What is N-Acetylcysteine NAC?
Acetylcysteine is one of the main precursors of L-cysteine which is a prominent amino acid in glutathione. NAC is considered as a plant-based antioxidant that is largely found in onion. It is registered as a safe drug for poisoning since the 1960s by WHO. Since then it was used in each every hospital all over the world for paracetamol poisoning. Currently, NAC is considered as safe as cosmetic treatment because of its antioxidant properties.
Mechanism of action of N-Acetylcysteine
The NAC’s mechanism is determined through the glutathione effect. NAC contains a -SH group which has its antioxidant property. Glutathione which presents as GSH in its redox state in body cells. Once body cells engage with oxidative stress due to Reactive Oxygen Species ( ROS ) like hydroxy ions glutathione helps to reduce oxidative stress. Thereby GSH converted into GSSG which is doubled with glutathione ions.
When the body’s oxidative stress increases the GSH molecules contain in cells are decreased. Thereby the body tends to have lots of health issues. Researches showed that health issues like heart diseases, liver damage, and even when a person gets old also have a reduced number of GSH molecules. Therefore it is confirmed that oxidative stress plays a great role in disease control.
Why use N-Acetylcysteine?
From the 1960s NAC is used in medical use. The Food and Drug Administration ( FDA ) committee confirmed that NAC is safe for medical use. NAC is used as a mucolytic and famous as an antidote for acetaminophen toxicity. Not only that NAC can be used each and every poison which generates free radicals like carbon monoxide and X-ray contrast.
Acetylcysteine is used as a compulsory treatment for certain neurological problems and neuropsychiatric manifestations like Parkinson’s disease, schizophrenia, autism, and bipolar affective disorder. As an example researches performed in schizophrenic patients showed that there is a significant deficiency of glutathione and increased oxidative stress in the brain. Several types of research show that there is an NMDA receptor involvement in certain addictions like alcohol, cannabis, cocaine, tobacco, and others. NAC is known as the NMDA receptor modulator and scientists are still trying to elicit whether there is the possibility of using NAC as a treatment for addiction.
One study showed that there’s a significant benefit of using acetylcysteine in cystic fibrosis. Patients with cystic fibrosis showed a reduction in biomarkers of neutrophils inflammation. But these studies still in their budding ages, but there’s a silver line in treatment for cystic fibrosis. Acetylcysteine is also considered as adjuvant therapy with antimicrobial medication. It has the ability to breakdown the biofilm and improves antibiotic permeability. Therefore effective use of antimicrobial drugs is established.
NAC is also confirmed as helpful to delay oocyte aging. This effect is not only because of its antioxidant activity but also the telomerase activation and apoptosis inhibition. Therefore NAC can be used to treat subfertility. This effect gives positive results in invertebrates and also in mammals as well.
NAC also considered using as a sport supplement. As it improves muscle fatigue, athletic performance, and aid muscle recovery. Other than this several preclinical studies show that NAC is very supportive for diseases like Alzheimer’s disease, asthma, inflammatory bowel disease, influenza, obesity and insulin resistance, heavy metal toxicity, ischemic heart disease, diabetic nephropathy, memory impairment, and intrauterine growth retardation.
The use of acetylcysteine as a treatment for cancer is still controversial. But as general rule antioxidants like NAC are able to delay the malignant transformation of cancer cells by reducing ROS and improve cell repair. As an example a study performed on breast cancer, the results show that using NAC in breast cancer can reduce the progression and aggressiveness of the disease and facilitates apoptosis of cancer cells. On the other hand, the doubtful evidence about NAC is when using it after malignant transformation there is a significant increase in the survival rate of cancer cells. In addition to that using NAC helps to reduce the chemo or radiotherapy requirements in cancer patients. But there is evidence that NAC can increase the complications related to chemo and radiotherapy. So the use of acetylcysteine as a treatment for cancer is still debatable.
Because of the ability to fight against harmful environmental substances and increase lifespan NAC is currently using as a dietary supplement. And also it has an ability to increase testosterone levels in males. Thereby NAC is getting more and more attention in the world. There is a significant increase in acetylcysteine production in the pharmaceutical industry as well.
How to use N-Acetylcysteine?
Acetylcysteine tablets are taking orally after dissolving the required amount of water. It’s better to only use prescribed dosage to prevent adverse effects from overdosing. The amount of water used to dissolve tablets is varies with the weight of the person. The general rule is 150 milliliters of water for weight between 19kgs to 60 kgs. Weight above 60 kilograms people can use 300 milliliters of water. But if the person’s weight is less than 19 kilograms it’s better to follow your health care providers’ advice before using it. And the advice is to drink the dissolved water within 2 hours after preparing the solution for maximum effect.
Pregnancy and breastfeeding are not confirmed as affected by the medication. But it’s better to consult your doctor before taking NAC. Acetylcysteine contains sodium, therefore it has a tendency to water retention. If you are advised to restrict salt or if you are having heart failure or kidney failure it’s better to avoid NAC.
And before you are prescribed inform the doctor whether you have any allergies. Because of NAC, there are reported cases of NAC induced allergic reactions. And also inform your doctor about whether you are having gastro-oesophageal reflux disease. Because reflux also can be exaggerated with acetylcysteine.
Nausea, vomiting, diarrhea, fetus, and gastric reflux are common with oral NAC treatment. Acetylcysteine is responsible for causing anaphylactoid reactions in patients who already have a history of bronchial asthma. Because NAC has a tendency to modulate histamine reaction and causing bronchospasms. But these reported incidents mostly minor cases which can be controlled by stopping the drug for some period of time and restart.
1. N Acetylcysteine by Ershad M, Naji A, Vearrier D. ( https://www.ncbi.nlm.nih.gov/books/NBK537183/ )
2. Medical and Dietary Uses of N-Acetylcysteine by Špela Šalamon, Barbara Kramar and Irina Milisav ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562654/#__ffn_sectitle )
3. N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action by Olivia Dean, BSc, PhD, Frank Giorlando, MBBS, BMedSc, and Michael Berk, MBBCh, MMed(Psych), PhD ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/ )