Overview

N-acetyl cysteine comes from the amino acid L-cysteine. Amino acids are the building blocks of proteins. N-acetyl cysteine has many uses as medicine.

N-acetyl cysteine is most commonly used by mouth for cough and other lung conditions. It is also used for flu, dry eye, and many other conditions, but there is no good scientific evidence to support many of these uses.

Healthcare providers give N-acetyl cysteine by IV for conditions such as acetaminophen (Tylenol) overdose. It is also given by IV to reduce nitrate tolerance.

Classification

Is a Form of:

Amino acid

Primary Functions:

Cough, lung conditions

Also Known As:

Acetyl Cysteine, Acétyl Cystéine, Acetylcysteine

How Does It Work?

N-acetyl cysteine treats acetaminophen (Tylenol) poisoning by binding the poisonous forms of acetaminophen that are formed in the liver. It is also an antioxidant, so it may play a role in preventing cancer.

Uses

• Acetaminophen (Tylenol) poisoning. N-acetyl cysteine is effective in reducing the death rate and preventing the permanent harm caused by acetaminophen poisoning. For this use, N-acetyl cysteine given by mouth is as effective as N-acetyl cysteine given intravenously (by IV).
• Complete or partial lung collapse (atelectasis). N-acetyl cysteine helps treat collapsed lungs caused by mucus blockage.
• Lung tests. N-acetyl cysteine is helpful when used to prepare people for diagnostic lung tests.
• Care of people with a tube placed in their windpipe (tracheostomy care). N-acetyl cysteine helps prevent crusting in people with a tube in their windpipe.
• Chest pain (angina). Taking N-acetyl cysteine by mouth or injecting it intravenously (by IV) seems to improve chest pain when used with the drug nitroglycerin. Intravenous N-acetyl cysteine seems to help prevent nitroglycerin tolerance. Taking N-acetyl cysteine by mouth might also help prevent nitroglycerin tolerance, but results are conflicting.
• Autism. Some research shows that taking N-acetyl cysteine by mouth improves irritability in children and adolescents with autism. But N-acetyl cysteine doesn't seem to improve other autism symptoms such as hyperactivity, social withdrawal, lethargy, repetitive behaviors, and inappropriate speech.
• Swelling (inflammation) of the main airways in the lung (bronchitis). Taking N-acetyl cysteine by mouth seems to reduce shortness of breath and coughing in people with air passage swelling due to mustard gas exposure. Also, taking N-acetyl cysteine by mouth for 3-6 months seems to prevent flare-ups in people with persistent air passage swelling. However, taking it for less time does not seem to be effective.
• A lung disease that makes it harder to breathe (chronic obstructive pulmonary disease or COPD). Taking N-acetyl cysteine by mouth seems to decrease flare-ups by about 40% and improve sputum (phlegm) consistency in people with moderate to severe COPD. It seems to work best in people who are not already taking corticosteroids. However, it might increase the risk of blockage of the breathing tube.
• Kidney damage caused by contrast dyes (contrast induced nephropathy). Research shows that taking N-acetyl cysteine by mouth, with or without other drugs, helps prevent kidney problems caused by dyes used during some X-ray exams in people with poor kidney function It does not seem to lower the risk of kidney problems caused by dyes used during X-ray exams in people with normal kidney function or people with diabetes.
• Serious kidney disease (end-stage renal disease or ESRD). Taking N-acetyl cysteine by mouth seems to help prevent problems, such as heart attack and stroke, in people with serious kidney disease. The risk reduction can be as much as 40%. However, N-acetyl cysteine doesn't reduce the overall risk of death or the risk of death from heart disease in these people.
• Seizure disorder (epilepsy). Taking N-acetyl cysteine by mouth seems to help treat a certain type of epilepsy seizure.
• High levels of homocysteine in the blood (hyperhomocysteinemia). Taking N-acetyl cysteine by mouth seems to reduce homocysteine levels, a possible risk factor for heart disease.
• High levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia). Taking N-acetyl cysteine by mouth seems to reduce levels of a blood fat called lipoprotein(a) in people with high levels of this blood fat.
• Toxicity in people taking the cancer drug ifosfamide (Ifex). Taking N-acetyl cysteine by mouth seems to help prevent side effects of ifosfamide (Ifex). This drug is used for certain types of cancer. But the drug mesna (Mesnex) seems to work better than N-acetyl cysteine.
• Flu (influenza). Taking N-acetyl cysteine by mouth seems to reduce flu symptoms.
• Heart attack. Giving N-acetyl cysteine intravenously (by IV) along with the drug nitroglycerin seems to help maintain heart function and reduces heart damage in people having a heart attack. Sometimes the drug streptokinase is also used along with N-acetyl cysteine and nitroglycerin.

