Indikace
Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease)
Chest pain in unstable angina pectoris
- Chest pain in combination with nitroglycerin
- Heart attack in combination with nitroglycerin and streptokinase [3]
- By mouth or injecting it intravenously
- Seems to improve chest pain when used with the drug nitroglycerin
- Prevent nitroglycerin tolerance, but results are conflicting [3]
Antidotum
- To counteract acetaminophen (Tylenol) [3]
- Carbon monoxide poisoning [3]
- Acrylonitrile poisoning [3]
Microbiological use
- Petroff's method i.e. liquefaction and decontamination of sputum
- In preparation for recovery of mycobacterium [1]
- Significant antiviral activity against the influenza A viruses [1]
- Bactericidal properties and breaks down bacterial biofilms of
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Enterococcus faecalis
- Enterobacter cloacae
- Staphylococcus epidermidis
- Klebsiella pneumoniae [1]
Antioxidační účinky
Hepatoprotektivní
Další využití
- Complex palladium - help it dissolve in water
- Helps to remove palladium from drugs or precursors synthesized by palladium-catalyzed coupling reactions [1]
Autism
- Cysteine and related sulfur amino acids may be depleted due to multifactorial dysfunction of methylation pathways involved in methionine catabolism [1]
Bile duct blockage in infants
Bipolar disorder
- Seems to help reduce depression symptoms in people with bipolar disorder [3]
Blepharitis
- Small studies benefit to people
- Reduce ocular soreness caused by Sjögren's syndrome [1]
Chemoprevence
- Prevent side effects of ifosfamide (Ifex)
- Mesna (Mesnex) seems to work better
- Nesnižuje cytotoxické ev. [3]
Cocaine craving reduction
- Dr. Peter W. Kalivas from the Medical University of South Carolina, Charleston
- Cocaine craving of 15 people with cocaine dependence
- Less cocaine craving and interest [4]
- Double-blind study to evaluate the effects on nicotine and marijuana craving.
- 15 volunteers received acetylcysteine or placebo during a 3-day hospitalization
- N-acetylcysteine, participants reported less desire to use and less interest in response to cocaine [4]
- Open-label trial of N-acetylcysteine for the treatment of cocaine dependence: a pilot study.
- 23 treatment-seeking cocaine-dependent patients 4-week medication trial
- N-acetylcysteine at doses of 1200 mg/day, 2400 mg/day or 3600 mg/day
- Doses were well tolerated
- Favor higher doses of NAC (2400 mg/day and 3600 mg/day)
- Majority of subjects who completed the study
- Terminated use of cocaine completely or significantly reduced their use of cocaine during treatment [4]
Obstructive lung disease - COPD
- Adjuvant treatment [1]
- N-acetyl cysteine p.o. seems to
- Decrease flare-ups by about 40%
- Improve sputum (phlegm) consistency
- Might increase the risk of blockage of the breathing tube [3]
Podpora detoxikace
- Detoxifying heavy metals such as
- Mercury
- Lead
- Cadmium [3]
- Protecting against environmental pollutants including
- Carbon monoxide
- Chloroform
- Urethanes
- Certain herbicides [3]
- Reducing toxicity of
- Ifosfamide
- doxorubicin [3]
Fibrosing alveolitis
- N-acetyl cysteine by mouth
- Seems to improve lung function in people with fibrosing alveolitis [3]
Hemorrhagic cystitis
- Cyclophosphamide-induced hemorrhagic cystitis
- Mesna is generally preferred
- Ability of acetylcysteine to diminish the effectiveness of cyclophosphamide teraphy [1]
Severe alcoholic hepatitis
- Acetylcysteine in combination with glucocorticoids
- Prednisolone
- Decreased mortality significantly at one month
- Compared to the prednisolone-only group
- (8% vs 24%, P=0.006) [1]
- Improvement was not as significant at 3 months or 6 months
- Death due to hepatorenal syndrome
- Less frequently for the combination group at 6 months
- (9% vs 22%, P=0.02)
- Infections were also less frequent in the combination group as well (P=0.001)
- Kidney failure in the presence of liver disease (hepatorenal syndrome)
- I.v. podání [3]
Hyperhomocysteinemie
- Taking N-acetyl cysteine by mouth
- Seems to reduce homocysteine levels, a possible risk factor for heart disease [3]
- Oral N-acetylcysteine supplementation in 9 young healthy females
- Induced a quick and highly significant decrease in plasma homocysteine
- Increase in whole blood concentration of the antioxidant glutathione [9]
- Oral N-acetylcysteine reduces plasma homocysteine concentrations regardless of lipid or smoking status [8]
- 2 double-blind, placebo-controlled trials in unmedicated middle-aged men
- Hyperlipidemic group (n = 40)
- Normolipidemic group (n = 42)
- Stratified for smokers and nonsmokers [8]
- Significantly decreased plasma tHcy concentrations
- Irrespective of lipid or smoking status
- Lowered systolic blood pressure in both groups
- Significant diastolic blood pressure reductions in the HYL group only [8]
Infertility in men
- selenium and/or N-acetyl-cysteine for improving semen parameters in infertile men
- Double-blind, placebo controlled, randomized study J Urol. 2009. Urology and Nephrology Research Center, Shahid Beheshti University, MC, Tehran, Islamic Republic of Iran.
