Acetylcysteine

Template:Short description Template:Dist Template:Use American English Template:Use dmy dates Template:Cs1 config Template:Main other {{#invoke:Infobox|infobox}}Template:Template other{{#invoke:TemplatePar |check |template=Template:Infobox_drug |all= |opt= pronounce= pronounce_ref= pronounce_comment= ATC_prefix= ATC_suffix= ATC_supplemental= ATCvet= biosimilars= CAS_number_Ref= CAS_number= CAS_supplemental= ChEBI= ChEBI_Ref= ChEMBL_Ref= ChEMBL= ChemSpiderID= ChemSpiderID_Ref= chirality= class= container_only= DailyMedID= data_page= DrugBank_Ref= DrugBank= Drugs.com= duration_of_action= INN= INN_EMA= IUPAC_name= IUPHAR_ligand= KEGG_Ref= KEGG= MedlinePlus= NIAID_ChemDB= PDB_ligand= PubChemSubstance= PubChem= StdInChIKey_Ref= StdInChIKey= StdInChI_Ref= StdInChI_comment= StdInChI= UNII_Ref= UNII= DTXSID= Verifiedfields= Watchedfields= addiction_liability= alt2= altL= altR= alt= bioavailability= boiling_high= boiling_notes= boiling_point= captionLR= caption= caption2= charge= chemical_formula= chemical_formula_ref= chemical_formula_comment= class1= class2= class3= class4= class5= class6= component1= component2= component3= component4= component5= component6= density= density_notes= dependency_liability= drug_name= elimination_half-life= engvar= excretion= image2= imageL= imageR= image= image_class= image_class2= image_classL= image_classR= Jmol= legal_AU= legal_BR= legal_CA= legal_DE= legal_EU= legal_NZ= legal_UK= legal_UN= legal_US= legal_AU_comment= legal_BR_comment= legal_CA_comment= legal_DE_comment= legal_UK_comment= legal_NZ_comment= legal_US_comment= legal_UN_comment= legal_EU_comment= legal_status= licence_CA= licence_EU= licence_US= license_CA= license_EU= license_US= mab_type= melting_high= melting_notes= melting_point= metabolism= metabolites= molecular_weight= molecular_weight_round= molecular_weight_unit= molecular_weight_ref= molecular_weight_comment= onset= pregnancy_AU= pregnancy_AU_comment= pregnancy_category= protein_bound= routes_of_administration= SMILES= smiles= solubility= sol_units= source= specific_rotation= synonyms= target= tradename= type= vaccine_type= verifiedrevid= width2= widthL= widthR= width= AAN= BAN= JAN= USAN= source_tissues= target_tissues= receptors= agonists= antagonists= precursor= biosynthesis= gt_target_gene= gt_vector= gt_nucleic_acid_type= gt_editing_method= gt_delivery_method= sec_combustion= Ac=Ag=Al=Am=Ar=As=At=Au=B=Ba=Be=Bh=Bi=Bk=Br=C=Ca=Cd=Ce=Cf=Cl=Cm=Cn=Co=Cr=Cs=Cu= D=Db=Ds=Dy=Er=Es=Eu=F=Fe=Fl=Fm=Fr=Ga=Gd=Ge=H=He=Hf=Hg=Ho=Hs=I=In=Ir=K=Kr=La=Li=Lr=Lu=Lv= Mc=Md=Mg=Mn=Mo=Mt=N=Na=Nb=Nd=Ne=Nh=Ni=No=Np=O=Og=Os=P=Pa=Pb=Pd=Pm=Po=Pr=Pt=Pu=Ra=Rb=Re=Rf=Rg=Rh=Rn=Ru=S=Sb=Sc=Se=Sg=Si=Sm=Sn=Sr=Ta=Tb=Tc=Te=Th=Ti=Tl=Tm=Ts=U=V=W=Xe=Y=Yb=Zn=Zr= index_label= index2_label= index_comment= index2_comment= CAS_number2= CAS_supplemental2= ATC_prefix2= ATC_suffix2= ATC_supplemental2= PubChem2= PubChemSubstance2= IUPHAR_ligand2= DrugBank2= ChemSpiderID2= UNII2= KEGG2= ChEBI2= ChEMBL2= PDB_ligand2= NIAID_ChemDB2= SMILES2= smiles2= StdInChI2= StdInChIKey2= CAS_number2_Ref= ChEBI2_Ref= ChEMBL2_Ref= ChemSpiderID2_Ref= DrugBank2_Ref= KEGG2_Ref= StdInChI2_Ref= StdInChIKey2_Ref= UNII2_Ref= DTXSID2= QID= QID2=PLLR= pregnancy_US= pregnancy_US_comment= |cat=Pages using infobox drug with unknown parameters |format=0|errNS=0

