N-Acetylcysteine

NAC is a precursor to L-cysteine and glutathione (master antioxidant). PROVEN life-saving for acetaminophen overdose. B-grade evidence for respiratory conditions (bronchitis, COPD) and blood glucose in PCOS. Widely studied for psychiatric conditions (OCD, addiction, depression) but evidence is mixed. Acts as mucolytic, antioxidant, and glutathione precursor. FDA controversially questioned its supplement status in 2020 but enforcement relaxed. Generally safe but may have pro-oxidant effects at very high doses. One of the most researched nutraceuticals.

Quick Answer

What it is

NAC is a precursor to L-cysteine and glutathione (master antioxidant). PROVEN life-saving for acetaminophen overdose.

Key findings

  • Grade B: Blood glucose (Polycystic Ovary Syndrome (PCOS))
  • Grade B: Bronchitis Symptoms (Chronic Obstructive Pulmonary Disease (COPD))
  • Grade B: Autism Symptoms (Autism Spectrum Disorder (ASD))

Safety

No specific caution or interaction language was detected in the current summary/outcome notes.

ℹ️ Quick Facts: N-Acetylcysteine

Quick Facts: N-Acetylcysteine

  • Best Evidence:Grade B
  • Conditions Studied:27
  • Research Outcomes:72
  • Grade B Findings:5
  • Key Effect:Chronic Obstructive Pulmonary Disease (COPD)
Outcomes by grade:
A0
B5
C4
D9
27 conditions Β· 72 outcomes

Detailed Outcomes

Grade:
Effect:
Size:
Sort:
|
B
Blood glucose
Small Improvement
11 studies
small↓Improves
?
Body Mass Index (BMI)
↓Improves
?
Endometrial Thickness
11 studies
↑Improves
?
Estrogen
8 studies
↑Worsens
?
Luteinizing Hormone
8 studies
↑Improves
?
Weight
7 studies
↓Improves
?
Follicle-Stimulating Hormone
6 studies
↑Improves
?
Testosterone
↑Improves
?
Progesterone
5 studies
↑Improves
?
High-density lipoprotein (HDL)
4 studies
↑Improves
?
Low-density lipoprotein (LDL)
4 studies
↓Improves
?
Sex Hormone Binding Globulin
4 studies
↑Improves
?
Total cholesterol
4 studies
↓Improves
?
Triglycerides
4 studies
↓Improves
B
Bronchitis Symptoms
Small Improvement
small↓Improves
D
Chronic Bronchitis
No effect
11 studies
none
?
COPD Symptoms
↓Improves
?
Glutathione (GSH)
6 studies
↑Improves
?
Lung Function
1 study
↑Improves
?
Neutrophil Activity
↑Improves
B
Bronchitis Symptoms
Small Improvement
small↓Improves
?
Chronic Bronchitis
11 studies
↑Improves
B
Bronchitis Symptoms
Small Improvement
small↓Improves
?
Chronic Bronchitis
11 studies
↑Improves
B
Autism Symptoms
Small Improvement
2 studies
small↓Improves
?
Irritability
↓Improves
C
COPD Symptoms
Small Improvement
small↓Improves
?
Neutrophil Activity
↑Improves
C
Anaerobic Capacity
Small Improvement
small↑Improves
?
Anti-Oxidant Enzyme Profile
1 study
↑Improves
?
Mineral Bioaccumulation
↑Improves
C
Anaerobic Capacity
Small Improvement
small↑Improves
?
Power Output
1 study
↑Improves
C
Cocaine Addiction Symptoms
Small Improvement
small↓Improves
?
Tobacco Addiction Symptoms
↓Improves
D
All-Cause Mortality
No effect
none
?
Length of hospitalization
↓Improves
?
Kidney Function
↑Improves
?
Heart Attack Risk
11 studies
↑Worsens
?
Heart Arrhythmias
10 studies
↑Worsens
?
Liver Enzymes
↑Worsens
D
All-Cause Mortality
No effect
none
?
Length of hospitalization
↓Improves
D
Anxiety Symptoms
No effect
3 studies
none
?
Depression Symptoms
↓Improves
D
Pain
No effect
none
?
Quality of Life
2 studies
↑Improves
D
Anxiety Symptoms
No effect
3 studies
none
?
Depression Symptoms
↓Improves
D
Processing Speed
No effect
3 studies
none
?
Schizophrenia symptoms
↓Improves
?
Working Memory
3 studies
↑Improves
D
Anxiety Symptoms
No effect
2 studies
none
?
Depression Symptoms
↓Improves
D
Anxiety Symptoms
No effect
1 study
none
?
Depression Symptoms
↓Improves
?
Subjective Well-Being
1 study
↑Improves
?
Trichotillomania Symptoms
↓Improves
?
Kidney Function
↑Improves
?
Helicobacter Pylori Infection Signs
↑Improves
?
Helicobacter Pylori Infection Signs
↑Improves
?
Liver Enzymes
↑Worsens
?
Hearing Loss
↑Improves
?
Hearing Loss
↑Improves
?
Hearing Loss
↑Improves
?
Acne Symptoms
1 study
↓Improves
?
Marijuana Addiction
↑Improves
?
Urinary NOx
↑Improves
?
Urinary NOx
↑Improves
?
Cocaine Addiction Symptoms
↓Improves
?
OCD Symptoms
↓Improves
?
Tobacco Addiction Symptoms
↓Improves

