brij 58, 0.17-5.5 g Brij 76, 0.17-5.5 g Tween 80, 1.4-5.5 g Tween 40, 1.4-5.5 g PEG 400, 1.4-5.5 g PEG 4000, 1.4-5.5 g PEG 8000, 1.4-5.5 g Span 60, 2.9-11.9 mg sodium benzoate, 0.17-5.5 g hydroxy ethylmethylcellulose, 0.17-5.5 g methylcellulose, 1.4-5.5 g Span 80, 3.3-13.2 mg sodium cyclamate, 17.4-69.9 mg glyceryl behenate, 11.3-45.2 mg oxide red, 1.4-5.5 g glycerin monostearate, 0.17-5.5 g Copovidone K28, 0.17-5.5 g starch acetate, 9.7-39.0 mg magnesium stearate, 4.7-19.0 mg sodium lauryl sulfate, 0.18-0.73 mg Providone K30 and 1.4-5.5 g PEG 2000.

(54) The new hepatotoxicity-free pharmaceutical composition provided in this invention significantly reduced hepatotoxicity caused by acetaminophen in terms of biochemical analysis (ALT and AST levels), pathological analysis and residual liver function (GSP levels) when compared with single administration of acetaminophen.

(55) The foregoing examples and embodiments are merely better examples of the present invention; therefore, it should be understood that they are only for illustration purpose and shall not limit the scope of the present invention. Any variations or modifications made according to the claims of the present invention are remain within the scope of the present invention. For example, the types, used concentrations and ratios of acetaminophen, cytochrome P450 2E1 inhibitors and selection of the cytochrome P450 2E1 inhibitors, shall remain within the scope of the present invention.

(56) In conclusion, the invention not only provides a novel application of acetaminophen but also reduces hepatotoxicity caused by acetaminophen by combination use of acetaminophen with common and safe excipients.