|preview=

}}{{Infobox drug/maintenance categoriesTemplate:Yesno | drug_name = | INN = | _drugtype =

| _has_physiological_data= | _has_gene_therapy=

| vaccine_type= | mab_type= | _number_of_combo_chemicals={{#invoke:ParameterCount |main |component1 |component2 |component3 |component4|component5|component6 }} | _vaccine_data= | _mab_data= | _mab_vaccine_data= | _mab_other_data=5913C/C(=N/[C@@H](CS)C(=O)O)/O+5° (c = 3% in water)<ref name="Sigma-2014"/>1S/C5H9NO3S/c1-3(7)6-4(2-10)5(8)9/h4,10H,2H2,1H3,(H,6,7)(H,8,9)/t4-/m0/s1PWKSKIMOESPYIA-BYPYZUCNSA-N109110 | _combo_data= | _physiological_data= | _clinical_data=Template:Drugs.coma615021Acetylcysteine B2Oral, intravenous, inhalationACC 200, Acetadote, Fluimucil, Mucomyst, othersR05Template:ATC Template:ATC | _legal_data=<ref name="DBL Acetylcysteine injection concentrate acetylcysteine 2 g">DBL Acetylcysteine injection concentrate acetylcysteine 2 g/ 10 mL injection ampoule</ref><ref name="TGA-eB-2022">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Healthdirect Australia-2022">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> and Schedule 2<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>S4<ref name="(emc)-2022">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>POM<ref name="Acetadote FDA label" />Rx-only

| _other_data=(2R)-2-acetamido-3-sulfanylpropanoic acid<ref name="PubChem-2005">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

| _image_0_or_2 = Acetylcysteine2.svgAcetylcysteine-from-xtal-3D-bs-17.png | _image_LR =

| _datapage = Acetylcysteine (data page) | _vaccine_target={{#ifeq: | vaccine | | _type_not_vaccine }} | _legal_all=S4POMRx-only | _ATC_prefix_supplemental=R05Template:ATC Template:ATC | _has_EMA_link = | CAS_number=616-91-1 | PubChem=12035 | ChemSpiderID=11540 | ChEBI=28939 | ChEMBL=600 | DrugBank=DB06151 | KEGG=D00221 | _hasInChI_or_Key={{#if:1S/C5H9NO3S/c1-3(7)6-4(2-10)5(8)9/h4,10H,2H2,1H3,(H,6,7)(H,8,9)/t4-/m0/s1PWKSKIMOESPYIA-BYPYZUCNSA-N |yes}} | UNII=WYQ7N0BPYC | _hasJmol02 = |_hasMultipleCASnumbers = |_hasMultiplePubChemCIDs = |_hasMultipleChEBIs =

| _countSecondIDs={{#invoke:ParameterCount |main |CAS_number2 |ATC_prefix2 |PubChem2 |PubChemStructure2 |IUPHAR_ligand2 |DrugBank2 |ChemSpiderID2 |UNII2 |KEGG2 |ChEBI2 |ChEMBL2 |PDB_ligand2 |NIAID_ChemDB2 |SMILES2 |smiles2 |StdInChI2 |StdInChIKey2 |DTXCID2}} | _countIndexlabels={{#invoke:ParameterCount |main |index_label |index2_label}} | _trackListSortletter= |QID = |QID2 = |Verifiedfields= |Watchedfields= |verifiedrevid=}}

