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{{dist|text=], for the proposed treatment of ]}}
{{Drugbox
{{Short description|Medication used to treat overdose of paracetamol}}
| verifiedrevid = 421715978
{{Use American English|date=October 2024}}
| IUPAC_name = (''R'')-2-acetamido-3-sulfanylpropanoic acid
{{Use dmy dates|date=March 2023}}
| synonyms=<small>(''R'')-2-acetamido-3-mercaptopropanoic acid</small>
{{cs1 config|name-list-style=vanc|display-authors=6}}
| image = (R)-N-Acetylcysteine Structural Formulae.png
{{Infobox drug
| image2 = Acetylcysteine 3D.png
| Watchedfields = changed
| CASNo_Ref = {{cascite|correct|CAS}}
| verifiedrevid = 443366456
| image = Acetylcysteine2.svg
| image_class = skin-invert-image
| width = 125
| alt =
| image2 = Acetylcysteine-from-xtal-3D-bs-17.png
| image_class2 = bg-transparent
| width2 =
| alt2 =
| drug_name =
| caption =

<!-- Clinical data -->
| pronounce = {{IPAc-en|ə|ˌ|s|iː|t|əl|ˈ|s|ɪ|s|t|iː|n}} and similar ({{IPAc-en|ə|ˌ|s|ɛ|t|əl|-|,_|ˌ|æ|s|ᵻ|t|əl|-|,_|-|t|iː|n}})
| tradename = ACC 200, Acetadote, Fluimucil, Mucomyst, others
| Drugs.com = {{drugs.com|monograph|acetylcysteine}}
| MedlinePlus =
| licence_EU = <!-- EMA requires brand name -->
| DailyMedID = Acetylcysteine
| licence_US =
| pregnancy_AU = B2
| routes_of_administration = ], ], ]
| ATC_prefix = R05
| ATC_suffix = CB01
| ATC_supplemental = {{ATC|S01|XA08}} {{ATC|V03|AB23}}

| legal_AU = S4
| legal_AU_comment = <ref name="DBL ACETYLCYSTEINE injection concentrate acetylcysteine 2 g"></ref><ref name="TGA-eB-2022">{{cite web | url=http://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2018-PI-01811-1 | title=TGA eBS - Product and Consumer Medicine Information Licence | access-date=30 December 2022 | archive-date=30 December 2022 | archive-url=https://web.archive.org/web/20221230074124/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2018-PI-01811-1 | url-status=live }}</ref><ref name="Healthdirect Australia-2022">{{cite web | title=Acetylcysteine (Omegapharm) | date=30 November 2022 | url=https://www.healthdirect.gov.au/medicines/brand/amt,26341000036106/acetylcysteine-omegapharm | access-date=29 December 2022 | work=Healthdirect Australia | archive-date=30 December 2022 | archive-url=https://web.archive.org/web/20221230074108/https://www.healthdirect.gov.au/medicines/brand/amt,26341000036106/acetylcysteine-omegapharm | url-status=live }}</ref>
| legal_BR =
| legal_BR_comment =
| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII -->
| legal_NZ = Prescription only
| legal_UK = POM
| legal_UK_comment = <ref name="(emc)-2022">{{cite web | title=Acepiro 600 mg effervescent tablets - Summary of Product Characteristics (SmPC) | website=(emc) | date=30 August 2022 | url=https://www.medicines.org.uk/emc/product/13849/smpc | access-date=29 December 2022 | archive-date=30 December 2022 | archive-url=https://web.archive.org/web/20221230073232/https://www.medicines.org.uk/emc/product/13849/smpc | url-status=live }}</ref>
| legal_US = Rx-only
| legal_US_comment = <ref name="DailyMed-2021">{{cite web | title=Acetadote- acetylcysteine injection, solution | website=DailyMed | date=1 October 2021 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=472f158a-5ab9-4308-8e49-1116e6ea3d39 | access-date=29 December 2022 | archive-date=30 December 2022 | archive-url=https://web.archive.org/web/20221230073232/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=472f158a-5ab9-4308-8e49-1116e6ea3d39 | url-status=live }}</ref>

<!-- Pharmacokinetic data -->
| bioavailability = 6–10% (Oral)<ref name="pmid35829920">{{cite journal | vauthors = Tsikas D, Mikuteit M | title = ''N''-acetyl-L-cysteine in human rheumatoid arthritis and its effects on nitric oxide (NO) and malondialdehyde (MDA): analytical and clinical considerations | journal = Amino Acids | volume = 54 | issue = 9 | pages = 1251–1260 | date = September 2022 | pmid = 35829920 | pmc = 9372125 | doi = 10.1007/s00726-022-03185-x }}</ref><ref name="Stockley-2008">{{cite book | vauthors = Stockley RA | title = Chronic Obstructive Pulmonary Disease a Practical Guide to Management. | date = 2008 | publisher = John Wiley & Sons | location = Chichester | isbn = 9780470755280 | page = 750 | url = https://books.google.com/books?id=y9li1geShyYC&pg=PA750 | url-status = live | archive-url = https://web.archive.org/web/20170908143219/https://books.google.com/books?id=y9li1geShyYC&pg=PA750 | archive-date = 8 September 2017 }}</ref><br>nearly 100% (intravenous)<ref name="pmid35361640">{{cite journal | vauthors = Luo A, Liu X, Hu Q, Yang M, Jiang H, Liu W | title = Efficacy of ''N''-acetylcysteine on idiopathic or postinfective non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis protocol | journal = BMJ Open | volume = 12 | issue = 3 | pages = e053625 | date = March 2022 | pmid = 35361640 | pmc = 8971804 | doi = 10.1136/bmjopen-2021-053625 | url = https://doi.org/10.1136/bmjopen-2021-053625 | access-date = 5 August 2024 | url-status = live | archive-url = https://web.archive.org/web/20240806002151/https://bmjopen.bmj.com/content/12/3/e053625 | archive-date = 6 August 2024 }}</ref>
| protein_bound = 50 to 83%<ref name="The American Society of Health-System Pharmacists"/>
| metabolism = ]<ref name="The American Society of Health-System Pharmacists"/>
| elimination_half-life = 5.6 hours<ref name="DailyMed-2021" />
| excretion = Kidney (30%),<ref name="The American Society of Health-System Pharmacists"/> faecal (3%)

<!-- Identifiers -->
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 616-91-1
| CAS_supplemental =
| PubChem = 12035
| IUPHAR_ligand =
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB06151
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 11540
| UNII_Ref = {{fdacite|correct|FDA}} | UNII_Ref = {{fdacite|correct|FDA}}
| UNII = WYQ7N0BPYC | UNII = WYQ7N0BPYC
| KEGG_Ref = {{keggcite|correct|kegg}}
| InChI = 1/C5H9NO3S/c1-3(7)6-4(2-10)5(8)9/h4,10H,2H2,1H3,(H,6,7)(H,8,9)/t4-/m0/s1
| KEGG = D00221
| smiles = O=C(O)(NC(=O)C)CS
| ChEBI_Ref = {{ebicite|correct|EBI}}
| InChIKey = PWKSKIMOESPYIA-BYPYZUCNBU
| ChEBI = 28939
| smiles1 = CC(=O)N(CS)C(=O)O
| ChEMBL_Ref = {{ebicite|correct|EBI}} | ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 600 | ChEMBL = 600
| synonyms = ''N''-acetylcysteine; ''N''-acetyl-<small>L</small>-cysteine; NALC; NAC

<!-- Chemical data -->
| IUPAC_name = (2''R'')-2-acetamido-3-sulfanylpropanoic acid<ref name="PubChem-2005">{{cite web|title=<small>L</small>-Cysteine, ''N''-acetyl- — Compound Summary|url=https://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=581|work=PubChem|publisher=National Center for Biotechnology Information, U.S. National Library of Medicine |access-date=9 January 2012|date=25 March 2005|at=Identification|url-status=live|archive-url=https://web.archive.org/web/20140112235508/http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=581|archive-date=12 January 2014}}</ref>
| C=5 | H=9 | N=1 | O=3 | S=1
| smiles = C/C(=N/(CS)C(=O)O)/O
| StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI_comment =
| StdInChI = 1S/C5H9NO3S/c1-3(7)6-4(2-10)5(8)9/h4,10H,2H2,1H3,(H,6,7)(H,8,9)/t4-/m0/s1
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C5H9NO3S/c1-3(7)6-4(2-10)5(8)9/h4,10H,2H2,1H3,(H,6,7)(H,8,9)/t4-/m0/s1
| StdInChIKey = PWKSKIMOESPYIA-BYPYZUCNSA-N
| StdInChIKey = PWKSKIMOESPYIA-BYPYZUCNSA-N
| CAS_number=616-91-1
| density =
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 11540 | melting_point = 109
| melting_high = 110
| ATC_prefix=R05
| melting_notes =<ref name="Sigma-2014"/>
| ATC_suffix=CB01
| boiling_point =
| ATC_supplemental={{ATC|S01|XA08}} {{ATC|V03|AB23}}
| boiling_notes =
| ChEBI = 28939
| solubility =
| PubChem=12035
| specific_rotation = +5° (c = 3% in water)<ref name="Sigma-2014"/>
| DrugBank=DB06151
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00221
| C=5 | H=9 | N=1 | O=3 | S=1
| molecular_weight = 163.19
| bioavailability = 6–10% (oral) <br /> <3% (topical)
| metabolism = ]
| elimination_half-life = 5.6 hours (adults)</br> 11 hours (neonates)
| excretion = ]
| licence_EU =
| licence_US = acetylcysteine
| pregnancy_US = B
| pregnancy_category = B2 (])
| legal_status = Schedule 4 (])<br />] or ] (])<br />Not available (])
| routes_of_administration= inhalation, ], oral
}} }}


<!-- Definition and uses -->
'''Acetylcysteine''' ] ({{IPAc-en|icon|ə|ˌ|s|ɛ|t|əl|ˈ|s|ɪ|s|t|iː|n}}), also known as '''''N''-acetylcysteine''' or '''''N''-acetyl-''L''-cysteine''' (abbreviated '''NAC'''), is a ] and ] used primarily as a ] and in the management of ] (acetaminophen) ]. Other uses include sulfate repletion in conditions, such as autism, where cysteine and related sulfur amino acids may be depleted.<ref name="pm1">{{cite journal |last1=Geier |first1=David A. |last2=Geier |first2=Mark R. |title=A Clinical and Laboratory Evaluation of Methionine Cycle-Transsulfuration and Androgen Pathway Markers in Children with Autistic Disorders |journal=Hormone Research |volume=66 |issue=4 |pages=182–8 |year=2006 |pmid=16825783 |doi=10.1159/000094467}}</ref>
'''''N''-acetylcysteine''', also known as '''Acetylcysteine''' and '''NAC''', is a ] that is used to treat ] and to loosen thick ] in individuals with chronic bronchopulmonary disorders, such as ] and ].<ref name="The American Society of Health-System Pharmacists">{{cite web|title=Acetylcysteine|url=https://www.drugs.com/monograph/acetylcysteine.html|publisher=The American Society of Health-System Pharmacists|access-date=22 August 2015|url-status=live|archive-url=https://web.archive.org/web/20150923231013/http://www.drugs.com/monograph/acetylcysteine.html|archive-date=23 September 2015}}</ref> It has been used to treat ] in infants. It can be taken ], ] (swallowed by mouth), or ].<ref name="The American Society of Health-System Pharmacists"/>{{Clarify|date=September 2024|reason= "inhaled as a mist" is too ambigious. Is it given via an inhaler, nebulizer, or something else?}} It is also sometimes used as a ].<ref name="Talbott-2012">{{cite book|vauthors=Talbott SM|title=A Guide to Understanding Dietary Supplements|date=2012|publisher=Routledge|isbn=9781136805707|page=469|url=https://books.google.com/books?id=9ZZrW_j9XrcC&pg=PA469|url-status=live|archive-url=https://web.archive.org/web/20170908143219/https://books.google.com/books?id=9ZZrW_j9XrcC&pg=PA469|archive-date=8 September 2017}}</ref><ref name="University of Maryland Medical Center">{{cite web|title=Cysteine|url=http://www.umm.edu/health/medical/altmed/supplement/cysteine|website=University of Maryland Medical Center|access-date=23 June 2017|url-status=live|archive-url=https://web.archive.org/web/20170701184417/http://www.umm.edu/health/medical/altmed/supplement/cysteine|archive-date=1 July 2017}}</ref>


