Condition
Acute Liver Failure
Acute liver failure is an emergency in which the liver quickly loses function in someone without prior liver disease, causing confusion, bleeding problems, and sometimes multi-organ failure. N-acetylcysteine has the strongest support, as a hospital standard after acetaminophen overdose, but a pooled analysis of trials found no clear difference in survival when it was used for other causes. That finding rests on very limited evidence, and support for other supplements is moderate at best.
Sources: PMID 39062036
- Supplements studied
- 2
- Graded outcomes
- 2
- People studied
- 469
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Liver Damage Risk Multiple human case reports document acute hepatitis, liver failure, and fatalities following germander ingestion. Neo-clerodane diterpenoids are metabolized by CYP3A4 to reactive compounds that deplete hepatic glutathione and cause hepatocyte damage. These findings led to product bans in France (1992) and FDA warnings. | Worsens (the measure goes up) | Large effect |
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| All-Cause Mortality No effect | NoneNo effect | 1 study | 469 people | |||
| Length of hospitalization | Improves (the measure goes down) | 1 study | 469 people | |||
Studies that measured length of hospitalization | ||||||
Key findings
- Liver Damage RiskWorsens (the measure goes up)
- All-Cause Mortality
The Acute Liver Failure Supportive Care protocol
1 primary supplement · 5 supporting supplements
- N-Acetylcysteine (NAC)Hospital protocol for overdose; oral 600–1,200 mg daily for general liver support (not for acute ALF)
Studies cited
34 studies from PubMed
- Safety and tolerability of N-acetylcysteine in cocaine-dependent individuals
- The administration of N-acetylcysteine reduces oxidative stress and regulates glutathione metabolism in the blood cells of workers exposed to lead
- N-Acetylcysteine Attenuates Fatigue Following Repeated-Bouts of Intermittent Exercise: Practical Implications for Tournament Situations
- N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study
- New developments in the treatment of COPD: comparing the effects of inhaled corticosteroids and N-acetylcysteine
- Induced sputum of patients with chronic obstructive pulmonary disease (COPD) contains adhesion-promoting, therapy-sensitive factors
- N-acetylcysteine add-on treatment in refractory obsessive-compulsive disorder: a randomized, double-blind, placebo-controlled trial
- Systematic review and meta-analysis of the efficacy of N-acetylcysteine in the treatment of acute exacerbation of chronic obstructive pulmonary disease.
- Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial
- Long-term oral n-acetylcysteine reduces exhaled hydrogen peroxide in stable COPD
- The efficacy of -acetylcysteine in chronic obstructive pulmonary disease patients: a meta-analysis.
- Effect of Orally Administered N-Acetylcysteine on Chronic Bronchitis: A Meta-analysis.
- A randomized controlled pilot trial of oral N-acetylcysteine in children with autism
- A randomized double blind placebo controlled clinical trial of N-Acetylcysteine added to risperidone for treating autistic disorders
- N-Acetylcysteine (NAC) inhibits renal nitrite and nitrate reabsorption in healthy subjects and in patients undergoing cardiac surgery: risk of nitric oxide (NO) bioavailability loss by NAC?
- The role of cystine-glutamate exchange in nicotine dependence in rats and humans
- N-acetylcysteine (NAC) in young marijuana users: an open-label pilot study
- N-Acetylcysteine in depressive symptoms and functionality: a systematic review and meta-analysis.
- N-acetylcysteine in the treatment of craving in substance use disorders: Systematic review and meta-analysis.
- Meta-analysis of randomised controlled trials with -acetylcysteine in the treatment of schizophrenia.
- Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration: A Systematic Review and Meta-analysis.
- The efficacy of adjuvant N acetyl cysteine for the eradication of H pylori infections: A systematic review and meta-analysis of randomized clinical trials.
- N-acetylcysteine in the Donor, Recipient, or Both Donor and Recipient in Liver Transplantation: A Systematic Review With Meta-analysis and Trial Sequential Analysis.
- N-acetylcysteine use among patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized trials.
- The effect of N-acetylcysteine on bipolar depression: a systematic review and meta-analysis of randomized controlled trials.
- N-acetylcysteine as an adjunctive treatment for bipolar depression: A systematic review and meta-analysis of randomized controlled trials.
- N-acetylcysteine as an adjunctive treatment for bipolar depression and major depressive disorder: a systematic review and meta-analysis of double-blind, randomized placebo-controlled trials.
- Efficacy and Safety of N-Acetylcysteine for the Management of Chronic Pain in Adults: A Systematic Review and Meta-Analysis.
- The effects of N-acetylcysteine on ovulation and sex hormones profile in women with polycystic ovary syndrome: a systematic review and meta-analysis
- The effects of N-acetylcysteine supplement on metabolic parameters in women with polycystic ovary syndrome: a systematic review and meta-analysis.
- A systematic review and meta-analysis of the efficacy and safety of N-acetylcysteine in preventing aminoglycoside-induced ototoxicity: implications for the treatment of multidrug-resistant TB.
- Effect of N-acetyl-cysteine in prevention of noise-induced hearing loss: a systematic review and meta-analysis of randomized controlled trials.
- Effect of N-acetyl-cysteine treatment on sensorineural hearing loss: a meta-analysis.
- No Significant Beneficial Effects of Intravenous N-Acetylcysteine on Patient Outcome in Non-Paracetamol Acute Liver Failure: A Meta-Analysis of Randomized Controlled Trials.