Acetylcysteine or N-acetylcysteine (NAC; not to be confused with N-acetylcarnosine, which is also abbreviated NAC) is a mucolytic that is used to treat paracetamol (acetaminophen) overdose and to loosen thick mucus in individuals with chronic bronchopulmonary disorders, such as pneumonia and bronchitis.<ref name="The American Society of Health-System Pharmacists">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Sandoz">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It has been used to treat lactobezoar in infants. It can be taken intravenously, orally (swallowed by mouth), or inhaled as a mist by use of a nebulizer.<ref name="The American Society of Health-System Pharmacists"/><ref name="f779">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It is also sometimes used as a dietary supplement.<ref name="Talbott-2012">Template:Cite book</ref><ref name="University of Maryland Medical Center">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Common side effects include nausea and vomiting when taken orally.<ref name="The American Society of Health-System Pharmacists"/> The skin may occasionally become red and itchy with any route of administration.<ref name="The American Society of Health-System Pharmacists"/> A non-immune type of anaphylaxis may also occur.<ref name="The American Society of Health-System Pharmacists"/> It appears to be safe in pregnancy.<ref name="The American Society of Health-System Pharmacists"/> For paracetamol overdose, it works by increasing the level of glutathione, an antioxidant that can neutralize the toxic breakdown products of paracetamol.<ref name="The American Society of Health-System Pharmacists"/> When inhaled, it acts as a mucolytic by decreasing the thickness of mucus.<ref name="pmid18044098">Template:Cite journal</ref>

Acetylcysteine was initially patented in 1960 and came into medical use in 1968.<ref name="Fischer-2006">Template:Cite book</ref><ref name="US3091569A-1963">Template:Cite patent Template:Webarchive</ref><ref name="US patent 3091569-1963">Template:Cite patent Template:Webarchive</ref> It is on the World Health Organization's List of Essential Medicines.<ref name="WHO23rd">Template:Cite book</ref> It is available as a generic medication.<ref name="Baker-2014">Template:Cite book</ref>

The sulfur-containing amino acids cysteine and methionine are more easily oxidized than the other amino acids.<ref name="pmid29445748">Template:Cite journal</ref><ref name="BCLee">Template:Cite journal</ref>

Uses

Medical uses

Paracetamol overdose antidote

{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}} Intravenous and oral formulations of acetylcysteine are available for the treatment of paracetamol (acetaminophen) overdose.<ref name="pmid23687539">Template:Cite journal</ref> When paracetamol is taken in large quantities, a toxic minor metabolite called N-acetyl-p-benzoquinone imine (NAPQI) accumulates within the body. It is normally conjugated by glutathione, but when taken in excess, the body's glutathione reserves are not sufficient to deactivate the toxic NAPQI. This metabolite is then free to react with key hepatic enzymes, thereby damaging liver cells. This may lead to severe liver damage and even death by acute liver failure.

In the treatment of paracetamol (acetaminophen) overdose, acetylcysteine acts to maintain or replenish depleted glutathione reserves in the liver and enhance non-toxic metabolism of acetaminophen.<ref name="Acetadote FDA label" /> These actions serve to protect liver cells from NAPQI toxicity. It is most effective in preventing or lessening hepatic injury when administered within 8–10 hours after overdose.<ref name="Acetadote FDA label" /> Research suggests that the rate of liver toxicity is approximately 3% when acetylcysteine is administered within 10 hours of overdose.<ref name="pmid23687539" />

Although IV and oral acetylcysteine are equally effective for this indication, oral administration is generally poorly tolerated due to the higher dosing required to overcome its low oral bioavailability,<ref name="pmid3803419">Template:Cite journal</ref> its foul taste and odor, and a higher incidence of adverse effects when taken orally, particularly nausea and vomiting. Prior pharmacokinetic studies of acetylcysteine did not consider acetylation as a reason for the low bioavailability of acetylcysteine.<ref name="pmid17371789">Template:Cite journal</ref> Oral acetylcysteine is identical in bioavailability to cysteine precursors.<ref name="pmid17371789"/> However, 3% to 6% of people given intravenous acetylcysteine show a severe, anaphylaxis-like allergic reaction, which may include extreme breathing difficulty (due to bronchospasm), a decrease in blood pressure, rash, angioedema, and sometimes also nausea and vomiting.<ref name="pmid16990628">Template:Cite journal</ref> Repeated doses of intravenous acetylcysteine will cause these allergic reactions to progressively worsen in these people.

Several studies have found this anaphylaxis-like reaction to occur more often in people given intravenous acetylcysteine despite serum levels of paracetamol not high enough to be considered toxic.<ref name="pmid2716644">Template:Cite journal</ref><ref name="pmid9624310">Template:Cite journal</ref><ref name="pmid11167669">Template:Cite journal</ref><ref name="pmid14700565">Template:Cite journal</ref>