<!-- Side effects and mechanism -->
Acetylcysteine is a derivative of ]; an acetyl group is attached to the nitrogen atom. This compound is sold as a dietary supplement commonly claiming antioxidant and liver protecting effects. It is used as a cough medicine because it breaks disulfide bonds in mucus and liquefies it, making it easier to cough up. It is also this action of breaking disulfide bonds that makes it useful in thinning the abnormally thick mucus in ] patients.
Common side effects include nausea and vomiting when taken orally.<ref name="The American Society of Health-System Pharmacists"/> The skin may occasionally become ] and ]y with any route of administration.<ref name="The American Society of Health-System Pharmacists"/> A non-immune type of ] 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 ], 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 ] by decreasing the thickness of mucus.<ref name="pmid18044098">{{cite journal | vauthors = Sadowska AM, Verbraecken J, Darquennes K, De Backer WA | title = Role of ''N''-acetylcysteine in the management of COPD | journal = International Journal of Chronic Obstructive Pulmonary Disease | volume = 1 | issue = 4 | pages = 425–434 | date = December 2006 | pmid = 18044098 | pmc = 2707813 | doi = 10.2147/copd.2006.1.4.425 | doi-access = free }}</ref>


<!-- History, society and culture -->
==Medical uses==
Acetylcysteine was initially patented in 1960 and came into medical use in 1968.<ref name="Fischer-2006">{{cite book | vauthors = Fischer J, Ganellin CR | title = Analogue-Based Drug Discovery | date = 2006 | publisher = Wiley-VCH | location = Weinheim | isbn = 9783527607495 | page = 544 | url = https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA544 | url-status = live | archive-url = https://web.archive.org/web/20170908143219/https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA544 | archive-date = 8 September 2017 }}</ref><ref name="US3091569A-1963">{{Cite patent|number=US3091569A|title=Mucolytic-nu-acylated sulfhydryl compositions and process for treating animal mucus|gdate=28 May 1963|inventor = Sheffner AL |url=https://patents.google.com/patent/US3091569A/en}} {{Webarchive|url=https://web.archive.org/web/20240806002723/https://patents.google.com/patent/US3091569A/en |date=6 August 2024 }}</ref><ref name="US patent 3091569-1963">{{cite patent |country=US |number=3091569 |status=patent |title=Mucolytic-''N''-acylated sulfhydryl compositions and process for treating animal mucus |pubdate=28 May 1963 |gdate=28 May 1963 |fdate=26 August 1960 |pridate=26 August 1960 |inventor = Sheffner AL |assign1=Mead Johnson & Co |url=https://worldwide.espacenet.com/publicationDetails/biblio?II=2&ND=3&adjacent=true&locale=en_EP&FT=D&date=19630528&CC=US&NR=3091569A&KC=A }} {{Webarchive|url=https://web.archive.org/web/20240630120932/https://worldwide.espacenet.com/publicationDetails/biblio?II=2&ND=3&adjacent=true&locale=en_EP&FT=D&date=19630528&CC=US&NR=3091569A&KC=A |date=30 June 2024 }}</ref> It is on the ].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> It is available as a ].<ref name="Baker-2014">{{cite book | vauthors = Baker E | title = Top 100 Drugs: Clinical pharmacology and practical prescribing | date = 2014 | publisher = Elsevier Health Sciences | isbn = 9780702055157 | entry = Acetylcysteine | url = https://books.google.com/books?id=oeYjAwAAQBAJ&pg=PT44 | url-status = live | archive-url = https://web.archive.org/web/20170908143223/https://books.google.com/books?id=oeYjAwAAQBAJ&pg=PT44 | archive-date = 8 September 2017 }}</ref>
===Paracetamol overdose===


<!-- Storage -->
The sulfur-containing amino acids ] and ] are more easily oxidized than the other amino acids.<ref name="pmid29445748">{{cite journal | vauthors = Bin P, Huang R, Zhou X | title = Oxidation Resistance of the Sulfur Amino Acids: Methionine and Cysteine | journal = BioMed Research International | volume = 2017 | pages = 9584932 | date = 2017 | pmid = 29445748 | pmc = 5763110 | doi = 10.1155/2017/9584932 | title-link = doi | doi-access = free }}</ref><ref name="BCLee">{{cite journal | vauthors = Lee BC, Dikiy A, Kim HY, Gladyshev VN | title = Functions and evolution of selenoprotein methionine sulfoxide reductases | journal = Biochimica et Biophysica Acta (BBA) - General Subjects | volume = 1790 | issue = 11 | pages = 1471–1477 | date = November 2009 | pmid = 19406207 | pmc = 3062201 | doi = 10.1016/j.bbagen.2009.04.014 }}</ref>

== Uses ==
=== Medical uses ===

====Paracetamol overdose antidote====
{{Main|Paracetamol poisoning}} {{Main|Paracetamol poisoning}}
Intravenous and oral formulations of acetylcysteine are available for the treatment of ] (acetaminophen) overdose.<ref name="pmid23687539">{{cite journal | vauthors = Green JL, Heard KJ, Reynolds KM, Albert D | title = Oral and Intravenous Acetylcysteine for Treatment of Acetaminophen Toxicity: A Systematic Review and Meta-analysis | journal = The Western Journal of Emergency Medicine | volume = 14 | issue = 3 | pages = 218–226 | date = May 2013 | pmid = 23687539 | pmc = 3656701 | doi = 10.5811/westjem.2012.4.6885 }}</ref> When paracetamol is taken in large quantities, a minor metabolite called ''N''-acetyl-''p''-benzoquinone imine (]) accumulates within the body. It is normally ] by ], 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 ]. This may lead to severe liver damage and even death by ].


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 Package Insert">{{cite web|title=Acetadote Package Insert|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021539s004lbl.pdf|publisher=FDA|access-date=19 April 2014|url-status=live|archive-url=https://web.archive.org/web/20130825114200/http://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021539s004lbl.pdf|archive-date=25 August 2013}}</ref> 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 Package Insert"/> Research suggests that the rate of liver toxicity is approximately 3% when acetylcysteine is administered within 10 hours of overdose.<ref name="pmid23687539" />
Intravenous acetylcysteine is indicated for the treatment of ] ( acetaminophen ) overdose. When paracetamol is taken in large quantities, a minor metabolite called ''N''-acetyl-''p''-benzoquinone imine ( ] ) accumulates within the body. It is normally ] by ], but when taken in excess, the body's glutathione reserves are not sufficient to inactivate the toxic NAPQI. This metabolite is then free to react with key hepatic enzymes, therefore damaging ]. This may lead to severe liver damage and even death by ] ].


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 ],<ref name="pmid3803419">{{cite journal | vauthors = Borgström L, Kågedal B, Paulsen O | title = Pharmacokinetics of ''N''-acetylcysteine in man | journal = European Journal of Clinical Pharmacology | volume = 31 | issue = 2 | pages = 217–222 | date = 1986 | pmid = 3803419 | doi = 10.1007/bf00606662 | s2cid = 41004554 }}</ref> its foul taste and odor, and a higher incidence of ]s when taken orally, particularly nausea and vomiting. Prior pharmacokinetic studies of acetylcysteine did not consider ] as a reason for the low bioavailability of acetylcysteine.<ref name="pmid17371789">{{cite journal | vauthors = Dilger RN, Baker DH | title = Oral ''N''-acetyl-<small>L</small>-cysteine is a safe and effective precursor of cysteine | journal = Journal of Animal Science | volume = 85 | issue = 7 | pages = 1712–1718 | date = July 2007 | pmid = 17371789 | doi = 10.2527/jas.2006-835 }}</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, ]-like allergic reaction, which may include extreme breathing difficulty (due to ]), ], rash, ], and sometimes also nausea and vomiting.<ref name="pmid16990628">{{cite journal | vauthors = Kanter MZ | title = Comparison of oral and i.v. acetylcysteine in the treatment of acetaminophen poisoning | journal = American Journal of Health-System Pharmacy | volume = 63 | issue = 19 | pages = 1821–1827 | date = October 2006 | pmid = 16990628 | doi = 10.2146/ajhp060050 | s2cid = 9209528 }}</ref> Repeated doses of intravenous acetylcysteine will cause these allergic reactions to progressively worsen in these people.
For this indication, acetylcysteine acts to augment the glutathione reserves in the body and, together with glutathione, directly bind to toxic metabolites. These actions serve to protect ]s in the liver from NAPQI toxicity.


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">{{cite journal | vauthors = Dawson AH, Henry DA, McEwen J | title = Adverse reactions to ''N''-acetylcysteine during treatment for paracetamol poisoning | journal = The Medical Journal of Australia | volume = 150 | issue = 6 | pages = 329–331 | date = March 1989 | pmid = 2716644 | doi = 10.5694/j.1326-5377.1989.tb136496.x | s2cid = 40296724 }}</ref><ref name="pmid9624310">{{cite journal | vauthors = Bailey B, McGuigan MA | title = Management of anaphylactoid reactions to intravenous ''N''-acetylcysteine | journal = Annals of Emergency Medicine | volume = 31 | issue = 6 | pages = 710–715 | date = June 1998 | pmid = 9624310 | doi = 10.1016/S0196-0644(98)70229-X }}</ref><ref name="pmid11167669">{{cite journal | vauthors = Schmidt LE, Dalhoff K | title = Risk factors in the development of adverse reactions to ''N''-acetylcysteine in patients with paracetamol poisoning | journal = British Journal of Clinical Pharmacology | volume = 51 | issue = 1 | pages = 87–91 | date = January 2001 | pmid = 11167669 | pmc = 2014432 | doi = 10.1046/j.1365-2125.2001.01305.x }}</ref><ref name="pmid14700565">{{cite journal | vauthors = Lynch RM, Robertson R | title = Anaphylactoid reactions to intravenous ''N''-acetylcysteine: a prospective case controlled study | journal = Accident and Emergency Nursing | volume = 12 | issue = 1 | pages = 10–15 | date = January 2004 | pmid = 14700565 | doi = 10.1016/j.aaen.2003.07.001 }}</ref>
Although both IV and oral acetylcysteine are equally effective for this indication, oral administration is poorly tolerated because high oral doses are required due to low oral ]<ref>{{cite journal |last1=Borgström |first1=L. |last2=Kågedal |first2=B. |last3=Paulsen |first3=O. |title=Pharmacokinetics of N-acetylcysteine in man |journal=European Journal of Clinical Pharmacology |volume=31 |issue=2 |pages=217–222 |year=1986 |pmid=3803419 |doi=10.1007/BF00606662}}</ref>, because of its very unpleasant taste and odour, and because of ]s, particularly nausea and vomiting. Studies conducted by Baker and Dilger<ref name = dilger>{{cite journal |last1=Dilger |first1=R. N. |last2=Baker |first2=D. H. |title=Oral N-acetyl-L-cysteine is a safe and effective precursor of cysteine |journal=Journal of Animal Science |volume=85 |issue=7 |pages=1712 |year=2007 |pmid=17371789 |doi=10.2527/jas.2006-835}}</ref> suggest that the prior pharmacokinetic studies of N-acetylcysteine did not include ] as a reason for the low ] of ''N''-acetylcysteine. In the research conducted by Baker,<ref name = dilger/> it was concluded that oral N-acetylcysteine was identical in bioavailability to Cysteine precursors. However, 3% to 6% of people given intravenous acetylcysteine show a severe, ]-like allergic reaction, which may include extreme breathing difficulty ( due to ] ), ], rash, ], and sometimes also nausea and vomiting.<ref>{{cite journal |last1=Kanter |first1=M. Z. |title=Comparison of oral and i.v. Acetylcysteine in the treatment of acetaminophen poisoning |journal=American Journal of Health-System Pharmacy |volume=63 |issue=19 |pages=1821 |year=2006 |pmid=16990628 |doi=10.2146/ajhp060050}}</ref> Repeated overdoses of intravenous ''N''-acetylcysteine will cause these allergic reactions to progressively worsen in these people.