Recommended Dosing

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:

• For acetaminophen (Tylenol) overdose: 140 mg/kg of N-acetyl cysteine at first, followed by 70 mg/kg every 4 hours for 3 days or until acetaminophen is no longer detected in the blood.
• For swelling (inflammation) of the main airways in the lung (bronchitis): Doses of 200 mg twice daily, 200 mg three times daily, 300 mg slow-release twice daily, and 600 mg controlled-release twice daily have been used for up to 6 months. Doses up to 1.5 grams per day for up to 4 months have also been used.
• For a lung disease that makes it harder to breathe (chronic obstructive pulmonary disease or COPD): 400-1200 mg of N-acetyl cysteine daily in divided doses, in addition to standard care, has been used for up to 6 months.
• For preventing kidney damage caused by contrast dyes (contrast induced nephropathy): 400-600 mg of N-acetyl cysteine twice daily on the day before and on the day of iopromide administration, with IV saline for 12 hours before and 12 hours after iopromide administration. Also, a starting dose of 1200 mg of N-acetyl cysteine, followed by 1200 mg twice daily thereafter for 48 hours after dye has also been used.
• For a lung disease that leads to scarring and thickening of the lung (idiopathic interstitial pneumonia): 600 mg of N-acetyl cysteine three times daily for 12 weeks.
• For preventing toxicity in people taking the cancer drug ifosfamide (Ifex): 1-3 grams of N-acetyl cysteine every 6 hours beginning one hour before ifosfamide treatment and continuing for up to 5 days after treatment.
• For reducing high levels of homocysteine in the blood (hyperhomocysteinemia): 600-1200 mg of N-acetyl cysteine daily.
• For seizure disorder (epilepsy): 4-6 grams daily.
• For reducing flu (influenza): 600 mg twice daily for up to 30 months.
• For reducing the risk of heart attacks and strokes in people with serious kidney disease (end-stage renal disease or ESRD): 600 mg twice daily.
• For high levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia): 1.2 grams daily for 6 weeks or 2 grams daily for 4 weeks followed by 4 grams daily for another 4 weeks.

BY INHALATION:

• For complete or partial lung collapse (atelectasis): 3-5 mL of 20% solution or 6-10 mL of 10% solution administered using a nebulizer 3-4 times per day. The solution may also be administered through a tracheostomy at a dose of 1-2 mL of 10% or 20% solution every 1-4 hours. The solution may also be administered through a tracheal catheter at a dose of 1-2 mL of 20% solution or 2-4 mL of 10% solution every 1-4 hours.
• For lung tests: 1-2 mL of 20% solution or 2-4 mL of 10% solution administered via intratracheal instillation 2-3 times prior to the diagnostic test.
• For a lung disease that makes it harder to breathe (chronic obstructive pulmonary disease or COPD): 20% solution administered via a nebulizer for at least 4 days.
• For care of people with a tube placed in their windpipe (tracheostomy care): 1-2 mL of 10-20% solution administered via intratracheal instillation.

BY INTRAVENOUS (IV) INJECTION:

• For acetaminophen (Tylenol) overdose: Healthcare providers give N-acetyl cysteine intravenously (by IV) for acetaminophen poisoning. Dosing is usually 150 mg/kg initially followed by 50 mg/kg over 4 hours, followed by 100 mg/kg over 16 hours or until acetaminophen levels are no longer detected.
• For preventing kidney damage caused by contrast dyes (contrast induced nephropathy): 900 mg before and after dye. Also, 1200 mg by IV before giving an oral dose of N-acetyl cysteine 1200 mg twice daily has also been used.
• For heart attack: 100 mg/kg six times daily with the drug streptokinase. Also, 10 mg/min for the first hour, followed by 20 mg/min for 23 hours with nitroglycerin has also been used, with or without streptokinase. In addition, 15 grams along with streptokinase over 24 hours has been used.

CHILDREN

BY MOUTH:

• For acetaminophen (Tylenol) overdose: 140 mg/kg initially followed by 70 mg/kg every 4 hours for 72 hours or until acetaminophen is no longer detected in the body.
• For autism: 900 mg daily for 4 weeks followed by 900 mg twice daily for 4 weeks followed by 900 mg three times daily for 4 weeks. Taking 1200 mg daily with the drug risperidone for 8 weeks has also been used.

BY INHALATION:

• For complete or partial lung collapse (atelectasis): 3-5 mL of 20% solution or 6-10 mL of 10% solution administered using a nebulizer three to four times per day. The solution may also be administered through a tracheostomy at a dose of 1-2 mL of 10% or 20% solution every 1-4 hours. The solution may also be administered through a tracheal catheter at a dose of 1-2 mL of 20% solution or 2-4 mL of 10% solution every 1-4 hours.
• For lung tests: 1-2 mL of 20% solution or 2-4 mL of 10% solution administered via intratracheal instillation 2-3 times prior to the diagnostic test.
• For care of people with a tube placed in their windpipe (tracheostomy care): 1-2 mL of 10% or 20% solution administered via intratracheal instillation.

N – Acetyl Cysteine (NAC) Supplements Frequently Asked Questions

Is NAC safe to take daily?

Twice daily administration or three times daily administration is commonly recommended by the manufactures. There is no recommended daily allowance for NAC, because unlike vitamins, it's not an essential nutrient. The dosage used to prevent radio contrast dye damage is 600 mg to 1200 mg every 12 hours for 48 hours.

What are the side effects of taking NAC?