Mucolytic agent

Acetylcysteine exhibits mucolytic properties, meaning it reduces the viscosity and adhesiveness of mucus. This therapeutic effect is achieved through the cleavage of disulfide bonds<ref name="pmid34171332">Template:Cite journal</ref> within mucoproteins (strongly cross-linked mucins),<ref name="pmid33380301">Template:Cite journal</ref> thereby decreasing the mucus viscosity and facilitating its clearance from the respiratory tract. This mechanism is particularly beneficial in conditions characterized by excessive or thickened mucus,<ref name="pmid34221501">Template:Cite journal</ref> such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, rhinitis or sinusitis.<ref name="doi1945892421994999">Template:Cite journal</ref> Acetylcysteine can be administered as a part of a complex molecule, thiamphenicol glycinate acetylcysteine, which also contains thiamphenicol, an antibiotic.<ref name="pmid17880774">Template:Cite journal</ref>

Lungs

Inhaled acetylcysteine has been used for mucolytic therapy in addition to other therapies in respiratory conditions with excessive and/or thick mucus production. It is also used post-operatively, as a diagnostic aid, and in tracheotomy care. It may be considered ineffective in cystic fibrosis.<ref name="Rossi-2006">Template:Cite book</ref> A 2013 Cochrane review in cystic fibrosis found no evidence of benefit.<ref name="pmid23852992">Template:Cite journal</ref>

Acetylcysteine is used in the treatment of obstructive lung disease as an adjuvant treatment.<ref name="pmid10743980">Template:Cite journal</ref><ref name="pmid10968500">Template:Cite journal</ref><ref name="pmid11375228">Template:Cite journal</ref>

Other uses

Acetylcysteine has been used to complex palladium, to help it dissolve in water. This helps to remove palladium from drugs or precursors synthesized by palladium-catalyzed coupling reactions.<ref name="Garrett-2004">Template:Cite journal</ref> N-acetylcysteine can be used to protect the liver.<ref name="pmid31643176">Template:Citation</ref>

Microbiological use

Acetylcysteine can be used in Petroff's method of liquefaction and decontamination of sputum, in preparation for recovery of mycobacterium.<ref name=Bujitels>Template:Cite journal</ref> It also displays significant antiviral activity against influenza A viruses.<ref name="pmid19732754">Template:Cite journal</ref>

Acetylcysteine has bactericidal properties and breaks down bacterial biofilms of clinically relevant pathogens including Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Enterobacter cloacae, Staphylococcus epidermidis, and Klebsiella pneumoniae.<ref name="pmid22094553">Template:Cite journal</ref>

Side effects

The most commonly reported adverse effects for I.V. formulations of acetylcysteine are rash, urticaria, and itchiness.<ref name="Acetadote FDA label" />

Adverse effects for inhalational formulations of acetylcysteine include nausea, vomiting, stomatitis, fever, rhinorrhea, drowsiness, clamminess, chest tightness, and bronchoconstriction. Although infrequent, bronchospasm has been reported to occur unpredictably in some patients.<ref name="Mucomyst Package Insert-2014">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Adverse effects for oral formulations of acetylcysteine have been reported to include nausea, vomiting, rash, and fever.<ref name="Mucomyst Package Insert-2014"/>

Large doses in a mouse model showed that acetylcysteine could potentially cause damage to the heart and lungs.<ref name="pmid17786245">Template:Cite journal</ref> They found that acetylcysteine was metabolized to S-nitroso-N-acetylcysteine (Template:Vanchor), which increased blood pressure in the lungs and right ventricle of the heart (pulmonary artery hypertension) in mice treated with acetylcysteine. The effect was similar to that observed following a 3-week exposure to an oxygen-deprived environment (chronic hypoxia). The authors also found that SNOAC induced a hypoxia-like response in the expression of several important genes both in vitro and in vivo. The implications of these findings for long-term treatment with acetylcysteine have not yet been investigated. The dose used by Palmer and colleagues was dramatically higher than that used in humans, the equivalent of about 20 grams per day.<ref name="pmid17786245"/> In humans, much lower dosages (600 mg per day) have been observed to counteract some age-related decline in the hypoxic ventilatory response as tested by inducing prolonged hypoxia.<ref name="pmid11861267">Template:Cite journal</ref>

Although N-acetylcysteine prevented liver damage in mice when taken before alcohol, when taken four hours after alcohol it made liver damage worse in a dose-dependent fashion.<ref name="Wang_2006">Template:Cite journal</ref>

Pharmacology

Pharmacodynamics

Acetylcysteine serves as a prodrug to L-cysteine, a precursor to the biologic antioxidant glutathione. Hence administration of acetylcysteine replenishes glutathione stores.<ref name=TGA>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