====Mucolytic agent====
Several studies have found this anaphylaxis-like reaction to occur more often in people given IV acetylcysteine despite serum levels of paracetamol not high enough to be considered toxic.<ref>{{cite journal |last1=Dawson |first1=AH |last2=Henry |first2=DA |last3=McEwen |first3=J |title=Adverse reactions to N-acetylcysteine during treatment for paracetamol poisoning |journal=The Medical journal of Australia |volume=150 |issue=6 |pages=329–31 |year=1989 |pmid=2716644}}</ref><ref>{{cite journal |last1=Bailey |first1=B |last2=McGuigan |first2=M |title=Management of Anaphylactoid Reactions to Intravenous -Acetylcysteine |journal=Annals of Emergency Medicine |volume=31 |issue=6 |pages=710–5 |year=1998 |pmid=9624310 |doi=10.1016/S0196-0644(98)70229-X}}</ref><ref>{{cite journal |last1=Schmidt |first1=L. E. |last2=Dalhoff |first2=K |title=Risk factors in the development of adverse reactions to N-acetylcysteine in patients with paracetamol poisoning |journal=British Journal of Clinical Pharmacology |volume=51 |issue=1 |pages=87–91 |year=2008 |pmid=11167669 |pmc=2014432 |doi=10.1046/j.1365-2125.2001.01305.x}}</ref><ref>{{cite journal |last1=Lynch |first1=R |last2=Robertson |first2=R |title=Anaphylactoid reactions to intravenous N-acetylcysteine: a prospective case controlled study |journal=Accident and Emergency Nursing |volume=12 |issue=1 |pages=10–5 |year=2004 |pmid=14700565 |doi=10.1016/j.aaen.2003.07.001}}</ref>
Acetylcysteine exhibits ] properties, meaning it reduces the viscosity and adhesiveness of ]. This therapeutic effect is achieved through the cleavage of ]s<ref name="pmid34171332">{{cite journal | vauthors = Pedre B, Barayeu U, Ezeriņa D, Dick TP | title = The mechanism of action of ''N''-acetylcysteine (NAC): The emerging role of H<sub>2</sub>S and sulfane sulfur species | journal = Pharmacology & Therapeutics | volume = 228 | pages = 107916 | date = December 2021 | pmid = 34171332 | doi = 10.1016/j.pharmthera.2021.107916 | doi-access = free }}</ref> within ]s (strongly cross-linked ]s),<ref name="pmid33380301">{{cite journal | vauthors = Raghu G, Berk M, Campochiaro PA, Jaeschke H, Marenzi G, Richeldi L, Wen FQ, Nicoletti F, Calverley PM | title = The Multifaceted Therapeutic Role of ''N''-acetylcysteine (NAC) in Disorders Characterized by Oxidative Stress | journal = Current Neuropharmacology | volume = 19 | issue = 8 | pages = 1202–1224 | date = 2021 | pmid = 33380301 | pmc = 8719286 | doi = 10.2174/1570159X19666201230144109 }}</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">{{cite journal | vauthors = Schwalfenberg GK | title = ''N''-acetylcysteine: A Review of Clinical Usefulness (an Old Drug with New Tricks) | journal = Journal of Nutrition and Metabolism | volume = 2021 | pages = 9949453 | date = 2021 | pmid = 34221501 | pmc = 8211525 | doi = 10.1155/2021/9949453 | doi-access = free }}</ref> such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, rhinitis or sinusitis.<ref name="doi1945892421994999">{{cite journal | vauthors = Saltagi MZ, Comer BT, Hughes S, Ting JY, Higgins TS | title = Management of Recurrent Acute Rhinosinusitis: A Systematic Review | journal = American Journal of Rhinology & Allergy | volume = 35 | issue = 6 | pages = 902–909 | date = November 2021 | pmid = 33622038 | doi = 10.1177/1945892421994999 }}</ref> Acetylcysteine can be administered as a part of a complex molecule, ], which also contains ], an antibiotic.<ref name="pmid17880774">{{cite journal | vauthors = Serra A, Schito GC, Nicoletti G, Fadda G | title = A therapeutic approach in the treatment of infections of the upper airways: thiamphenicol glycinate acetylcysteinate in sequential treatment (systemic-inhalatory route) | journal = International Journal of Immunopathology and Pharmacology | volume = 20 | issue = 3 | pages = 607–617 | date = 2007 | pmid = 17880774 | doi = 10.1177/039463200702000319 }}</ref>


=====Lungs=====
In some countries, a specific intravenous formulation does not exist to treat ] overdose. In these cases, the formulation used for inhalation may be used intravenously.
Inhaled acetylcysteine has been used for ] 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 ] care. It may be considered ineffective in ].<ref name="Rossi-2006">{{cite book | veditors = Rossi S | title = ] | date = 2006 | location = Adelaide | publisher = Australian Medicines Handbook }}</ref> A 2013 Cochrane review in cystic fibrosis found no evidence of benefit.<ref name="pmid23852992">{{cite journal | vauthors = Tam J, Nash EF, Ratjen F, Tullis E, Stephenson A | title = Nebulized and oral thiol derivatives for pulmonary disease in cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 7 | pages = CD007168 | date = July 2013 | pmid = 23852992 | pmc = 8078644 | doi = 10.1002/14651858.CD007168.pub3 | url = http://www.repository.heartofengland.nhs.uk/157/1/Nebulized%20and%20oral%20thiol%20derivatives%20for%20pulmonary%20disease%20in%20cystic%20fibrosis..pdf | access-date = 16 May 2018 | url-status = dead | archive-url = https://web.archive.org/web/20220327121154/http://www.repository.uhblibrary.co.uk/id/eprint/157/1/Nebulized%20and%20oral%20thiol%20derivatives%20for%20pulmonary%20disease%20in%20cystic%20fibrosis..pdf | archive-date = 27 March 2022 }}</ref>


Acetylcysteine is used in the treatment of ] as an adjuvant treatment.<ref name="pmid10743980">{{cite journal | vauthors = Grandjean EM, Berthet P, Ruffmann R, Leuenberger P | title = Efficacy of oral long-term ''N''-acetylcysteine in chronic bronchopulmonary disease: a meta-analysis of published double-blind, placebo-controlled clinical trials | journal = Clinical Therapeutics | volume = 22 | issue = 2 | pages = 209–221 | date = February 2000 | pmid = 10743980 | doi = 10.1016/S0149-2918(00)88479-9 }}</ref><ref name="pmid10968500">{{cite journal | vauthors = Stey C, Steurer J, Bachmann S, Medici TC, Tramèr MR | title = The effect of oral ''N''-acetylcysteine in chronic bronchitis: a quantitative systematic review | journal = The European Respiratory Journal | volume = 16 | issue = 2 | pages = 253–262 | date = August 2000 | pmid = 10968500 | doi = 10.1034/j.1399-3003.2000.16b12.x | title-link = doi | doi-access = free | citeseerx = 10.1.1.516.9510 }}</ref><ref name="pmid11375228">{{cite journal | vauthors = Poole PJ, Black PN | title = Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease: systematic review | journal = BMJ | volume = 322 | issue = 7297 | pages = 1271–1274 | date = May 2001 | pmid = 11375228 | pmc = 31920 | doi = 10.1136/bmj.322.7297.1271 }}</ref>
===Mucolytic therapy===


===Other uses===
Inhaled acetylcysteine is indicated for mucolytic ("mucus-dissolving") therapy as an adjuvant in respiratory conditions with excessive and/or thick mucus production. Such conditions include ], ], ], ], ], ], ] and ] ]. It is also used post-operatively, as a diagnostic aid, and in ] care. It may be considered ineffective in ].<ref>Rossi S, editor. ] 2006. Adelaide: Australian Medicines Handbook; 2006.</ref> However, a recent paper in the Proceedings of the National Academy of Sciences reports that high-dose oral N-acetylcysteine modulates inflammation in cystic fibrosis and has the potential to counter the intertwined redox and inflammatory imbalances in CF.<ref>{{cite journal |last1=Tirouvanziam |first1=R. |last2=Conrad |first2=CK |last3=Bottiglieri |first3=T |last4=Herzenberg |first4=LA |last5=Moss |first5=RB |last6=Herzenberg |first6=LA |title=High-dose oral N-acetylcysteine, a glutathione prodrug, modulates inflammation in cystic fibrosis |journal=Proceedings of the National Academy of Sciences |volume=103| issue=12 |pages=4628–33 |year=2006 |doi=10.1073/pnas.0511304103 |pmc=1450222 | pmid = 16537378
Acetylcysteine has been used to ] ], to help it dissolve in water. This helps to remove palladium from drugs or precursors synthesized by palladium-catalyzed ]s.<ref name="Garrett-2004">{{cite journal | vauthors = Garrett CE, Prasad K |title=The Art of Meeting Palladium Specifications in Active Pharmaceutical Ingredients Produced by Pd-Catalyzed Reactions |journal=Advanced Synthesis & Catalysis |volume=346 |pages=889–900 |year=2004 |doi=10.1002/adsc.200404071 |issue=8|s2cid=94929244 }}</ref> ''N''-acetylcysteine can be used to protect the liver.<ref name="pmid31643176">{{citation |title=Acetylcysteine |url=https://livertox.nih.gov/Acetylcysteine.htm |website=livertox.nih.gov |date=2012 |pmid=31643176 |access-date=26 April 2019 |archive-date=25 April 2019 |archive-url=https://web.archive.org/web/20190425234436/https://livertox.nih.gov/Acetylcysteine.htm |url-status=live }}</ref>
}}</ref> Oral acetylcysteine may also be used as a mucolytic in less serious cases.


====Microbiological use====
For this indication, acetylcysteine acts to reduce mucus viscosity by splitting ]s linking proteins present in the mucus (mucoproteins).
Acetylcysteine can be used in Petroff's method of liquefaction and decontamination of ], in preparation for recovery of ].<ref name=Bujitels>{{cite journal | vauthors = Buijtels PC, Petit PL | title = Comparison of NaOH-''N''-acetyl cysteine and sulfuric acid decontamination methods for recovery of mycobacteria from clinical specimens | journal = Journal of Microbiological Methods | volume = 62 | issue = 1 | pages = 83–88 | date = July 2005 | pmid = 15823396 | doi = 10.1016/j.mimet.2005.01.010 }}</ref> It also displays significant antiviral activity against ].<ref name="pmid19732754">{{cite journal | vauthors = Geiler J, Michaelis M, Naczk P, Leutz A, Langer K, Doerr HW, Cinatl J | title = ''N''-acetyl-L-cysteine (NAC) inhibits virus replication and expression of pro-inflammatory molecules in A549 cells infected with highly pathogenic H5N1 influenza A virus | journal = Biochemical Pharmacology | volume = 79 | issue = 3 | pages = 413–420 | date = February 2010 | pmid = 19732754 | doi = 10.1016/j.bcp.2009.08.025 | url = https://hal.archives-ouvertes.fr/hal-00538093/file/PEER_stage2_10.1016%252Fj.bcp.2009.08.025.pdf | access-date = 14 October 2021 | url-status = live | archive-url = https://web.archive.org/web/20240806002728/https://hal.archives-ouvertes.fr/hal-00538093/file/PEER_stage2_10.1016%252Fj.bcp.2009.08.025.pdf | archive-date = 6 August 2024 }}</ref>


Acetylcysteine has ] properties and breaks down bacterial ]s of clinically relevant pathogens including '']'', '']'', '']'', '']'', '']'', and '']''.<ref name="pmid22094553">{{cite journal | vauthors = Aslam S, Darouiche RO | title = Role of antibiofilm-antimicrobial agents in controlling device-related infections | journal = The International Journal of Artificial Organs | volume = 34 | issue = 9 | pages = 752–758 | date = September 2011 | pmid = 22094553 | pmc = 3251652 | doi = 10.5301/ijao.5000024 }}</ref>
===Nephroprotective agent===


