Abstract
Objective To review the clinical usefulness of N-acetylcysteine (NAC) as treatment or adjunctive therapy in a number of medical conditions. Use in Tylenol overdose, cystic fibrosis, and chronic obstructive lung disease has been well documented, but there is emerging evidence many other conditions would benefit from this safe, simple, and inexpensive intervention. Quality of Evidence. PubMed, several books, and conference proceedings were searched for articles on NAC and health conditions listed above reviewing supportive evidence. This study uses a traditional integrated review format, and clinically relevant information is assessed using the American Family Physician Evidence-Based Medicine Toolkit. A table summarizing the potential mechanisms of action for N-acetylcysteine in these conditions is presented. Main Message. N-acetylcysteine may be useful as an adjuvant in treating various medical conditions, especially chronic diseases. These conditions include polycystic ovary disease, male infertility, sleep apnea, acquired immune deficiency syndrome, influenza, parkinsonism, multiple sclerosis, peripheral neuropathy, stroke outcomes, diabetic neuropathy, Crohn's disease, ulcerative colitis, schizophrenia, bipolar illness, and obsessive compulsive disorder; it can also be useful as a chelator for heavy metals and nanoparticles. There are also a number of other conditions that may show benefit; however, the evidence is not as robust. Conclusion The use of N-acetylcysteine should be considered in a number of conditions as our population ages and levels of glutathione drop. Supplementation may contribute to reducing morbidity and mortality in some chronic conditions as outlined in the article.
Highlights
N-acetylcysteine (NAC) is a sulfhydryl-containing compound, with mucolytic properties, originally patented in 1960, and its use in medicine was first reported in 1967 [1]
Preclinical studies in cell cultures or animal studies were added when relevant. e terms searched for were N-acetylcysteine, NAC, acetaminophen, cystic fibrosis, chronic obstructive lung disease, asthma, bronchitis, bronchiectasis, idiopathic pulmonary fibrosis, sarcopenia, Parkinson’s disease, dementia, multiple sclerosis, acquired immune deficiency syndrome (AIDS), tuberculosis, influenza, SARSCoV-2, glutamate, glutathione, contrast nephropathy, schizophrenia, autism, obsessive compulsive disorder, polycystic ovary disease, male infertility, sleep apnea, cancer, hypertension, ulcerative colitis, and others
Nonalcoholic Fatty Liver Disease (LOE B). ere is evidence that NAC may block hepatic lipid accumulation and provide therapeutic benefit against metabolic complications found in nonalcoholic fatty liver disease (NAFLD). is is primarily due to the antioxidant effects and attenuation of lipid peroxidation [64]. is is supported by most preclinical studies and a few clinical studies, and there is an urgent need for larger clinical studies. is disorder affects up to 25% of the population, a condition which may lead to significant pathology such as fibrosis of the liver
Summary
To review the clinical usefulness of N-acetylcysteine (NAC) as treatment or adjunctive therapy in a number of medical conditions. Use in Tylenol overdose, cystic fibrosis, and chronic obstructive lung disease has been well documented, but there is emerging evidence many other conditions would benefit from this safe, simple, and inexpensive intervention. PubMed, several books, and conference proceedings were searched for articles on NAC and health conditions listed above reviewing supportive evidence. N-acetylcysteine may be useful as an adjuvant in treating various medical conditions, especially chronic diseases. Ere are a number of other conditions that may show benefit; the evidence is not as robust. E use of N-acetylcysteine should be considered in a number of conditions as our population ages and levels of glutathione drop. Supplementation may contribute to reducing morbidity and mortality in some chronic conditions as outlined in the article
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