• Glutathione, along with oxidized glutathione (GSSG) and S-nitrosoglutathione (GSNO), have been found to bind to the glutamate recognition site of the NMDA and AMPA receptors (via their γ-glutamyl moieties), and may be endogenous neuromodulators.<ref name="SteulletNeijt2006">Template:Cite journal</ref><ref name="VargaJenei1997">Template:Cite journal</ref> At millimolar concentrations, they may also modulate the redox state of the NMDA receptor complex.<ref name="VargaJenei1997" /> In addition, glutathione has been found to bind to and activate ionotropic receptors that are different from any other excitatory amino acid receptor, and which may constitute glutathione receptors, potentially making it a neurotransmitter.<ref name="pmid10812215">Template:Cite journal</ref> As such, since N-acetylcysteine is a prodrug of glutathione, it may modulate all of the aforementioned receptors as well.
• Glutathione also modulates the NMDA receptor by acting at the redox site.<ref name="pmid23369637"/><ref name="DOI2008">Template:Cite journal</ref>

Acetylcysteine also serves as a precursor to cystine, which in turn serves as a substrate for the cystine-glutamate antiporter on astrocytes; hence there is increasing glutamate release into the extracellular space. This glutamate in turn acts on mGluR_2/3 receptors, and at higher doses of acetylcysteine, mGluR₅.<ref name="BM2008">Template:Cite journal</ref><ref name="NAc2012">Template:Cite journal</ref> Acetylcysteine may have other biological functions in the brain, such as the modulation of dopamine release and the reduction in inflammatory cytokine formation possibly via inhibiting NF-κB and modulating cytokine synthesis.<ref name="pmid23369637" /> These properties, along with the reduction of oxidative stress and the re-establishment of glutamatergic balance, would lead to an increase in growth factors, such as brain-derived neurotrophic factor (BDNF), and the regulation of neuronal cell death through B-cell lymphoma 2 expression (BLC-2).<ref name="pmid21118657" />

As mentioned before, actylcysteine clears mucus by opening disulfide bonds.<ref name="pmid34171332"/>

Pharmacokinetics

The oral bioavailability of acetylcysteine is relatively low due to extensive first-pass metabolism in the gut wall and liver. It ranges between 6% and 10%.

Intravenous administration of acetylcysteine bypasses the first-pass metabolism, resulting in higher bioavailability compared to oral administration. Intravenous administration of acetylcysteine ensures nearly 100% bioavailability as it directly enters the bloodstream.

Acetylcysteine is extensively liver metabolized, CYP450 minimal, urine excretion is 22–30% with a half-life of 5.6 hours in adults and 11 hours in newborns.Template:Medical citation needed

Acetylcysteine is the N-acetyl derivative of the amino acid L-cysteine, and is a precursor in the formation of the antioxidant glutathione in the body. The thiol (sulfhydryl) group confers antioxidant effects and is able to reduce free radicals.

Chemistry

Pure acetylcysteine is in a solid state at room temperature, appearing as a white crystalline powder or granules.<ref name="pmid33638319">Template:Cite journal</ref> The solid form of acetylcysteine is stable under normal conditions, but it can undergo oxidation if exposed to air or moisture over time, leading to the formation of its dimeric form, diacetylcysteine, which can have different properties.<ref name="Amini-2016">Template:Cite book</ref> Acetylcysteine is highly hygroscopic, i.e., it absorbs moisture if exposed to open air.<ref name="pmid33638319"/>

Acetylcysteine can sometimes appear as a light yellow cast powder instead of pure white due to oxidation. The sulfur-containing amino acids, like cysteine, are more easily oxidized than other amino acids. When exposed to air or moisture, acetylcysteine can oxidize, leading to a slight yellowish tint.<ref name="pmid33638319"/>

Acetylcysteine in a form of a white or white with light yellow cast powder has a pK_a of 9.5 at 30 °C.<ref name="Sigma-2014">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

N-acetyl-L-cysteine is soluble in water and alcohol, and practically insoluble in chloroform and ether.<ref name="PubChem-2016">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Acetylcysteine dissolves readily in water, forming a colorless solution. The pH of a 1% acetylcysteine solution in water typically ranges between 2.0 and 2.8.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Solutions with higher concentrations of acetylcysteine have lower pH. Aqueous solutions of acetylcysteine are compatible with 0.9% sodium chloride solution; compatibility with 5% and 10% glucose solutions is also good.<ref name="pmid33638319"/>