Common side effects of acetylcysteine solution include:

• inflammation of the mouth,
• nausea,
• vomiting,
• fever,
• runny nose,
• drowsiness,
• clamminess,
• chest tightness,

Is NAC good for lungs?

NAC (N-Acetylcysteine)

NAC is an antioxidant supplement that has shown promise in some studies but not in others. "NAC is a robust treatment for COPD that reduces phlegm and cough, thins mucus, and eases expectoration," says Mikolai. It's said to decrease the deterioration of lung function.

How long does it take for NAC supplement to work?

56% of subjects reported "much or very much improved" on NAC compared to 16% on placebo (sugar pill or inert substance). Significant improvement was initially noted after 9 weeks of treatment.

Who should not take NAC?

When inhaled, it can cause swelling in the mouth, runny nose, drowsiness and chest tightness. People with bleeding disorders or taking blood thinning medications should not take NAC, as it may slow blood clotting. NAC has an unpleasant smell that makes it hard to consume.

Is NAC hard on the kidneys?

N-Acetylcysteine (NAC) has been reported to protect the kidney from injury induced by contrast media, ischemia, and toxins. In all these studies, glomerular filtration rate (GFR) is the surrogate marker of kidney injury and serum creatinine changes are the measured metric of GFR.

Can NAC cause liver damage?

The liver is responsible for the metabolism of carbohydrate, lipid and protein; these processes are all interlinked [14], therefore, prolonged treatment with a high dose of NAC may interfere with hepatic normal metabolic functions and impairs liver recovery from APAP hepatotoxicity.

What is NAC supplement good for?

As a prescription drug, doctors use NAC to treat acetaminophen overdose. It may also help break up mucus in people with some lung diseases, like chronic bronchitis. As a supplement, some people use NAC to try to protect the liver. There's evidence it can help prevent kidney or neurologic damage caused by some drugs.

Can NAC be harmful?

Side Effects

NAC is likely safe for adults when provided as a prescription medication. However, high amounts may cause nausea, vomiting, diarrhea and constipation ( 47 ). When inhaled, it can cause swelling in the mouth, runny nose, drowsiness and chest tightness.

Does NAC help anxiety?

On a clinical level, in day-to-day work with patients, NAC seems to help with ruminations, with difficult-to-control extreme negative self-thoughts. Such thoughts are common in depression and anxiety disorders, and also in eating disorders, schizophrenia, OCD, etc.

Can NAC be taken long term?

Hypothesis: Long-term oral N-acetylcysteine can reduce the frequency of acute exacerbations of patients with non-cystic fibrosis bronchiectasis and improve their quality of life. ... Patients were randomly assigned to receive oral N-acetylcysteine (600 mg, twice daily, 12 months) or on-demand treatment.

Can NAC be taken at night?

I typically take it for about 4 weeks every night before bed. It works great, and it helps restore my health. I find that I feel better faster after an illness by taking it. Just so you know, NAC binds to Tylenol and flushes it out of the liver.

Does NAC make you sleepy?

NAC is available as an oral solution as well as intravenous and inhaled preparations. With regard to side effects, oral or inhaled NAC has been associated with drowsiness, stomatitis, clamminess, rhinorrhea, and hemoptysis.

Does NAC help with sleep?

Results: In the patients of NAC group, compared to their baseline values, slow wave sleep as sleep percent time (27.9 +/- 2.7 vs 42.3 +/- 4.2; p < 0.01) and sleep efficiency (90.8 +/- 1.3 vs 94.4 +/- 1.5; p < 0.05) improved considerably.

Does NAC raise blood pressure?

A diet high in salt or sugar, and low in antioxidants and protein, has been implicated in hypertension. Studies using dietary supplementation of the cysteine analogue N-acetylcysteine (NAC) have shown that, overall, it prevents or attenuates increased blood pressure in animal models of hypertension (22–33).

Does NAC help fatty liver?

Conclusions. N-acetylcysteine can improve liver function in patients with non-alcoholic fatty liver disease. Better results may be achievable in a longer follow up.

Does NAC kill viruses?

The antioxidant N-acetyl-L-cysteine (NAC) had been shown to inhibit replication of seasonal human influenza A viruses. Here, the effects of NAC on virus replication, virus-induced pro-inflammatory responses and virus-induced apoptosis were investigated in H5N1-infected lung epithelial (A549) cells.

Is NAC a blood thinner?

People with bleeding disorders or taking blood thinning medications should not take NAC, as it may slow blood clotting. Summary While NAC is considered safe as a prescription medication, it can cause nausea, vomiting, gastrointestinal disturbances, as well as mouth issues if inhaled.

Does NAC interact with medications?

NAC may strengthen the effect of nitroglycerin and isosorbide (Isordil), two medications commonly used to treat chest pain. But this combination may also raise the risk of side effects, such as severe headaches, and may lead to abnormally low blood pressure.

Does NAC cause body odor?

The odor you smell is likely from the sulfur that is part of NAC (N-acetyl-cysteine) — this is normal. In our NAC Supplements Review, capsules with twice as much NAC as in VitaPulse sell for as little as 10 to 20 cents.

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