Evidence by Condition

Best grade per condition (each condition may have multiple outcomes)

BChronic Obstructive Pulmonary Disease (COPD)
1
↓Bronchitis SymptomsImprovesChronic Bronchitis↓COPD SymptomsImproves
BAutism Spectrum Disorder (ASD)
1
↓Autism SymptomsImproves↓IrritabilityImproves
BPolycystic Ovary Syndrome (PCOS)
1
↓Blood glucoseImproves↓Body Mass Index (BMI)Improves↑Endometrial ThicknessImproves
BAcute Bronchitis
1
↓Bronchitis SymptomsImproves↑Chronic BronchitisImproves
CTrichotillomania (Hair Pulling)
2
Anxiety Symptoms↓Depression SymptomsImproves↑Subjective Well-BeingImproves
CImmune Health
1
↓COPD SymptomsImproves↑Neutrophil ActivityImproves
CMetabolic Health
1
↑Anaerobic CapacityImproves↑Anti-Oxidant Enzyme ProfileImproves↑Mineral BioaccumulationImproves
CSoccer Performance
1
↑Anaerobic CapacityImproves↑Power OutputImproves
CSubstance Use Disorder
1
↓Cocaine Addiction SymptomsImproves↓Tobacco Addiction SymptomsImproves
CCannabis Use Disorder
1
↑Marijuana AddictionImproves
DBipolar Disorder
1
Anxiety Symptoms↓Depression SymptomsImproves
DSurgical Recovery
1
All-Cause Mortality↓Length of hospitalizationImproves↑Kidney FunctionImproves
DDepression
1
Anxiety Symptoms↓Depression SymptomsImproves
DChronic pain
1
Pain↑Quality of LifeImproves
DMajor Depressive Disorder (MDD)
1
Anxiety Symptoms↓Depression SymptomsImproves
DSchizophrenia
1
Processing Speed↓Schizophrenia symptomsImproves↑Working MemoryImproves
DAcute Liver Failure
1
All-Cause Mortality↓Length of hospitalizationImproves

Research Citations (34)

Safety and tolerability of N-acetylcysteine in cocaine-dependent individuals
PMID: 16449100
The administration of N-acetylcysteine reduces oxidative stress and regulates glutathione metabolism in the blood cells of workers exposed to lead
PMID: 23731375
N-Acetylcysteine Attenuates Fatigue Following Repeated-Bouts of Intermittent Exercise: Practical Implications for Tournament Situations
PMID: 21896942
N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study
PMID: 19581567
New developments in the treatment of COPD: comparing the effects of inhaled corticosteroids and N-acetylcysteine
PMID: 16204787
Induced sputum of patients with chronic obstructive pulmonary disease (COPD) contains adhesion-promoting, therapy-sensitive factors
PMID: 10778915
N-acetylcysteine add-on treatment in refractory obsessive-compulsive disorder: a randomized, double-blind, placebo-controlled trial
PMID: 23131885
Systematic review and meta-analysis of the efficacy of N-acetylcysteine in the treatment of acute exacerbation of chronic obstructive pulmonary disease.
PMID: 34237968
Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial
PMID: 15866309
Long-term oral n-acetylcysteine reduces exhaled hydrogen peroxide in stable COPD
PMID: 15607126

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