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It works on a different pathway than either medication, which is why it stacks well with both

21 Chronic alcohol ingestion, however, augments APAP hepatotoxicity by up-regulating, enhancing and increasing the synthesis and activity of CYP 2E1 and decreasing GSH stores and synthesis, thus enhancing liver necrosis and worsening prognosis

Some people also mention nausea, headaches, dizziness, tiredness, or sleep changes

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The induced gene cluster pcaHGBL (cluster II) encodes a two component ring-cleavage dioxygenase ( pcaHG ), a 3-carboxy- cis , cis -muconate cycloisomerase ( pcaB ) and a bifunctional (-carboxymuconolactone decarboxylase and -ketoadipate enol-lactone hydrolase) enzyme ( pcaL )