==Side effects==
Oral acetylcysteine is used for the prevention of ]-induced nephropathy (a form of ]). Some studies show that prior administration of acetylcysteine markedly decreases (90%) radiocontrast nephropathy,<ref>{{cite journal |last1=Tepel |first1=Martin |last2=Van Der Giet |first2=Marcus |last3=Schwarzfeld |first3=Carola |last4=Laufer |first4=Ulf |last5=Liermann |first5=Dieter |last6=Zidek |first6=Walter |title=Prevention of Radiographic-Contrast-Agent–Induced Reductions in Renal Function by Acetylcysteine |journal=New England Journal of Medicine |volume=343 |issue=3 |pages=180–4 |year=2000 |pmid=10900277 |doi=10.1056/NEJM200007203430304}}</ref> whereas others appear to cast doubt on its efficacy.<ref>{{cite journal |last1=Hoffmann |first1=U. |last2=Fischereder |first2=M |last3=Krüger |first3=B |last4=Drobnik |first4=W |last5=Krämer |first5=BK |title=The Value of N-Acetylcysteine in the Prevention of Radiocontrast Agent-Induced Nephropathy Seems Questionable |journal=Journal of the American Society of Nephrology |volume=15 |issue=2 |pages=407–10 |year=2004 |pmid=14747387 |doi=10.1097/01.ASN.0000106780.14856.55}}</ref><ref>{{cite journal |last1=Miner |first1=S |last2=Dzavik |first2=V |last3=Nguyen-Ho |first3=P |last4=Richardson |first4=R |last5=Mitchell |first5=J |last6=Atchison |first6=D |last7=Seidelin |first7=P |last8=Daly |first8=P |last9=Ross |first9=J |title=N-acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up |journal=American Heart Journal |volume=148 |issue=4 |pages=690–5 |year=2004 |pmid=15459602 |doi=10.1016/j.ahj.2004.05.015}}</ref> Worth considering is the newest data published in two papers in the ''New England Journal of Medicine'' and the ''Journal of the American Medical Association.'' The authors' conclusions in those papers were:
{{redirect|SNOAC|the gene|snoaC{{!}}''sno''aC}}
#"Intravenous and oral N-acetylcysteine may prevent contrast-medium–induced nephropathy with a dose-dependent effect in patients treated with primary angioplasty and may improve hospital outcome."<ref>{{cite journal |last1=Marenzi |first1=Giancarlo |last2=Assanelli |first2=Emilio |last3=Marana |first3=Ivana |last4=Lauri |first4=Gianfranco |last5=Campodonico |first5=Jeness |last6=Grazi |first6=Marco |last7=De Metrio |first7=Monica |last8=Galli |first8=Stefano |last9=Fabbiocchi |first9=Franco |title=N-Acetylcysteine and Contrast-Induced Nephropathy in Primary Angioplasty |journal=New England Journal of Medicine |volume=354 |issue=26 |pages=2773–82 |year=2006 |pmid=16807414 |doi=10.1056/NEJMoa054209}}</ref>
#"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"<ref>{{cite journal |last1=Kay |first1=J. |last2=Chow |first2=WH |last3=Chan |first3=TM |last4=Lo |first4=SK |last5=Kwok |first5=OH |last6=Yip |first6=A |last7=Fan |first7=K |last8=Lee |first8=CH |last9=Lam |first9=WF |title=Acetylcysteine for Prevention of Acute Deterioration of Renal Function Following Elective Coronary Angiography and Intervention: A Randomized Controlled Trial |journal=JAMA |volume=289 |issue=5 |pages=553 |year=2003 |pmid=12578487 |doi=10.1001/jama.289.5.553}}</ref>
The latest clinical trial, whose results were announced in November 2010, has found that acetylcysteine is ineffective for the prevention of contrast-induced nephropathy. This trial, involving 2,308 patients, found that acetylcysteine was no better than placebo; whether acetylcysteine or placebo was used, the incidence of nephropathy was the same—13%.<ref>Smith, W. Thomas Jr. . ''Medical News Today'', 17 November 2010.</ref> {{Citation needed|date=November 2010}}


The most commonly reported adverse effects for IV formulations of acetylcysteine are rash, ], and ].<ref name="Acetadote Package Insert" />
Acetylcysteine continues to be commonly used in individuals with ] to prevent the precipitation of acute renal failure.{{Citation needed|date=March 2009}}


Adverse effects for inhalational formulations of acetylcysteine include nausea, vomiting, ], fever, ], drowsiness, clamminess, chest tightness, and bronchoconstriction. Although infrequent, bronchospasm has been reported to occur unpredictably in some patients.<ref name="Mucomyst Package Insert-2014">{{cite web|title=Mucomyst Package Insert|url=http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d2dc24f3-3ad7-4c6c-8e9f-7202d9a146f7|access-date=20 April 2014|url-status=live|archive-url=https://web.archive.org/web/20140421050640/http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d2dc24f3-3ad7-4c6c-8e9f-7202d9a146f7|archive-date=21 April 2014}}</ref>
===Microbiological use===


Adverse effects for oral formulations of acetylcysteine have been reported to include nausea, vomiting, rash, and fever.<ref name="Mucomyst Package Insert-2014"/>
Acetylcysteine can be used in Petroff's method i.e. liquefaction and decontamination of ], in preparation for diagnosis of ].


Large doses in a mouse model showed that acetylcysteine could potentially cause damage to the ] and ].<ref name="pmid17786245">{{cite journal | vauthors = Palmer LA, Doctor A, Chhabra P, Sheram ML, Laubach VE, Karlinsey MZ, Forbes MS, Macdonald T, Gaston B | title = S-nitrosothiols signal hypoxia-mimetic vascular pathology | journal = The Journal of Clinical Investigation | volume = 117 | issue = 9 | pages = 2592–2601 | date = September 2007 | pmid = 17786245 | pmc = 1952618 | doi = 10.1172/JCI29444 }}</ref> They found that acetylcysteine was ] to ''S''-nitroso-''N''-acetylcysteine ('''{{vanchor|SNOAC}}'''), which increased ] in the lungs and ] of the heart (]) in ] treated with acetylcysteine. The effect was similar to that observed following a 3-week exposure to an oxygen-deprived environment (chronic ]). The authors also found that SNOAC induced a hypoxia-like response in the ] of several important ]s both '']'' and '']''. 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, a much lower dosages (600&nbsp;mg per day) have been observed to counteract some age-related decline in the ] as tested by inducing prolonged ].<ref name="pmid11861267">{{cite journal | vauthors = Hildebrandt W, Alexander S, Bärtsch P, Dröge W | title = Effect of ''N''-acetyl-cysteine on the hypoxic ventilatory response and erythropoietin production: linkage between plasma thiol redox state and O(2) chemosensitivity | journal = Blood | volume = 99 | issue = 5 | pages = 1552–1555 | date = March 2002 | pmid = 11861267 | doi = 10.1182/blood.V99.5.1552 | s2cid = 24375953 | title-link = doi | doi-access = free }}</ref>
=== Interstitial lung disease ===


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">{{cite journal | vauthors = Wang AL, Wang JP, Wang H, Chen YH, Zhao L, Wang LS, Wei W, Xu DX | title = A dual effect of ''N''-acetylcysteine on acute ethanol-induced liver damage in mice | journal = Hepatology Research | volume = 34 | issue = 3 | pages = 199–206 | date = March 2006 | pmid = 16439183 | doi = 10.1016/j.hepres.2005.12.005 }}</ref>
Acetylcysteine is used in the treatment of ] to prevent disease progression.<ref>{{cite journal |last1=Kasielski |first1=M |last2=Nowak |first2=D |title=Long-term administration of N-acetylcysteine decreases hydrogen peroxide exhalation in subjects with chronic obstructive pulmonary disease |journal=Respiratory Medicine |volume=95 |issue=6 |pages=448–56 |year=2001 |pmid=11421501 |doi=10.1053/rmed.2001.1066}}</ref><ref>{{cite journal |last1=Grandjean |first1=E |last2=Berthet |first2=P |last3=Ruffmann |first3=R |last4=Leuenberger |first4=P |title=Efficacy of oral long-term -acetylcysteine in chronic bronchopulmonary disease: A meta-analysis of published double-blind, placebo-controlled clinical trials |journal=Clinical Therapeutics |volume=22 |issue=2 |pages=209–21 |year=2000 |pmid=10743980 |doi=10.1016/S0149-2918(00)88479-9}}</ref><ref>{{cite journal |last1=Stey |first1=C. |last2=Steurer |first2=J. |last3=Bachmann |first3=S. |last4=Medici |first4=T.C. |last5=Tramèr |first5=M.R |title=The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review |journal=European Respiratory Journal |volume=16 |issue=2 |pages=253–62 |year=2000 |pmid=10968500 |doi=10.1034/j.1399-3003.2000.16b12.x}}</ref><ref>{{cite journal |last1=Poole |first1=P. |last2=Black |first2=PN |title=Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease: systematic review |journal=BMJ |volume=322 |issue=7297 |pages=1271–4 |year=2001 |pmid=11375228 |pmc=31920 |doi=10.1136/bmj.322.7297.1271}}</ref>


=== Psychiatry === ==Pharmacology==


===Pharmacodynamics===
Acetylcysteine has been shown to reduce the symptoms of both schizophrenia<ref name="pmid18436195">{{cite journal |last1=Berk |first1=Michael |last2=Copolov |first2=David |last3=Dean |first3=Olivia |last4=Lu |first4=Kristy |last5=Jeavons |first5=Sue |last6=Schapkaitz |first6=Ian |last7=Anderson-Hunt |first7=Murray |last8=Judd |first8=Fiona |last9=Katz |first9=Fiona |title=N-Acetyl Cysteine as a Glutathione Precursor for Schizophrenia—A Double-Blind, Randomized, Placebo-Controlled Trial |journal=Biological Psychiatry |volume=64 |issue=5 |pages=361–8 |year=2008 |pmid=18436195 |doi=10.1016/j.biopsych.2008.03.004}}</ref> and bipolar disorder<ref>{{cite journal |last1=Berk |first1=M |last2=Copolov |first2=D |last3=Dean |first3=O |last4=Lu |first4=K |last5=Jeavons |first5=S |last6=Schapkaitz |first6=I |last7=Andersonhunt |first7=M |last8=Bush |first8=A |title=N-Acetyl Cysteine for Depressive Symptoms in Bipolar Disorder—A Double-Blind Randomized Placebo-Controlled Trial |journal=Biological Psychiatry |volume=64 |issue=6 |pages=468–75 |year=2008 |pmid=18534556 |doi=10.1016/j.biopsych.2008.04.022}}</ref> in two placebo controlled trials conducted at Melbourne University. It is thought to act via modulation of NMDA glutamate receptors or by increasing ]. Replicatory trials in bipolar disorder, schizophrenia and depression are underway.
Acetylcysteine serves as a ] to ], a precursor to the biologic antioxidant ]. Hence administration of acetylcysteine replenishes glutathione stores.<ref name=TGA>{{cite web|title=Product Information: Aceradote Concentrated Injection|work=TGA eBusiness Services|publisher=Phebra Pty Ltd|url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-03960-3|format=PDF|date=16 January 2013|access-date=8 November 2013|url-status=live|archive-url=https://web.archive.org/web/20170908143219/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-03960-3|archive-date=8 September 2017}}</ref>
* Glutathione, along with ] (GSSG) and ] (GSNO), have been found to bind to the ] recognition site of the ] and ]s (via their γ-glutamyl moieties), and may be ] ]s.<ref name="SteulletNeijt2006">{{cite journal | vauthors = Steullet P, Neijt HC, Cuénod M, Do KQ | title = Synaptic plasticity impairment and hypofunction of NMDA receptors induced by glutathione deficit: relevance to schizophrenia | journal = Neuroscience | volume = 137 | issue = 3 | pages = 807–819 | date = February 2006 | pmid = 16330153 | doi = 10.1016/j.neuroscience.2005.10.014 | s2cid = 1417873 }}</ref><ref name="VargaJenei1997">{{cite journal | vauthors = Varga V, Jenei Z, Janáky R, Saransaari P, Oja SS | title = Glutathione is an endogenous ligand of rat brain N-methyl-D-aspartate (NMDA) and 2-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) receptors | journal = Neurochemical Research | volume = 22 | issue = 9 | pages = 1165–1171 | date = September 1997 | pmid = 9251108 | doi = 10.1023/A:1027377605054 | s2cid = 24024090 }}</ref> At ] 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 ]s that are different from any other ], and which may constitute ''glutathione receptors'', potentially making it a ].<ref name="pmid10812215">{{cite journal | vauthors = Oja SS, Janáky R, Varga V, Saransaari P | title = Modulation of glutamate receptor functions by glutathione | journal = Neurochemistry International | volume = 37 | issue = 2–3 | pages = 299–306 | year = 2000 | pmid = 10812215 | doi = 10.1016/S0197-0186(00)00031-0 | s2cid = 44380765 }}</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 ] by acting at the redox site.<ref name="pmid23369637"/><ref name="DOI2008">{{cite journal | vauthors = Lavoie S, Murray MM, Deppen P, Knyazeva MG, Berk M, Boulat O, Bovet P, Bush AI, Conus P, Copolov D, Fornari E, Meuli R, Solida A, Vianin P, Cuénod M, Buclin T, Do KQ | title = Glutathione precursor, ''N''-acetyl-cysteine, improves mismatch negativity in schizophrenia patients | journal = Neuropsychopharmacology | volume = 33 | issue = 9 | pages = 2187–2199 | date = August 2008 | pmid = 18004285 | doi = 10.1038/sj.npp.1301624 | hdl-access = free | title-link = doi | doi-access = free | hdl = 10536/DRO/DU:30071388 }}</ref>