- Infertile men with low sperm counts of unknown reason
- 200 micrograms selenium orally daily, 600 mg NAC orally daily, 200 microg selenium plus 600 mg N-acetyl-cysteine orally daily
- Similar regimen of placebo
- For 26 weeks
- Response to treatment:
- Serum follicle-stimulating hormone decreased
- Serum testosterone and inhibin B increased
- All semen parameters significantly improved with treatment [4]
Keratoconjunctivitis
Lipoprotein (a) vyšší
- K redukci [2]
Loosen thick mucus
Cystic fibrosis
Chronic obstructive pulmonary disease
- Inhaled acetylcysteine
- Used for mucolytic ("mucus-dissolving") therapy
- Post-operatively - diagnostic aid in tracheotomy care
- 2013 Cochrane review in cystic fibrosis found no evidence of benefit [1]
Emphysema, bronchitis, cystic fibrosis, pneumonia
- [2]
Collapse of part or all of a lung (atelectasis)
- Helps treat collapsed lungs caused by mucus blockage [3]
Diagnostic lung tests
- Helpful when used to prepare people for diagnostic lung tests.
Intubation care
- Tracheostomy
- Helps prevent crusting in people with a tube in their windpipe [3]
Mustard gas exposure
- Air passage swelling due to mustard gas
- NAC reduce shortness of breath
- P.o. 3-6 months
- Seems to prevent flare-ups in people with persistent air passage swelling
- Less time does not seem to be effective [3]
Unverricht-Lundborg disease
- Open trial in 4 patients
- Marked decrease in myoclonus
- Some normalization of somatosensory evoked potentials with acetylcysteine treatment documented [1]
Epilepsie při alergii na fenytoin
- Allergic reactions to phenytoin (Dilantin) [3]
Nephroprotective agent
- Prevention of radiocontrast-induced nephropathy
- Form of acute kidney failure
- Prior administration of acetylcysteine decreases radiocontrast nephropathy
- Některé studie potvrdily / jiné ne [1]
- Intravenous and oral N-acetylcysteine
- May prevent contrast-medium–induced nephropathy
- Dose-dependent effect in patients treated with primary angioplasty
- May improve hospital outcome [1]
- Acetylcysteine protects patients with moderate chronic renal insufficiency
- From contrast-induced deterioration in renal function
- After coronary angiographic procedures
- With minimal adverse effects and at a low cost [1]
- Clinical trial from 2010 found that acetylcysteine is ineffective for the prevention of contrast-induced nephropathy
- 2,308 patients
- Acetylcysteine was no better than a placebo
- Incidence of nephropathy was the same — 13% [1]
- 2012 Kidney Disease: Improving Global Outcomes Guidelines
- Suggest the use of oral acetylcysteine for the prevention of contrast-induced nephropathy in high-risk individuals
- Given its potential for benefit, low likelihood of adverse effects, and low cost [1]
- Serious kidney disease
- NAC p.o. seems to help prevent problems
- Heart attack and stroke in people with serious kidney disease
- Risk reduction can be as much as 40%
- Doesn’t reduce the overall risk of death or the risk of death from heart disease in these people [3]
- Patients with a heart attack undergoing primary angioplasty are at high risk for contrast-medium–induced kidney damage
- Randomly assigned 354 consecutive patients
- 116 patients 600-mg i.v. bolus before angioplasty + 600 mg p.o. 2xd 2 dny 48 after angioplasty
- 119 patients 1200-mg i.v. bolus + 1200 mg p.o. 2xd 2d after intervention
- 119 patients to placebo [4]
- Serum creatinine concentration increased 25 % or more after primary angioplasty in:
- 33 % of the control patients
- 15 % of the patients receiving 600mg N-acetylcysteine
- 10 % receiving high-dose
- In-hospital mortality was higher in patients with contrast-medium–induced nephropathy than in those without such nephropathy
- 13 patients (11 %) in the control group died
- 5 (4 %) in the 600mg dose N-acetylcysteine group
- 3 (3 %) in the high-dose N-acetylcysteine group [4]
- Saudi J Kidney Dis Transpl. 2014.
