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NAC (N-Acetyl Cysteine)

N-acetyl cysteine is the rate-limiting precursor for intracellular glutathione synthesis, functioning as an antioxidant, mucolytic agent, and liver protectant; clinical evidence supports its use for hepatoprotection in early acute liver failure and reduction of oxidative stress and inflammatory biomarkers.

antioxidantliverdetoxificationimmunerespiratoryglutathione
Dosing model
FLATFixed dose (no body-weight scaling).
Min dose
600 mg
Max dose
1800 mg
Rounding
100 mg
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Evidence
2 records
Transplant-free survival in non-acetaminophen acute liver failure
Adults with non-acetaminophen-induced acute liver failure (coma grades I-II) • RCT
Moderate

A multicenter RCT (n=173) found IV NAC significantly improved transplant-free survival versus placebo (40% vs 27%; p=0.043); benefit was confined to patients with early-stage encephalopathy (coma grades I-II: 52% vs 30%; p=0.010). Overall survival was similar between groups.

Dose: 1200 mg • Duration: 3 days IV
Citation: Lee WM, Hynan LS, Rossaro L, et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology. 2009;137(3):856-864.
IV protocol used in this trial; oral NAC is used for chronic supplementation and prophylaxis.
Inflammatory and oxidative stress biomarkers
Adults across various clinical conditions • systematic review and meta-analysis of controlled clinical trials
Moderate

Meta-analysis of 28 controlled trials found NAC supplementation significantly reduced malondialdehyde (lipid peroxidation marker), interleukin-8, and homocysteine; no significant effect on CRP was observed; results support NAC as an adjunct antioxidant and anti-inflammatory agent.

Dose: 1200 mg • Duration: 4–24 weeks
Citation: Faghfouri AH, Zarezadeh M, Ostadrahimi A, et al. The effects of N-acetylcysteine on inflammatory and oxidative stress biomarkers: A systematic review and meta-analysis of controlled clinical trials. Eur J Pharmacol. 2020;884:173368.
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