L-cysteine also serves as a precursor to ], which in turn serves as a substrate for the ] on ]; hence there is increasing glutamate release into the extracellular space. This glutamate in turn acts on ] receptors, and at higher doses of acetylcysteine, ].<ref name="BM2008">{{cite journal | vauthors = Dodd S, Dean O, Copolov DL, Malhi GS, Berk M | title = ''N''-acetylcysteine for antioxidant therapy: pharmacology and clinical utility | journal = Expert Opinion on Biological Therapy | volume = 8 | issue = 12 | pages = 1955–1962 | date = December 2008 | pmid = 18990082 | doi = 10.1517/14728220802517901 | s2cid = 74736842 }}</ref><ref name="NAc2012">{{cite journal | vauthors = Kupchik YM, Moussawi K, Tang XC, Wang X, Kalivas BC, Kolokithas R, Ogburn KB, Kalivas PW | title = The effect of ''N''-acetylcysteine in the nucleus accumbens on neurotransmission and relapse to cocaine | journal = Biological Psychiatry | volume = 71 | issue = 11 | pages = 978–986 | date = June 2012 | pmid = 22137594 | pmc = 3340445 | doi = 10.1016/j.biopsych.2011.10.024 }}</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 ] 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 (]), and the regulation of neuronal cell death through B-cell lymphoma 2 expression (]).<ref name="pmid21118657" />
==Adverse effects==


===Pharmacokinetics===
Researchers at the ] reported in 2007 study using very large doses in a mouse model that acetylcysteine, which is found in many ], could potentially cause damage to the ] and ].<ref name = palmer>{{cite journal |last1=Palmer |first1=Lisa A. |last2=Doctor |first2=Allan |last3=Chhabra |first3=Preeti |last4=Sheram |first4=Mary Lynn |last5=Laubach |first5=Victor E. |last6=Karlinsey |first6=Molly Z. |last7=Forbes |first7=Michael S. |last8=MacDonald |first8=Timothy |last9=Gaston |first9=Benjamin |title=S-Nitrosothiols signal hypoxia-mimetic vascular pathology |journal=Journal of Clinical Investigation |volume=117 |issue=9 |pages=2592–601 |year=2007 |pmid=17786245 |pmc=1952618 |doi=10.1172/JCI29444}}</ref>
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%.
They found that acetylcysteine was ] to ''S''-nitroso-''N''-acetylcysteine (]), which increased ] in the lungs and ] of the heart (]) in ] treated with acetylcysteine. The effect was similar to that observed following a 3-week exposure to an oxygen-deprived environment (chronic ]). The authors also found that SNOAC induced a hypoxia-like response in the ] of several important ]s both '']'' and '']''.


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.
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;<ref name = palmer/> nonetheless, positive effects on age-diminished control of respiration (the ]) have been observed previously in human subjects at more moderate doses.<ref>{{cite journal |last1=Hildebrandt |first1=W. |last2=Alexander |first2=S |last3=Bärtsch |first3=P |last4=Dröge |first4=W |title=Effect of N-acetyl-cysteine on the hypoxic ventilatory response and erythropoietin production: linkage between plasma thiol redox state and O2 chemosensitivity |journal=Blood |volume=99 |issue=5 |pages=1552–5 |year=2002 |pmid=11861267 |doi=10.1182/blood.V99.5.1552}}</ref>


Acetylcysteine is extensively liver metabolized, CYP450 minimal, urine excretion is 22–30% with a ] of 5.6 hours in adults and 11 hours in newborns.{{medical citation needed|date=August 2024}}
==Complexing agent==


Acetylcysteine is the ''N''-] derivative of the amino acid <small>L</small>-cysteine, and is a precursor in the formation of the antioxidant ] in the body. The ] (sulfhydryl) group confers antioxidant effects and is able to ] ]s.
''N''-Acetylcysteine has been used to complex ], to help it dissolve in water. This helps to remove palladium from drugs or precursors synthesized by palladium-catalyzed coupling reactions.<ref>{{cite journal |last1=Garrett |first1=Christine E. |last2=Prasad |first2=Kapa |title=The Art of Meeting Palladium Specifications in Active Pharmaceutical Ingredients Produced by Pd-Catalyzed Reactions |journal=Advanced Synthesis & Catalysis |volume=346 |pages=889–900 |year=2004 |doi=10.1002/adsc.200404071}}</ref>


==Chemistry== ==Chemistry==
Pure acetylcysteine is in a solid state at room temperature, appearing as a white crystalline powder or granules.<ref name="pmid33638319">{{cite journal| doi=10.1515/jbcpp-2020-0099 | title=An insight on safety, efficacy, and molecular docking study reports of N-acetylcysteine and its compound formulations | date=2022 | journal=Journal of Basic and Clinical Physiology and Pharmacology | volume=33 | issue=3 | pages=223–233 | pmid=33638319 | vauthors = Rind L, Ahmad M, Khan MI, Badruddeen, Akhtar J, Ahmad U, Yadav C, Owais M }}</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">{{cite book|isbn=978-3-319-28570-2|doi=10.1007/978-3-319-28570-2_4 |chapter=N-Acetylcysteine |title=Utility of Bromelain and N-Acetylcysteine in Treatment of Peritoneal Dissemination of Gastrointestinal Mucin-Producing Malignancies |date=2016 |pages=81–98 | vauthors = Amini A, Masoumi-Moghaddam S, Morris DL }}</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 is the ''N''-] derivative of the amino acid <small>L</small>-], and is a precursor in the formation of the antioxidant ] in the body. The ] (sulfhydryl) group confers antioxidant effects and is able to ] ]s.


Acetylcysteine in a form of a white or white with light yellow cast powder has a ] of 9.5 at 30&nbsp;°C.<ref name="Sigma-2014">{{cite web|title=''N''-Acetyl-<small>L</small>-cysteine Product Information |url=https://www.sigmaaldrich.com/content/dam/sigma-aldrich/docs/Sigma-Aldrich/Product_Information_Sheet/a7250pis.pdf |website=Sigma |publisher=Sigma-Aldrich |access-date=9 November 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140611120709/http://www.sigmaaldrich.com/content/dam/sigma-aldrich/docs/Sigma-Aldrich/Product_Information_Sheet/a7250pis.pdf |archive-date=11 June 2014 }}</ref>
== Trade names ==


''N''-acetyl-<small>L</small>-cysteine is soluble in water and alcohol, and practically insoluble in chloroform and ether.<ref name="PubChem-2016">{{cite web|title=''N''-Acetyl-<small>L</small>-cysteine {{pipe}} C<sub>5</sub>H<sub>9</sub>NO<sub>3</sub>S|work = PubChem |publisher=National Center for Biotechnology Information, U.S. National Library of Medicine |url=https://pubchem.ncbi.nlm.nih.gov/compound/''N''-acetyl-L-cysteine#section=Chemical-and-Physical-Properties|access-date=22 July 2016|url-status=live|archive-url=https://web.archive.org/web/20160816171151/https://pubchem.ncbi.nlm.nih.gov/compound/''N''-acetyl-L-cysteine#section=Chemical-and-Physical-Properties|archive-date=16 August 2016}}</ref>
In addition to being available as an over-the-counter nutritional supplement, acetylcysteine is also marketed under these ]s:
* '''ACC''' (])
* '''Acemuc''' (Betapharm, Germany)
* '''Acetyst''' (Ristert, Germany)
* '''Acetadote''' (Cumberland Pharmaceuticals)
* '''Asist''' (Bilim Pharmaceuticals, Turkey)
* '''Brunac''' eyedrops (Bruschettini, Italy)
* '''Fluimucil''' (]).
* '''Fluimukan''' (Lek, Slovenia).
* '''Flumil''' (Pharmazam, Spain).
* '''Lysox''' (])
* '''Mucinac''' (Cipla, India)
* '''Mucohelp''' (Neiss Labs, India)
* '''Mucolysin''' (])
* '''Mucomelt''' (Venus Remedies, India)
* '''MUCOMIX''' (Samarth Life Sciences, India)
* '''Mucomyst''' (])
* '''Nytex'''(Pharos,Indonesia)
* '''Parvolex''' (])
* '''PharmaNAC (BioAdvantex Pharma Inc., North America).
* '''Rheunac''' (Tree Of Life, Israel).
* '''Solmucaïne''' (IBSA, Switzerland).
* '''Trebon N''' (]).


Acetylcysteine is highly soluble in water: it dissolves readily in water, forming a clear solution. The pH of a maximum-saturated acetylcysteine solution typically ranges between 6.0 and 7.5,<ref name="USP-Monographs-2000">{{cite web | url=http://ftp.uspbpep.com/v29240/usp29nf24s0_m780.html?form=MG0AV3 | title=USP Monographs: Acetylcysteine Solution }}</ref> depending on temperature, purity of the compount, presense of other ions (thet can affect the pH by interacting with acetylcysteine or altering the overall ionic strength of the solution), thus on the concentraton of acetylcysteine itself: higher concentrations of acetylcysteine can lead to a lower pH due to the increased presence of the acetylcysteine molecule itself. This range of pH between 6.0 and 7.5 ensures that the solution is neither too acidic nor too alkaline, making it suitable for various medical applications. 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"/>
==Dosage forms==


As for the sunlight stability, acetylcysteine in dry powder form is relatively stable and does not degrade quickly when exposed to sunlight, but when dissolved in aqueous solution, acetylcysteine can degrade when exposed to sunlight, especially if the solution is not stored in a dark, cool place. Besides that, 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">{{cite journal|doi=10.2146/ajhp100214 |title=Stability of extemporaneously prepared acetylcysteine 1% and 10% solutions for treatment of meconium ileus |date=2011 |journal=American Journal of Health-System Pharmacy |volume=68 |pages=69–72 |pmid=21164069 | vauthors = Fohl AL, Johnson CE, Cober MP |issue=1 }}</ref><ref name="pmid33638319"/>
Acetylcysteine is available in different dosage forms for different indications:

*Solution for inhalation (Asist,Mucomyst, Mucosil) – inhaled for mucolytic therapy or ingested for nephroprotective effect (to protect the kidneys)
==Society and culture==
*] injection (Asist,Parvolex, Acetadote) – treatment of paracetamol/acetaminophen overdose
Acetylcysteine was first studied as a drug in 1963. Amazon removed acetylcysteine for sale in the US in 2021, due to claims by the FDA of it being classified as a drug rather than a supplement.<ref name="Long-2021b">{{cite news |vauthors=Long J |date=6 May 2021 |title=Amazon confirms plans on removing NAC supplements |url=https://www.naturalproductsinsider.com/regulatory/amazon-confirms-plans-removing-nac-supplements |access-date=21 September 2023 |archive-date=16 May 2021 |archive-url=https://web.archive.org/web/20210516105959/https://www.naturalproductsinsider.com/regulatory/amazon-confirms-plans-removing-nac-supplements |url-status=live }}</ref><ref name="Long-2021a">{{cite news | vauthors = Long J | date = 22 April 2021 | work = Natural Products Inside | url = https://www.naturalproductsinsider.com/regulatory/amazon-reportedly-removes-nac-containing-dietary-supplements | title = Amazon reportedly removes NAC-containing dietary supplements | access-date = 16 May 2021 | archive-date = 16 May 2021 | archive-url = https://web.archive.org/web/20210516121310/https://www.naturalproductsinsider.com/regulatory/amazon-reportedly-removes-nac-containing-dietary-supplements | url-status = live }}</ref><ref name="benjaminmcevoy.com">{{cite news |title=Warning Letter |work=benjaminmcevoy.com |url=https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/benjaminmcevoycom-607149-05142020 |publisher=U.S. Food and Drug Administration |access-date=3 May 2022 |archive-date=3 May 2022 |archive-url=https://web.archive.org/web/20220503215137/https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/benjaminmcevoycom-607149-05142020 |url-status=live }}</ref><ref name="FDA Sends Warning Letters to Seven Companies Illegally Selling Hangover Products">{{cite news |title=FDA Sends Warning Letters to Seven Companies Illegally Selling Hangover Products |url=https://www.fda.gov/food/cfsan-constituent-updates/fda-sends-warning-letters-seven-companies-illegally-selling-hangover-products |access-date=3 May 2022 |archive-date=3 May 2022 |archive-url=https://web.archive.org/web/20220503215141/https://www.fda.gov/food/cfsan-constituent-updates/fda-sends-warning-letters-seven-companies-illegally-selling-hangover-products |url-status=live }}</ref> In April 2022, the FDA released draft guidance on FDA's policy regarding products labeled as dietary supplements that contain ''N''-acetyl-<small>L</small>-cysteine.<ref name="FDA Releases Draft Guidance on Enforcement Discretion for Certain NAC Products">{{cite news|title=FDA Releases Draft Guidance on Enforcement Discretion for Certain NAC Products|url=https://www.fda.gov/food/cfsan-constituent-updates/fda-releases-draft-guidance-enforcement-discretion-certain-nac-products|access-date=3 May 2022|archive-date=3 May 2022|archive-url=https://web.archive.org/web/20220503215145/https://www.fda.gov/food/cfsan-constituent-updates/fda-releases-draft-guidance-enforcement-discretion-certain-nac-products|url-status=live}}</ref> Amazon subsequently re-listed NAC products as of August 2022.<ref name="Long-2022">{{cite web | vauthors = Long J |title=Amazon resumes sales of NAC supplements |url=https://www.naturalproductsinsider.com/regulatory/amazon-resumes-sales-nac-supplements |website=Natural Products Insider |access-date=11 January 2023 |date=25 August 2022}}</ref>
*Oral solution – various indications.
*Effervescent Tablets (200&nbsp;mg) - Reolin (Hochland Pharma Germany), Solmucol (600&nbsp;mg)(IBSA, Switzerland) and Mucinac (Cipla India).
*Ocular solution - for mucolytic therapy
*Sachet (600&nbsp;mg) - Bilim Pharmaceuticals
*CysNAC (900&nbsp;mg) – NeuroScience Inc.
*PharmaNAC Effervescent Tablets (900&nbsp;mg) - Bioadvantex Pharma.
The IV injection and inhalation preparations are, in general, prescription only, whereas the oral solution and the effervescent tablets are available ] in many countries.


