NAC
n-acetylcysteine
- Most commonly known for acetaminophen overdose
- 100% effective if given within 8 hours of overdose
"NAC is also approved for use in conditions with abnormal viscid or inspissated mucous secretions, such as pneumonia, bronchitis, tracheobronchitis, cystic fibrosis, tracheostomy patients, postoperative pulmonary complications, posttraumatic chest conditions and before diagnostic bronchoscopy to help with mucous plugging. Off-label indications include acute hepatic failure, prevention of contrast-induced nephropathy, and topical treatment of keratoconjunctivitis sicca."n-acetylcysteine
How?
- N-acetylcysteine helps restore reduced glutathione stores in the setting of acetaminophen toxicity
Thus N-acetylcysteine is a reducing agent
- N-acetylcysteine is a mucolytic agent that liquifies mucus by disrupting disulfide bonds; useful in chronic bronchitis / COPD and cystic fibrosis patients
But wait!
The American Association for the Study of Liver Diseases (AASLD) guidelines suggest [...] other potential applications, still in the experimental stage, include NAC being used as an antineoplastic agent as well as for psychiatric conditions like schizophrenia, bipolar disorder, depression, gastrointestinal conditions like hepatorenal syndrome, Helicobacter pylori infections, necrotizing enterocolitis, critical care patients with conditions such as lung injury, cardiac injury, multiorgan dysfunction, sepsis and hematological conditions like sickle cell disease. There are case reports of NAC improving neurological status in patients comatose with carbon monoxide poisoning.[9]
How (part 2)
"NAC also increases oxygen delivery to tissues, increases mitochondrial ATP production, and alters the microvascular tone to increase blood flow and oxygen delivery to the liver and other vital organs" *
* Citation needed
ACG
American College of Gasteroenterology
Summary
- NAC for acetaminophen
- NAC for DILI
- NAC for mucus secretions
- Maybe NAC for other liver pathologies, but less clear
Also
Heme-Onc World
- Besides MESNA, N-acetylcysteine can also be used to prevent hemorrhagic cystitis from cyclophosphamide, ifosfamide use