Obstructive lung disease
- Adjuvant treatment [1]
Treatment of paracetamol (acetaminophen) overdose
- Minor metabolite called N-acetyl-p-benzoquinone imine (NAPQI) accumulates within the body
- Toxic
- Normally conjugated by glutathione
- When in excess, the body's glutathione reserves are not sufficient
- Metabolite is free and react with key hepatic enzymes
- Damaging liver cells až acute liver failure [1]
- Acetylcysteine acts to maintain or replenish depleted glutathione reserves in the liver
- Enhance non-toxic metabolism of acetaminophen [1]
- Protect liver cells from NAPQI toxicity
- Most effective in preventing /lessening hepatic injury within 8–10 hours after overdose [1]
- Rate of liver toxicity is cca 3% when acetylcysteine is administered within 10 hours of overdose [1]
- IV and oral acetylcysteine are equally effective for this indication
- Oral administration is poorly tolerated
- High oral doses are required
- Very unpleasant taste and odour
- Adverse effects
- Nausea and vomiting [1]
- Acetaminophen is associated with higher rates of:
- Liver and kidney toxicity
- Asthma
- Chronic obstructive pulmonary disease
- Reduced lung function
- Animal experiments have suggested that:
- Acetaminophen lowers antioxidant activity in the lungs, and causes harm to the liver and kidneys [4]
- Those on chronic Tylenol treatment
- Dose of 100 mg a day would seem reasonable [4]
Parkinsonova choroba
- Hypothesized to be beneficial in Parkinson's disease - undergoing clinical trials [1]
PCOS (polycystic ovary syndrome)
- Reduce insulin problems
- Possibly improve fertility [1]
Psychiatrie/neurologie
- Successfully tried as a treatment for a number of psychiatric disorders
- A systematic review from 2015 a další
- Favorable evidence for N-acetylcysteine efficacy in the treatment of
- Alzheimer's disease
- Bipolar disorder
- Major depressive disorder
- Obsessive-compulsive disorder
- Schizophrenia
- Specific drug addictions (cocaine)
- Certain form of epilepsy (progressive myoclonic)
- Cannabis use disorder [1]
- Modulation of glutamate and dopamine neurotransmission
- Antioxidant properties [1]
Samter's triad
- May help
- Increasing levels of glutathione
- Allowing faster breakdown of salicylates
- no evidence that it is of benefit [1]
Traumatické poškození mozku
- Double-blind placebo-controlled trial
- Reduce the effects of blast induced mild traumatic brain and neurological injury in soldiers [1]
- Animal studies - efficacy in reducing the damage - moderate traumatic brain or spinal injury and ischemia-induced brain injury
- Reduce neuronal losses
- Improve cognitive and neurological outcomes associated with these traumatic events [1]
Ulcerative colitis
- World J Gastroenterol. 2008.
- Evaluate the effectiveness and safety of oral NAC co-administration with mesalamine in ulcerative colitis patients
- 37 patients with mild to moderate ulcerative colitis were randomized
- 4 wk course of oral mesalamine (2.4 g/d) + N-acetyl-L-cysteine (0.8 g/d) (group A)
- Mesalamine + placebo (group B)
- Clinical remission rates after 4 wk treatment were
- 63% in group A
- 50% in group B
Addiction to certain addictive drugs
- Cocaine, heroin, alcohol, and nicotine
- Correlated with a persistent reduction in the expression of excitatory amino acid transporter 2 (EAAT2) in the nucleus accumbens (NAcc)
- Implicated in addictive drug-seeking behavior
- Long-term dysregulation of glutamate neurotransmission in the NAcc of addicts
- Associated with an increase in vulnerability to relapse after re-exposure to the addictive drug or its associated drug cues
- Drugs which help to normalize the expression of EAAT2 in this region
- N-acetylcysteine - proposed as an adjunct therapy for the treatment [1]
- NAC appears to normalize glutamate neurotransmission into the nucleus accumbens and other brain structures
- In individuals with addiction upregulating the expression of
- Excitatory amino acid transporter 2 (EAAT2)
- A.k.a. glutamate transporter 1 (GLT1) [1]
- Modulate glutamate neurotransmission in adult humans who are addicted to cocaine
- Does not appear to modulate glutamate neurotransmission in healthy adult humans [1]