==Research== ==Research==
While many ]s have been researched to treat a large number of diseases by reducing the negative effect of ], acetylcysteine is one of the few that has yielded promising results, and is currently already approved for the treatment of paracetamol overdose.<ref name="pmid29034480">{{cite journal | vauthors = Head SI | title = Antioxidant therapy in a mouse model of Duchenne muscular dystrophy: some promising results but with a weighty caveat | journal = The Journal of Physiology | volume = 595 | issue = 23 | pages = 7015 | date = December 2017 | pmid = 29034480 | pmc = 5709324 | doi = 10.1113/jp275232 }}</ref>
* In mouse ] models of ], treatment with 1–2% acetylcysteine in drinking water significantly reduces muscle damage and improves strength.<ref name="pmid29034480" />
* It is being studied in conditions such as ], where cysteine and related sulfur amino acids may be depleted due to multifactorial dysfunction of methylation pathways involved in ] catabolism.<ref name="pmid25405315">{{cite journal | vauthors = Gu F, Chauhan V, Chauhan A | title = Glutathione redox imbalance in brain disorders | journal = Current Opinion in Clinical Nutrition and Metabolic Care | volume = 18 | issue = 1 | pages = 89–95 | date = January 2015 | pmid = 25405315 | doi = 10.1097/MCO.0000000000000134 | s2cid = 25333289 }}</ref>
* Animal studies have also demonstrated its efficacy in reducing the damage associated with moderate traumatic brain or spinal injury, and also ischaemia-induced brain injury. In particular, it has been demonstrated to reduce neuronal losses and to improve cognitive and neurological outcomes associated with these traumatic events.<ref name="pmid24683506" />
* Research on acetylcysteine usage seems to show a positive efficiency in treating ] (male baldness), with or without adjacent treatments such as the use of topical ] solution.<ref name="QJM-2021">{{cite journal|title= Efficacy and Tolerability of N-Acetyl-Cysteine for Treatment of The Early-onset Androgenetic Alopecia in Men|journal=]|editor=]|issue=Suppl.1|date=October 2021|volume=114|doi=10.1093/qjmed/hcab093.024|author1=Mahira Hamdy El Sayed|author2=Marwa Yassin Soltan|author3=Ahmed Sadek|author4=Mohamed Abo Shabana Hussein Mohamed}}</ref>
* Research on mouse models also shows that acetylcysteine could be "used as an efficient and safe therapeutic option for hair loss induced by ]".<ref name="pmid38641701">{{cite journal |author=Yomna F Hassan, Dalia A Shabaan|title= Effect of N-acetylcysteine on hair follicle changes in mouse model of cyclophosphamide-induced alopecia: histological and biochemical study|journal= Histochemistry and Cell Biology|volume=161|date=20 April 2024|issue= 6|pages=477–491|pmid= 38641701|pmc=11162382|doi=10.1007/s00418-024-02282-0}}</ref>
* It has been suggested that acetylcysteine may help people with ] by increasing levels of glutathione allowing faster breakdown of ]s, although there is no evidence that it is of benefit.<ref name="pmid12653791">{{cite journal | vauthors = Bachert C, Hörmann K, Mösges R, Rasp G, Riechelmann H, Müller R, Luckhaupt H, Stuck BA, Rudack C | title = An update on the diagnosis and treatment of sinusitis and nasal polyposis | journal = Allergy | volume = 58 | issue = 3 | pages = 176–191 | date = March 2003 | pmid = 12653791 | doi = 10.1034/j.1398-9995.2003.02172.x | s2cid = 35319457 | title-link = doi | doi-access = }}</ref>
* Small studies have shown acetylcysteine to be of benefit to people with ].<ref name="pmid16390346">{{cite journal | vauthors = Aitio ML | title = ''N''-acetylcysteine -- passe-partout or much ado about nothing? | journal = British Journal of Clinical Pharmacology | volume = 61 | issue = 1 | pages = 5–15 | date = January 2006 | pmid = 16390346 | pmc = 1884975 | doi = 10.1111/j.1365-2125.2005.02523.x }}</ref> It has been shown to reduce ocular soreness caused by ].<ref name="pmid4433493">{{cite journal | vauthors = Williamson J, Doig WM, Forrester JV, Tham MH, Wilson T, Whaley K, Dick WC | title = Management of the dry eye in Sjogren's syndrome | journal = The British Journal of Ophthalmology | volume = 58 | issue = 9 | pages = 798–805 | date = September 1974 | pmid = 4433493 | pmc = 1215027 | doi = 10.1136/bjo.58.9.798 }}</ref>
* Research has found that acetylcysteine may have otoprotective properties and could potentially be useful for preventing ] and ] in some cases.<ref name="Schlee 2024">{{cite book | vauthors = Schlee W, Langguth B, Ridder DD, Vanneste S, Kleinjung T, Møller AR |title=Textbook of Tinnitus |publisher=Springer |year=2024 |edition=2nd |isbn=978-3-031-35646-9 |page=394, 620}}</ref><ref name="pmid36457967">{{cite journal | vauthors = Chang PH, Liu CW, Hung SH, Kang YN | title = Effect of ''N''-acetyl-cysteine in prevention of noise-induced hearing loss: a systematic review and meta-analysis of randomized controlled trials | journal = Archives of Medical Science | volume = 18 | issue = 6 | pages = 1535–1541 | date = 2022 | pmid = 36457967 | pmc = 9710288 | doi = 10.5114/aoms/109126 }}</ref> A 2011 study showed that ''N''-acetylcysteine may protect the human cochlea from subclinical hearing loss caused by loud noises such as impulse noise.<ref name="pmid22122955">{{cite journal | vauthors = Lindblad AC, Rosenhall U, Olofsson A, Hagerman B | title = The efficacy of ''N''-acetylcysteine to protect the human cochlea from subclinical hearing loss caused by impulse noise: a controlled trial | journal = Noise & Health | volume = 13 | issue = 55 | pages = 392–401 | date = November–December 2011 | pmid = 22122955 | doi = 10.4103/1463-1741.90293 | title-link = doi | doi-access = free }}</ref> In animal models, it reduced age-related hearing loss.{{citation needed|date=July 2024}}
* It has been shown effective in the treatment of ] in an open trial in four patients. A marked decrease in myoclonus and some normalization of somatosensory evoked potentials with acetylcysteine treatment has been documented.<ref name="pmid12427904">{{cite journal | vauthors = Edwards MJ, Hargreaves IP, Heales SJ, Jones SJ, Ramachandran V, Bhatia KP, Sisodiya S | title = ''N''-acetylcysteine and Unverricht-Lundborg disease: variable response and possible side effects | journal = Neurology | volume = 59 | issue = 9 | pages = 1447–1449 | date = November 2002 | pmid = 12427904 | doi = 10.1212/wnl.59.9.1447 }}</ref><ref name="Ataxia with Identified Genetic and Biochemical Defects at eMedicine">{{EMedicine|article|1153370|Ataxia with Identified Genetic and Biochemical Defects}}</ref>
* Addiction to certain addictive drugs (including ], ], ], and ]) is correlated with a persistent reduction in the expression of ] (EAAT2) in the ] (NAcc);<ref name="pmid24442756" /> the reduced expression of EAAT2 in this region is implicated in addictive drug-seeking behavior.<ref name="pmid24442756" /> In particular, the long-term dysregulation of glutamate neurotransmission in the NAcc of long-term, drug-dependent users is associated with an increase in vulnerability to ] after re-exposure to the addictive drug or its associated ].<ref name="pmid24442756" /> Drugs that help to normalize the expression of EAAT2 in this region, such as ''N''-acetylcysteine, have been proposed as an ] for the treatment of addiction to cocaine, nicotine, alcohol, and other drugs.<ref name="pmid24442756" />
* It has been tested for the reduction of hangover symptoms, though the overall results indicate very limited efficacy.<ref name="Clinical trial number NCT02541422 for">{{ClinicalTrialsGov|NCT02541422|Use of NAC in Alleviation of Hangover Symptoms – Study Results}}</ref><ref name="pmid34183702">{{cite journal | vauthors = Coppersmith V, Hudgins S, Stoltzfus J, Stankewicz H | title = The use of ''N''-acetylcysteine in the prevention of hangover: a randomized trial | journal = Scientific Reports | volume = 11 | issue = 1 | pages = 13397 | date = June 2021 | pmid = 34183702 | pmc = 8238992 | doi = 10.1038/s41598-021-92676-0 | s2cid = 235673455 | bibcode = 2021NatSR..1113397C }}</ref>
* A double-blind placebo controlled trial of 262 patients has shown NAC treatment was well-tolerated and resulted in a significant decrease in the frequency of influenza-like episodes, severity, and length of time confined to bed.<ref name="pmid9230243">{{cite journal | vauthors = De Flora S, Grassi C, Carati L | title = Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term ''N''-acetylcysteine treatment | journal = The European Respiratory Journal | volume = 10 | issue = 7 | pages = 1535–1541 | date = July 1997 | pmid = 9230243 | doi = 10.1183/09031936.97.10071535 | title-link = doi | doi-access = free }}</ref>


===Kidney and bladder===
The following uses have not been well-established or investigated:
''N''-acetylcysteine has been widely believed to prevent adverse effects of long term ] use on the bladder and kidneys, and there is growing body of evidence to support this.<ref name="pmid31148586">{{cite journal | vauthors = Ryu CM, Shin JH, Yu HY, Ju H, Kim S, Lim J, Heo J, Lee S, Shin DM, Choo MS | title = ''N''-acetylcysteine prevents bladder tissue fibrosis in a lipopolysaccharide-induced cystitis rat model | journal = Scientific Reports | volume = 9 | issue = 1 | pages = 8134 | date = May 2019 | pmid = 31148586 | pmc = 6544636 | doi = 10.1038/s41598-019-44631-3 | bibcode = 2019NatSR...9.8134R }}</ref>


Evidence for the benefit of acetylcysteine to prevent ] induced ] is mixed.<ref name="pmid29802583">{{cite journal | vauthors = Pistolesi V, Regolisti G, Morabito S, Gandolfini I, Corrado S, Piotti G, Fiaccadori E | title = Contrast medium induced acute kidney injury: a narrative review | journal = Journal of Nephrology | volume = 31 | issue = 6 | pages = 797–812 | date = December 2018 | pmid = 29802583 | doi = 10.1007/s40620-018-0498-y | s2cid = 44128861 }}</ref>
* Evidence that NAC and other ] can exert beneficial effects on ] ] function in ] was published in a 1999 study. The authors conclude that a sufficient supply of antioxidants (NAC, ] plus ], or both) may prevent or delay b-cell dysfunction in diabetes by providing protection against ] toxicity.<ref>{{cite journal |last1=Kaneto |first1=H. |last2=Kajimoto |first2=Y. |last3=Miyagawa |first3=J. |last4=Matsuoka |first4=T. |last5=Fujitani |first5=Y. |last6=Umayahara |first6=Y. |last7=Hanafusa |first7=T. |last8=Matsuzawa |first8=Y. |last9=Yamasaki |first9=Y. |title=Beneficial effects of antioxidants in diabetes: possible protection of pancreatic beta-cells against glucose toxicity |journal=Diabetes |volume=48 |issue=12 |pages=2398–406 |year=1999 |pmid=10580429 |doi=10.2337/diabetes.48.12.2398}}</ref>


