From the Guidelines
N-acetylcysteine (NAC) is currently being tested for its safety and tolerability in patients with ovarian cancer receiving platinum-based chemotherapeutic agents, and may be a potential treatment for brain fog after chemotherapy, but its effectiveness is still under investigation. The most recent study published in the BMJ in 2023 1 discusses the emerging treatments for cognitive impairment after cancer treatment, including NAC. Although the evidence is limited, NAC has shown potential as an antioxidant and precursor to glutathione, which could protect brain cells from oxidative damage caused by chemotherapy.
- A typical dosage of NAC ranges from 600-1800 mg daily, divided into 2-3 doses, but it is essential to consult with an oncologist before starting NAC to ensure it won't interfere with cancer treatment or other medications.
- NAC may also reduce inflammation that contributes to cognitive symptoms, and combining it with other brain-supporting strategies like adequate sleep, physical exercise, cognitive activities, and a nutrient-rich diet may lead to better results.
- It is crucial to note that individual responses to NAC may vary, and it may take several weeks of consistent use to notice improvements.
- Other non-drug therapeutic avenues under investigation for brain fog after chemotherapy include brain training, physical brain stimulation, and exercise, which aim to improve cognition by augmenting neuroplasticity and reducing inflammatory biomarkers 1.
From the Research
NAC for Brain Fog after Chemo
- N-acetylcysteine (NAC) has been studied for its potential to ameliorate chemotherapy-induced cognitive impairment, including brain fog 2, 3.
- A study published in Behavioural brain research found that NAC treatment ameliorated methotrexate-induced anxiety and depression-like behaviors in rats, and increased antioxidant capacity, reduced oxidative stress and inflammatory response, and regulated acetylcholinesterase activity and brain-derived neurotrophic factor release 2.
- A narrative review published in Annals of translational medicine discussed the risk factors and interventions for cancer-related cognitive impairment, including the use of antioxidants such as NAC, and suggested that NAC may be beneficial in alleviating cancer-related cognitive impairment symptoms 3.
- Other studies have also explored the potential benefits of NAC in neurodegenerative diseases, including its antioxidant and anti-inflammatory activities, and its potential to counteract cognitive aging and dementia 4, 5.
Potential Mechanisms of Action
- NAC's potential mechanisms of action in reducing brain fog after chemo include its antioxidant and anti-inflammatory activities, as well as its ability to regulate acetylcholinesterase activity and brain-derived neurotrophic factor release 2, 4.
- NAC may also have a role in reducing oxidative stress and inflammatory response, which are thought to contribute to chemotherapy-induced cognitive impairment 2, 3.
Clinical Usefulness
- NAC has been reviewed for its clinical usefulness in a number of medical conditions, including cancer-related cognitive impairment, and has been found to be a safe, simple, and inexpensive intervention 5.
- A study published in Journal of neuro-oncology found that NAC chemoprotection did not alter cisplatin therapy, if delayed until 4 h after chemotherapy, and suggested that delayed NAC may be useful in reducing ototoxicity in children with localized pediatric cancers 6.