From the Guidelines
N-acetyl cysteine (NAC) is not typically used in the treatment of hiatal issues, but it may be used in certain cases of liver disease, such as acetaminophen overdose or non-acetaminophen-associated acute liver failure (ALF), as an adjunctive treatment to improve outcomes. The use of NAC in these cases is based on its antioxidant properties and its ability to regulate glutamate levels, which can help reduce oxidative stress and improve liver function. According to the American Gastroenterological Association Institute guidelines for the diagnosis and management of acute liver failure 1, NAC is recommended for use in patients with acetaminophen-associated ALF, but its use in non-acetaminophen-associated ALF is only recommended in the context of clinical trials.
In cases of acetaminophen overdose, NAC has been shown to be effective in reducing hepatotoxicity and improving survival rates 1. The typical dosage of NAC in these cases is 150 mg/kg intravenously over 1 hour, followed by 50 mg/kg over 4 hours, and then 100 mg/kg over 16 hours. However, the use of NAC in hiatal issues, such as hiatal hernia or gastroesophageal reflux disease (GERD), is not supported by the evidence.
Some studies have investigated the use of NAC in other liver diseases, such as alcoholic hepatitis, but the evidence is limited and inconclusive 1. In the management of liver diseases in pregnancy, NAC may be considered in certain cases, such as acute fatty liver of pregnancy, but the evidence is limited and more research is needed to determine its effectiveness 1.
- Key points to consider when using NAC in liver disease include:
- Dosage: The typical dosage of NAC varies depending on the specific condition being treated, but it is often administered intravenously or orally at a dose of 600-1200 mg daily.
- Side effects: NAC is generally well-tolerated, but it can cause mild side effects such as nausea, vomiting, or diarrhea.
- Interactions: NAC may interact with certain medications, such as antibiotics or nitroglycerin, and patients should consult with a healthcare provider before starting treatment.
- Monitoring: Patients receiving NAC should be monitored closely for signs of liver improvement or worsening, as well as for any potential side effects.
From the FDA Drug Label
Acetylcysteine has been shown to reduce the extent of liver injury following acetaminophen overdose Acetylcysteine probably protects the liver by maintaining or restoring the glutathione levels, or by acting as an alternate substrate for conjugation with, and thus detoxification of, the reactive metabolite. Acetylcysteine solution, USP administered orally, is indicated as an antidote to prevent or lessen hepatic injury which may occur following the ingestion of a potentially hepatotoxic quantity of acetaminophen.
N-acetyl cysteine is used in hepatology (also known as hepatology or liver disease) as an antidote to prevent or lessen hepatic injury following acetaminophen overdose 2 2.
- The primary use is to counteract the toxic effects of acetaminophen on the liver.
- It is essential to initiate treatment as soon as possible after the overdose.
From the Research
Use of N-Acetyl Cysteine in Psychiatry
- N-Acetyl Cysteine (NAC) has been investigated as a potential treatment for various psychiatric disorders, including depression, bipolar disorder, schizophrenia, and anxiety disorders 3, 4, 5, 6, 7.
- The evidence suggests that NAC may have a beneficial effect as an adjuvant agent in the treatment of depressive symptoms in bipolar disorder, with studies showing significant improvements in depressive symptoms and functional outcomes 3, 7.
- NAC has also been shown to have potential benefits in the treatment of other psychiatric disorders, including schizophrenia, obsessive-compulsive disorder, and substance-use disorders, although the evidence is not yet conclusive 4, 5, 6.
- The mechanisms underlying the potential therapeutic effects of NAC in psychiatric disorders are thought to include its antioxidant, anti-inflammatory, and glutamate modulation activity, as well as its ability to regulate neurotransmitters and inflammatory mediators 4, 5, 6.
- Further research is needed to fully establish the efficacy and safety of NAC as a treatment for psychiatric disorders, with larger, well-powered studies and longer follow-up periods required to confirm the preliminary positive findings 3, 4, 5, 6, 7.