Acetylcysteine has been used for ]-induced haemorrhagic ], although ] is generally preferred due to the ability of acetylcysteine to diminish the effectiveness of cyclophosphamide.<ref name="Hemorrhagic Cystitis Treatment-2019">{{cite web |title=Hemorrhagic Cystitis Treatment & Management: Approach Considerations, Clot Evacuation, Bladder Irrigation Agents |url=https://emedicine.medscape.com/article/2056130-treatment#d12 |access-date=18 December 2019 |date=5 December 2019 |archive-date=29 October 2020 |archive-url=https://web.archive.org/web/20201029193235/https://emedicine.medscape.com/article/2056130-treatment#d12 |url-status=live }}</ref>
* NAC is undergoing ]s in the ] for the treatment of ].<ref>{{ClinicalTrialsGov|NCT00539513|N-Acetylcysteine Augmentation in Treatment-Refractory Obsessive-Compulsive Disorder}}</ref> It is thought to counteract the ] hyperactivity in OCD.
*NAC has had anecdotal reports and some research suggesting efficacy in preventing nail biting<ref>{{cite journal |last1=Berk |first1=M |last2=Jeavons |first2=S |last3=Dean |first3=OM |last4=Dodd |first4=S |last5=Moss |first5=K |last6=Gama |first6=CS |last7=Malhi |first7=GS |title=Nail-biting stuff? The effect of N-acetyl cysteine on nail-biting |journal=CNS spectrums |volume=14 |issue=7 |pages=357–60 |year=2009 |pmid=19773711}}</ref>
* NAC has been shown to reduce cravings associated with chronic ] use in a study conducted at the ]<ref>{{cite journal |last1=Mardikian |first1=P |last2=Larowe |first2=S |last3=Hedden |first3=S |last4=Kalivas |first4=P |last5=Malcolm |first5=R |title=An open-label trial of N-acetylcysteine for the treatment of cocaine dependence: A pilot study |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |volume=31 |issue=2 |pages=389–94 |year=2007 |pmid=17113207 |doi=10.1016/j.pnpbp.2006.10.001}}</ref><ref>{{cite journal |last1=Larowe |first1=S. D. |last2=Myrick |first2=H. |last3=Hedden |first3=S. |last4=Mardikian |first4=P. |last5=Saladin |first5=M. |last6=McRae |first6=A. |last7=Brady |first7=K. |last8=Kalivas |first8=P. W. |last9=Malcolm |first9=R. |title=Is Cocaine Desire Reduced by N-Acetylcysteine? |journal=American Journal of Psychiatry |volume=164 |issue=7 |pages=1115–7 |year=2007 |pmid=17606664 |doi=10.1176/appi.ajp.164.7.1115}}</ref>
* It may reduce the incidence of ] (COPD) exacerbations<ref>{{cite journal |last1=Pela |first1=R. |last2=Calcagni |first2=A.M. |last3=Subiaco |first3=S. |last4=Isidori |first4=P. |last5=Tubaldi |first5=A. |last6=Sanguinetti |first6=C.M. |title=N-Acetylcysteine Reduces the Exacerbation Rate in Patients with Moderate to Severe COPD |journal=Respiration |volume=66 |issue=6 |pages=495–500 |year=1999 |pmid=10575333 |doi=10.1159/000029447}}</ref>
* In the treatment of ], NAC has been shown to cause a "marked increase in immunological functions and plasma albumin concentrations"<ref>{{cite journal |last1=Breitkreutz |first1=Raoul |last2=Pittack |first2=Nicole |last3=Nebe |first3=Carl Thomas |last4=Schuster |first4=Dieter |last5=Brust |first5=Jürgen |last6=Beichert |first6=Matthias |last7=Hack |first7=Volker |last8=Daniel |first8=Volker |last9=Edler |first9=Lutz |title=Improvement of immune functions in HIV infection by sulfur supplementation: Two randomized trials |journal=Journal of Molecular Medicine |volume=78 |issue=1 |pages=55–62 |year=2000 |pmid=10759030 |doi=10.1007/s001090050382}}</ref> Albumin concentration are inversely correlated with muscle wasting (]), a condition associated with AIDS.
* An animal study indicates that acetylcysteine may decrease mortality associated with ]<ref>{{cite journal |last1=Ungheri |first1=D |last2=Pisani |first2=C |last3=Sanson |first3=G |last4=Bertani |first4=A |last5=Schioppacassi |first5=G |last6=Delgado |first6=R |last7=Sironi |first7=M |last8=Ghezzi |first8=P |title=Protective effect of n-acetylcysteine in a model of influenza infection in mice |journal=International journal of immunopathology and pharmacology |volume=13 |issue=3 |pages=123–128 |year=2000 |pmid=12657201}}</ref>
* Animal studies suggest that NAC may help prevent ].<ref>{{cite journal |last1=Kopke |first1=Richard |last2=Bielefeld |first2=Eric |last3=Liu |first3=Jianzhong |last4=Zheng |first4=Jiefu |last5=Jackson |first5=Ronald |last6=Henderson |first6=Donald |last7=Coleman |first7=John |title=Prevention of impulse noise-induced hearing loss with antioxidants |journal=Acta Oto-Laryngologica |volume=125 |issue=3 |pages=235–43 |year=2005 |pmid=15966690 |doi=10.1080/00016480410023038}}</ref> A clinical trial to determine efficacy in preventing noise-induced sensorineural hearing loss in humans is currently (2006) being jointly conducted by the US Army<ref>Acker-Mills, B., Robinette, M., LaPrath, A., and Kopke, R. (December, 2004). Effects of N-acetylcysteine on otoacoustic emissions following noise exposure. Proceedings of the 2004 Army Science Conference, Orlando, Florida. AD Number: ADA433105</ref> and US Navy<ref>{{cite journal | last1 = Kopke | first1 = R | last2 = Jackson | first2 = R | last3 = Coleman | first3 = J | last4 = Liu | first4 = J | last5 = Bielefeld | first5 = E | last6 = Balough | first6 = B | title = NAC for noise: From the bench top to the clinic∗ | journal = Hearing Research | volume = 226 | issue = 1-2 | pages = 114 | year = 2007 | pmid = 17184943 | doi = 10.1016/j.heares.2006.10.008}}</ref>
* A human study of 262 primarily elderly individuals indicates that NAC may decrease ] symptoms. In the study, 25% of virus-infected subjects who received NAC treatment developed symptoms, whereas 79% in the placebo group developed symptoms.<ref>{{cite journal |last1=De Flora |first1=S. |last2=Grassi |first2=C. |last3=Carati |first3=L. |title=Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment |journal=European Respiratory Journal |volume=10 |issue=7 |pages=1535–41 |year=1997 |pmid=9230243 |doi=10.1183/09031936.97.10071535}}</ref>
* It has been suggested that NAC may help sufferers of ] by increasing levels of glutathione allowing faster breakdown of ]s, though there is no evidence that it is of benefit<ref>{{cite journal |last1=Bachert |first1=C. |last2=Hormann |first2=K. |last3=Mosges |first3=R. |last4=Rasp |first4=G. |last5=Riechelmann |first5=H. |last6=Muller |first6=R. |last7=Luckhaupt |first7=H. |last8=Stuck |first8=B. A. |last9=Rudack |first9=C. |title=An update on the diagnosis and treatment of sinusitis and nasal polyposis |journal=Allergy |volume=58 |issue=3 |pages=176–91 |year=2003 |pmid=12653791 |doi=10.1034/j.1398-9995.2003.02172.x}}</ref>
* There are claims that acetylcysteine taken together with vitamin C and ] can be used to prevent and relieve symptoms of ] (hangover following ] (alcohol) consumption). The claimed mechanism is through scavenging of ], a toxic intermediate in the metabolism of ethanol.<ref>Fawkes, SW ''Smart Drug News'' 1996 Dec 13</ref><ref>Resat Ozaras, Veysel Tahan, Seval Aydin, Hafize Uzun, Safiye Kaya, Hakan Senturk. ''World Journal of Gastroenterology'' 2003 Apr 15</ref>
* It has been shown to help women with PCOS (]) to reduce insulin problems and possibly improve fertility.<ref>{{cite journal |last1=Fulghesu |first1=A |last2=Ciampelli |first2=M |last3=Muzj |first3=G |last4=Belosi |first4=C |last5=Selvaggi |first5=L |last6=Ayala |first6=GF |last7=Lanzone |first7=A |title=N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome |journal=Fertility and Sterility |volume=77 |issue=6 |pages=1128–35 |year=2002 |pmid=12057717 |doi=10.1016/S0015-0282(02)03133-3}}</ref>
* Small studies have shown acetylcysteine to be of benefit to sufferers of ]<ref>{{cite journal | last1 =Aitio | first1 =Mirja-Liisa | title =N-acetylcysteine - passe-partout or much ado about nothing? | journal =British Journal of Clinical Pharmacology | volume =61 | issue =1 | pages =5 | year =2006 | pmid =16390346 | pmc =1884975 | doi =10.1111/j.1365-2125.2005.02523.x}} and has been shown to reduce ocular soreness caused by ].{{cite journal | last1 =Williamson | first1 =J | last2 =Doig | first2 =W M | last3 =Forrester | first3 =J V | last4 =Tham | first4 =M H | last5 =Wilson | first5 =T | last6 =Whaley | first6 =K | last7 =Dick | first7 =W C | title =Management of the dry eye in Sjogren's syndrome. | journal =British Journal of Ophthalmology | volume =58 | issue =9 | pages =798 | year =1974 | pmid =4433493 | pmc =1215027 | doi =10.1136/bjo.58.9.798 }}</ref>
* Studies in mice models of Ataxia Telangictasia (] knockout) indicate that NAC prevents genomic instability and retards lymphomagenesis in these animals.<ref>{{cite journal | last1 =Reliene | first1 =R. | last2 =Fischer | first2 =E | last3 =Schiestl | first3 =RH | title =Effect of N-Acetyl Cysteine on Oxidative DNA Damage and the Frequency of DNA Deletions in Atm-Deficient Mice | journal =Cancer Research | volume =64 | issue =15 | pages =5148 | year =2004 | pmid =15289318 | doi =10.1158/0008-5472.CAN-04-0442}}</ref> Clinical trials in human ] patients are underway.{{Citation needed|date=March 2009}}
* It has been shown to help ],<ref>{{cite journal |last1=Grant |first1=J. E. |last2=Odlaug |first2=B. L. |last3=Won Kim |first3=S. |title=N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study |journal=Archives of General Psychiatry |volume=66 |issue=7 |pages=756–63 |year=2009 |pmid=19581567 |doi=10.1001/archgenpsychiatry.2009.60}}</ref> a condition causing compulsive hair-pulling as well as compulsive nailbiting.
* Sulfur and sulfur-related amino acids are commonly depleted in autism.<ref name="pm1"/> Glutathione, which largely depends on cysteine for its formation, is also frequently depleted in autism,<ref>{{cite journal |last1=Adams |first1=J. B. |last2=Baral |first2=M. |last3=Geis |first3=E. |last4=Mitchell |first4=J. |last5=Ingram |first5=J. |last6=Hensley |first6=A. |last7=Zappia |first7=I. |last8=Newmark |first8=S. |last9=Gehn |first9=E. |title=The Severity of Autism Is Associated with Toxic Metal Body Burden and Red Blood Cell Glutathione Levels |journal=Journal of Toxicology |volume=2009 |pages=1 |year=2009 |doi=10.1155/2009/532640}}</ref> and may contribute to the heavy metal burden commonly found in autistic patients.<ref>{{cite journal | last1 = Fido | first1 = A. | last2 = Al-Saad | first2 = S | title = Toxic trace elements in the hair of children with autism | journal = Autism | volume = 9 | issue = 3 | pages = 290 | year = 2005 | pmid = 15937043 | doi = 10.1177/1362361305053255 }}</ref>
* Possible antidote for ] poisoning. It produced an acceleration of urinary methyl-mercury excretion in mice<ref>{{cite journal |last1=Ballatori |first1=Nazzareno |last2=Lieberman |first2=Michael W. |last3=Wang |first3=Wei |title=N-Acetylcysteine as an Antidote in Methylmercury Poisoning |journal=Environmental Health Perspectives |volume=106 |issue=5 |pages=267–71 |year=1998 |pmid=9520359 |pmc=1533084 |doi=10.2307/3434014 |jstor=3434014}}</ref>
* It has been shown effective in ] in an open trial in 4 patients. A marked decrease in myoclonus and some normalization of somatosensory evoked potentials with N -acetylcysteine treatment has been documented.<ref>http://emedicine.medscape.com/article/1153370-overview</ref>
* Small reduction of cell death in chemotherapy patients, due to reduction in oxidative stress. Reduced ROS and lipid peroxidation, and restored of antioxidant enzyme activities.<ref>http://www.biomedcentral.com/1471-2210/9/7</ref>


