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J Infect Dis 222(7):S570S576 Wu D, Wu C, Zhang S, Zhong Y (2019) Risk factors of ventilator-associated pneumonia in critically III patients
Eurasian J Med 54(1):2735 Karimian A, Yousefi B, Sadeghi F, Feizi F, Najafzadehvarzi H, Parsian H (2022) Synthesis of biocompatible nanocrystalline cellulose against folate receptors as a novel carrier for targeted delivery of doxorubicin

Consequently, it would be difficult to predict which individuals might have a serious adverse drug reaction if ingesting ethanol and acetaminophen
If you notice reduced effectiveness at doses that previously worked well, degradation is a likely culprit
