Acetaminophen metabolism revisited using non-targeted analyses: Implications for human biomonitoring

Arthur David*, Jade Chaker, Thibaut Léger, Raghad Al-Salhi, Marlene D. Dalgaard, Bjarne Styrishave, Daniel Bury, Holger M. Koch, Bernard Jégou, David M. Kristensen

*Corresponding author for this work

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The analgesic paracetamol/acetaminophen (N-acetyl-4-aminophenol, APAP) is commonly used to relieve pain, fever and malaise. While sales have increased worldwide, a growing body of experimental and epidemiological evidence has suggested APAP as a possible risk factor for various health disorders in humans. To perform internal exposure-based risk assessment, the use of accurate and optimized biomonitoring methods is critical. However, retrospectively assessing pharmaceutical use of APAP in humans is challenging because of its short half-life. The objective of this study was to address the key issue of potential underestimation of APAP use using current standard analytical methods based on urinary analyses of free APAP and its phase II conjugates. The question we address is whether investigating additional metabolites than direct phase II conjugates could improve the monitoring of APAP. Using non-targeted analyses based on high-resolution mass spectrometry, we identified, in a controlled longitudinal exposure study with male volunteers, overlooked APAP metabolites with delayed formation and excretion rates. We postulate that these metabolites are formed via the thiomethyl shunt after the enterohepatic circulation as already observed in rodents. Importantly, these conjugated thiomethyl metabolites were (i) of comparable diagnostic sensitivity as the free APAP and its phase II conjugates detected by current methods; (ii) had delayed peak levels in blood and urine compared to other APAP metabolites and therefore potentially extend the window of exposure assessment; and (iii) provide relevant information regarding metabolic pathways of interest from a toxicological point of view. Including these metabolites in future APAP biomonitoring methods therefore provides an option to decrease potential underestimation of APAP use. Moreover, our data challenge the notion that the standard methods in biomonitoring based exclusively on the parent compound and its phase II metabolites are adequate for human biomonitoring of a non-persistent chemical such as APAP.

Original languageEnglish
Article number106388
JournalEnvironment International
Publication statusPublished - 2021

Bibliographical note

Funding Information:
We declare no competing interests. We thank Shanna Swan for her editorial comments and Romain Letourneur and Claudia Pälmke for technical assistance. The study was supported by the Candys Foundation and a research chair of excellence (2016-52/IdeX University of Sorbonne Paris Cité) awarded to AD.


  • High-resolution mass spectrometry (HRMS)
  • Human biomonitoring
  • Non-targeted analyses
  • Paracetamol/acetaminophen


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