==References== ===Psychiatry===
Acetylcysteine has been studied for major psychiatric disorders,<ref name="pmid34509090">{{cite journal | vauthors = Bartoli F, Cavaleri D, Bachi B, Moretti F, Riboldi I, Crocamo C, Carrà G | title = Repurposed drugs as adjunctive treatments for mania and bipolar depression: A meta-review and critical appraisal of meta-analyses of randomized placebo-controlled trials | journal = Journal of Psychiatric Research | volume = 143 | pages = 230–238 | date = November 2021 | pmid = 34509090 | doi = 10.1016/j.jpsychires.2021.09.018 | s2cid = 237485915 }}</ref><ref name="pmid21118657"/><ref name="pmid23369637"/><ref name="pmid24683506">{{cite journal | vauthors = Bavarsad Shahripour R, Harrigan MR, Alexandrov AV | title = ''N''-acetylcysteine (NAC) in neurological disorders: mechanisms of action and therapeutic opportunities | journal = Brain and Behavior | volume = 4 | issue = 2 | pages = 108–122 | date = March 2014 | pmid = 24683506 | pmc = 3967529 | doi = 10.1002/brb3.208 }}</ref> including ],<ref name="pmid34509090" /> ], and ].<ref name="pmid21118657">{{cite journal | vauthors = Dean O, Giorlando F, Berk M | title = ''N''-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action | journal = Journal of Psychiatry & Neuroscience | volume = 36 | issue = 2 | pages = 78–86 | date = March 2011 | pmid = 21118657 | pmc = 3044191 | doi = 10.1503/jpn.100057 }}</ref><ref name="pmid23369637">{{cite journal | vauthors = Berk M, Malhi GS, Gray LJ, Dean OM | title = The promise of ''N''-acetylcysteine in neuropsychiatry | journal = Trends in Pharmacological Sciences | volume = 34 | issue = 3 | pages = 167–177 | date = March 2013 | pmid = 23369637 | doi = 10.1016/j.tips.2013.01.001 }}</ref>
{{Reflist|2}}


Tentative evidence exists for ''N''-acetylcysteine also in the treatment of ], ], ],<ref name="pmid38385640">{{cite journal | vauthors = Carollo M, Carollo N, Montan G | title = The promise of ''N''-acetylcysteine in the treatment of obsessive-compulsive disorder | journal = CNS Neuroscience & Therapeutics | volume = 30 | issue = 2 | pages = e14653 | date = February 2024 | pmid = 38385640 | pmc = 10883097 | doi = 10.1111/cns.14653 }}</ref> specific ]s (]), drug-induced ], ], ], and a certain form of epilepsy (]).<ref name="pmid21118657" /><ref name="pmid23369637"/><ref name="pmid25957927"/> Preliminary evidence showed efficacy in ], ] and ] although confirmatory studies are required.<ref name="pmid25957927">{{cite journal | vauthors = Slattery J, Kumar N, Delhey L, Berk M, Dean O, Spielholz C, Frye R | title = Clinical trials of ''N''-acetylcysteine in psychiatry and neurology: A systematic review | journal = Neuroscience and Biobehavioral Reviews | volume = 55 | pages = 294–321 | date = August 2015 | pmid = 25957927 | doi = 10.1016/j.neubiorev.2015.04.015 | title-link = doi | doi-access = free }}</ref><ref name="The efficacy of adjunctive ''N''-acetyl">{{cite journal | vauthors = Berk M, Dean OM, Cotton SM, Jeavons S, Tanious M, Kohlmann K, Hewitt K, Moss K, Allwang C, Schapkaitz I, Robbins J, Cobb H, Ng F, Dodd S, Bush AI, Malhi GS | title = The efficacy of adjunctive ''N''-acetylcysteine in major depressive disorder: a double-blind, randomized, placebo-controlled trial | journal = The Journal of Clinical Psychiatry | volume = 75 | issue = 6 | pages = 628–636 | date = June 2014 | pmid = 25004186 | doi = 10.4088/JCP.13m08454 | title-link = doi | doi-access = free }}</ref><ref name="''N''-acetyl cysteine in the treatment">{{cite journal | vauthors = Oliver G, Dean O, Camfield D, Blair-West S, Ng C, Berk M, Sarris J | title = ''N''-acetyl cysteine in the treatment of obsessive compulsive and related disorders: a systematic review | journal = Clinical Psychopharmacology and Neuroscience | volume = 13 | issue = 1 | pages = 12–24 | date = April 2015 | pmid = 25912534 | pmc = 4423164 | doi = 10.9758/cpn.2015.13.1.12 }}</ref><ref name = BBA>{{cite journal | vauthors = Samuni Y, Goldstein S, Dean OM, Berk M | title = The chemistry and biological activities of ''N''-acetylcysteine | journal = Biochimica et Biophysica Acta (BBA) - General Subjects | volume = 1830 | issue = 8 | pages = 4117–4129 | date = August 2013 | pmid = 23618697 | doi = 10.1016/j.bbagen.2013.04.016 | hdl-access = free | s2cid = 2567773 | hdl = 11343/43874 }}</ref> Tentative evidence also supports use in ].<ref name="''N''-acetylcysteine in the treatment o">{{cite journal | vauthors = Minarini A, Ferrari S, Galletti M, Giambalvo N, Perrone D, Rioli G, Galeazzi GM | title = ''N''-acetylcysteine in the treatment of psychiatric disorders: current status and future prospects | journal = Expert Opinion on Drug Metabolism & Toxicology | volume = 13 | issue = 3 | pages = 279–292 | date = March 2017 | pmid = 27766914 | doi = 10.1080/17425255.2017.1251580 | hdl-access = free | s2cid = 20873065 | hdl = 11380/1116466 }}</ref>
==External links==
* CIMS India database ""
* N-acetylcysteine replenishes glutathione in HIV infection. ""
*{{Cite journal |last1=Stanislaus |first1=Romesh |last2=Gilg |first2=Anne G |last3=Singh |first3=Avtar K |last4=Singh |first4=Inderjit |title=N-acetyl-L-cysteine ameliorates the inflammatory disease process in experimental autoimmune encephalomyelitis in Lewis rats. |journal=Journal of Autoimmune Diseases |volume=2 |issue=1 |pages=4 |year=2005 |pmid=15869713 |pmc=1097751 |doi=10.1186/1740-2557-2-4}}
* British National Formulary 55, March 2008; ISBN 978-0-85369-776-3
*
*


It is also being studied for use as a treatment of ].<ref name=hwang2022>{{cite journal | vauthors = Hwang AS, Campbell EH, Sartori-Valinotti JC | title = Evidence of ''N''-acetylcysteine efficacy for skin picking disorder: A retrospective cohort study | journal = Journal of the American Academy of Dermatology | volume = 87 | issue = 1 | pages = 148–150 | date = July 2022 | pmid = 34224772 | doi = 10.1016/j.jaad.2021.06.874 | s2cid = 235746237 | doi-access = free }}</ref><ref name="pmid35647220">{{cite journal | vauthors = Popova L, Mancuso J | title = Dramatic Improvement of Trichotillomania with 6 Months of Treatment With ''N''-acetylcysteine | journal = Global Pediatric Health | volume = 9 | pages = 2333794X221086576 | year = 2022 | pmid = 35647220 | pmc = 9133858 | doi = 10.1177/2333794X221086576 }}</ref>
{{Cough and cold preparations}}

{{Antioxidants}}
====Addiction====
Evidence to date does not support the efficacy for ''N''-acetylcysteine in treating ]s to ], ], or ].<ref name="pmid25957927" /> Based upon limited evidence, NAC appears to normalize ] ] in the ] and other brain structures, in part by ] the expression of ] (EAAT2), {{aka}} glutamate transporter 1 (GLT1), in individuals with addiction.<ref name="pmid24442756">{{cite journal | vauthors = McClure EA, Gipson CD, Malcolm RJ, Kalivas PW, Gray KM | title = Potential role of ''N''-acetylcysteine in the management of substance use disorders | journal = CNS Drugs | volume = 28 | issue = 2 | pages = 95–106 | date = February 2014 | pmid = 24442756 | pmc = 4009342 | doi = 10.1007/s40263-014-0142-x }}</ref> While NAC has been demonstrated to modulate glutamate neurotransmission in adult humans who are addicted to ], NAC does not appear to modulate glutamate neurotransmission in healthy adult humans.<ref name="pmid24442756" /> NAC has been hypothesized to exert beneficial effects through its modulation of glutamate and dopamine neurotransmission as well as its antioxidant properties.<ref name="pmid23369637"/>

====Bipolar disorder====
In ], ''N''-acetylcysteine has been repurposed as an augmentation strategy for depressive episodes in light of the possible role of inflammation in the pathogenesis of ]. 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">{{cite journal | vauthors = Nery FG, Li W, DelBello MP, Welge JA | title = ''N''-acetylcysteine as an adjunctive treatment for bipolar depression: A systematic review and meta-analysis of randomized controlled trials | journal = Bipolar Disorders | volume = 23 | issue = 7 | pages = 707–714 | date = November 2021 | pmid = 33354859 | doi = 10.1111/bdi.13039 | s2cid = 229692736 }}</ref>

=== COVID-19 ===
Acetylcysteine has been studied as a possible treatment for ].<ref name="pmid34262324">{{cite journal | vauthors = Wong KK, Lee SW, Kua KP | title = ''N''-acetylcysteine as Adjuvant Therapy for COVID-19 - A Perspective on the Current State of the Evidence | journal = Journal of Inflammation Research | volume = 14 | issue = | pages = 2993–3013 | year = 2021 | pmid = 34262324 | pmc = 8274825 | doi = 10.2147/JIR.S306849 | doi-access = free }}</ref><ref name="pmid34182881">{{cite journal | vauthors = Assimakopoulos SF, Aretha D, Komninos D, Dimitropoulou D, Lagadinou M, Leonidou L, Oikonomou I, Mouzaki A, Marangos M | title = ''N''-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study | journal = Infectious Diseases | volume = 53 | issue = 11 | pages = 847–854 | date = November 2021 | pmid = 34182881 | doi = 10.1080/23744235.2021.1945675 | s2cid = 235673520 }}</ref><ref name="pmid35433335">{{cite journal | vauthors = Kapur A, Sharma M, Sageena G | title = Therapeutic potential of ''N''-acetyl cysteine during COVID-19 epoch | journal = World Journal of Virology | volume = 11 | issue = 2 | pages = 104–106 | date = March 2022 | pmid = 35433335 | pmc = 8966593 | doi = 10.5501/wjv.v11.i2.104 | doi-access = free }}</ref>

A combination of ] and ''N''-acetylcysteine has been found to lift the "]" of eight patients with ], according to researchers, but the results are inconclusive and have not been confirmed by other studies.<ref name="Fesharaki-Zadeh-2022">{{cite journal | vauthors = Fesharaki-Zadeh A, Lowe N, Arnstien A | title = Clinical experience with the α2A-adrenoceptor agonist, guanfacine, and ''N''-acetylcysteine for the treatment of cognitive deficits in "Long-COVID19" | journal = Neuroimmunology Reports | volume= 3 | issue = 3 | date = 2022 | page = 100154 | doi = 10.1016/j.nerep.2022.100154 | doi-access = free }}</ref>

A combination of ] and ''N''-acetylcysteine is suspected to have potential to safely replenish depleted ] levels in COVID-19 patients.<ref name="pmid35052554">{{cite journal | vauthors = Kumar P, Osahon O, Vides DB, Hanania N, Minard CG, Sekhar RV | title = Severe Glutathione Deficiency, Oxidative Stress and Oxidant Damage in Adults Hospitalized with COVID-19: Implications for GlyNAC (Glycine and ''N''-Acetylcysteine) Supplementation | journal = Antioxidants | volume = 11 | issue = 1 | pages = 50 | date = December 2021 | pmid = 35052554 | pmc = 8773164 | doi = 10.3390/antiox11010050 | doi-access = free }}</ref>

== External links ==
* {{commonscat-inline}}
== References ==
{{Reflist}}

{{Portal bar|Medicine}}
{{Antidotes}} {{Antidotes}}
{{Antioxidants}}
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{{Cough and cold preparations}}
{{Glutamatergics}}


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