As for photochemical stability, acetylcysteine in dry powder form is relatively stable and does not degrade quickly when exposed to light, but in aqueous solution, acetylcysteine can degrade when exposed to sunlight. In addition, acetylcysteine in aqueous solution can undergo hydrolysis, leading to the breakdown of the amide bond in the molecule. Still, aqueous solutions of acetylcysteine are generally stable when stored properly: the solutions should be kept in tightly sealed containers and stored at controlled room temperature to prolong the stability.<ref name="pmid21164069">Template:Cite journal</ref><ref name="pmid33638319"/>

Acetylcysteine has been reported to have a pH of 2.2 when administered through inhalation.<ref name="Tomkiewicz_1997">Template:Cite book</ref>

Society and culture

File:Acetylcysteine Life Extension.jpg

Acetylcysteine capsules sold by the supplement company Life Extension

File:Fluimucil NAC pills in China.jpg

Over-the-counter (OTC) Acetylcysteine pills in China, with brand name Fluimucil

Acetylcysteine was first studied as a drug in 1963. Amazon removed acetylcysteine for sale in the US in 2021, due to claims by the Food and Drug Administration (FDA) of it being classified as a drug rather than a supplement.<ref name="Long-2021b">Template:Cite news</ref><ref name="Long-2021a">Template:Cite news</ref><ref name="benjaminmcevoy.com">Template:Cite news</ref><ref name="FDA Sends Warning Letters to Seven Companies Illegally Selling Hangover Products">Template:Cite news</ref> In April 2022, the FDA released draft guidance on its policy regarding products labeled as dietary supplements that contain N-acetyl-L-cysteine.<ref name="FDA Releases Draft Guidance on Enforcement Discretion for Certain NAC Products">Template:Cite news</ref> Amazon subsequently re-listed NAC products as of August 2022.<ref name="Long-2022">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Research

Acetylcysteine is under preliminary research for its potential to treat androgenetic alopecia (male baldness), with or without adjacent treatments such as with minoxidil.<ref name="QJM-2021">Template:Cite journal</ref> Acetylcysteine may have otoprotective properties and could be useful for preventing hearing loss and tinnitus in some cases.<ref name="Schlee 2024">Template:Cite book</ref><ref name="pmid36457967">Template:Cite journal</ref>

Acetylcysteine may be an adjunct therapy for the treatment of addiction to cocaine, nicotine, alcohol, and other drugs.<ref name="pmid24442756">Template:Cite journal</ref>

Psychiatry

Acetylcysteine has been studied for major psychiatric disorders,<ref name="pmid34509090">Template:Cite journal</ref><ref name="pmid21118657"/><ref name="pmid23369637"/><ref name="pmid24683506">Template:Cite journal</ref> including bipolar disorder,<ref name="pmid34509090" /> major depressive disorder, and schizophrenia.<ref name="pmid21118657">Template:Cite journal</ref><ref name="pmid23369637">Template:Cite journal</ref>

Preliminary research indicates N-acetylcysteine may be useful in treating obsessive-compulsive disorder,<ref name="pmid38385640">Template:Cite journal</ref> specific drug addictions (cocaine), drug-induced neuropathy, trichotillomania, excoriation disorder, and a certain form of epilepsy (progressive myoclonic).<ref name="pmid21118657" /><ref name="pmid23369637"/><ref name="pmid25957927"/> Other research has tested N-acetylcysteine in anxiety disorder, attention deficit hyperactivity disorder and mild traumatic brain injury, although further studies are required.<ref name="pmid25957927">Template:Cite journal</ref><ref name="N-acetyl cysteine in the treatment">Template:Cite journal</ref>

Addiction

Evidence to date does not support the efficacy for N-acetylcysteine in treating addictions to gambling, methamphetamine, or nicotine.<ref name="pmid25957927" />

Bipolar disorder

In bipolar disorder, N-acetylcysteine has been repurposed as an augmentation strategy for depressive episodes in light of the possible role of inflammation in the pathogenesis of mood disorders. Nonetheless, meta-analytic evidence shows that add-on N-acetylcysteine was more effective than placebo only in reducing depression scales scores (low quality evidence), without positive effects on response and remission outcomes, limiting its possible role in clinical practice to date.<ref name="pmid34509090" /><ref name="pmid33354859">Template:Cite journal</ref>

COVID-19

Acetylcysteine has been studied as a possible treatment for COVID-19, but has not improved patient outcomes by common measures.<ref>Template:Cite journal</ref>

External links

• Template:Commonscat-inline