Although many dietary supplement products contain N-acetyl cysteine, the U.S. Food and Drug Administration (FDA) states that it is illegal for dietary supplements to contain N-acetyl cysteine. Prescription N-acetyl cysteine products are available for use under the guidance of a healthcare provider.
N-acetyl cysteine is most commonly used by mouth for cough and other lung conditions. It is also used for flu, dry eye, and many other conditions, but there is no good scientific evidence to support many of these uses.
Healthcare providers give N-acetyl cysteine by IV or by mouth for acetaminophen (Tylenol) overdose. It is also given by IV to reduce nitrate tolerance.
How does it work ?
Uses & Effectiveness ?
- Acetaminophen (Tylenol) poisoning. N-acetyl cysteine is effective in reducing the death rate and preventing the permanent harm caused by acetaminophen poisoning. For this use, N-acetyl cysteine given by mouth is as effective as N-acetyl cysteine given intravenously (by IV).
- Complete or partial lung collapse (atelectasis). N-acetyl cysteine helps treat collapsed lungs caused by mucus blockage.
- Lung tests. N-acetyl cysteine is helpful when used to prepare people for diagnostic lung tests.
- Care of people with a tube placed in their windpipe (tracheostomy care). N-acetyl cysteine helps prevent crusting in people with a tube in their windpipe.
Possibly Effective for
- Chest pain (angina). Taking N-acetyl cysteine by mouth or injecting it intravenously (by IV) seems to improve chest pain when used with the drug nitroglycerin. Intravenous N-acetyl cysteine seems to help prevent nitroglycerin tolerance. Taking N-acetyl cysteine by mouth might also help prevent nitroglycerin tolerance, but results are conflicting.
- Autism. Some research shows that taking N-acetyl cysteine by mouth improves irritability in children and adolescents with autism. But N-acetyl cysteine doesn't seem to improve other autism symptoms such as hyperactivity, social withdrawal, lethargy, repetitive behaviors, and inappropriate speech.
- Swelling (inflammation) of the main airways in the lung (bronchitis). Taking N-acetyl cysteine by mouth seems to reduce shortness of breath and coughing in people with air passage swelling due to mustard gas exposure. Also, taking N-acetyl cysteine by mouth for 3-36 months seems to prevent flare-ups in people with persistent air passage swelling. However, taking it for less time does not seem to be effective.
- A lung disease that makes it harder to breathe (chronic obstructive pulmonary disease or COPD). Taking N-acetyl cysteine by mouth for at least 6 months seems to decrease flare-ups by about 40% and improve sputum (phlegm) consistency in people with moderate to severe COPD. It seems to work best in people who are not already taking corticosteroids. In people with COPD who need to be hospitalized due to a flare-up, taking N-acetyl cysteine in addition to regular treatment helps with recovery.
- Kidney damage caused by contrast dyes (contrast induced nephropathy). Research shows that taking N-acetyl cysteine by mouth, with or without other drugs, helps prevent kidney problems caused by dyes used during some X-ray exams in people with poor kidney function It does not seem to lower the risk of kidney problems caused by dyes used during X-ray exams in people with normal kidney function or people with diabetes.
- High levels of homocysteine in the blood (hyperhomocysteinemia). Taking N-acetyl cysteine by mouth seems to reduce homocysteine levels, a possible risk factor for heart disease.
- High levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia). Taking N-acetyl cysteine by mouth seems to reduce levels of a blood fat called lipoprotein(a) in people with high levels of this blood fat.
- Toxicity in people taking the cancer drug ifosfamide (Ifex). Taking N-acetyl cysteine by mouth seems to help prevent side effects of ifosfamide (Ifex). This drug is used for certain types of cancer. But the drug mesna (Mesnex) seems to work better than N-acetyl cysteine.
- Flu (influenza). Taking N-acetyl cysteine by mouth seems to reduce flu symptoms.
- Kidney failure. Taking N-acetyl cysteine by mouth seems to help prevent problems such as heart attack and stroke in people with kidney failure. But N-acetyl cysteine doesn't reduce the overall risk of death or the risk of death from heart disease in these people.
- Heart attack. Giving N-acetyl cysteine intravenously (by IV) along with the drug nitroglycerin seems to help maintain heart function and reduces heart damage in people having a heart attack. Sometimes the drug streptokinase is also used along with N-acetyl cysteine and nitroglycerin.
Possibly Ineffective for
- Lou Gehrig's disease (amyotrophic lateral sclerosis or ALS). Injecting N-acetyl cysteine intravenously (by IV) doesn't seem to improve ALS symptoms.
- Heart damage caused by certain cancer drugs (anthracycline cardiotoxicity). Taking N-acetyl cysteine by mouth doesn't seem to prevent or treat heart damage caused by doxorubicin.
- A lung disease that affects newborns (bronchopulmonary dysplasia). Giving N-acetyl cysteine through a hole in the windpipe does not seem to prevent breathing problems in premature infants.
- Cannabis use disorder. Taking N-acetyl cysteine doesn't seem to improve symptoms of depression or help reduce use of cannabis in teens and adults with cannabis use disorder.
- Cystic fibrosis. Taking N-acetyl cysteine by mouth or inhaling it doesn't seem to improve lung function in people with cystic fibrosis. However, N-acetyl cysteine might reduce markers of swelling in people with cystic fibrosis when taken by mouth in high doses.
- An inherited disorder marked by sensitivity to light (erythropoietic protoporphyria or EPP). Taking N-acetyl cysteine by mouth doesn't seem to reduce light sensitivity in people with EPP.
- A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori). Most evidence shows that taking N-acetyl cysteine by mouth along with usual treatment for H. pylori infection does not help to eliminate the infection any more than usual treatment.
- Swelling (inflammation) of the liver (hepatitis). Taking N-acetyl cysteine by mouth doesn't seem to help treat viral hepatitis. It also doesn't seem to improve response to interferon therapy in people with hepatitis C. However, it might help prevent relapses in people with hepatitis C.
- HIV/AIDS. Taking N-acetyl cysteine by mouth doesn't seem to improve immune function or reduce the amount of virus in the body in most people with HIV. However, it might improve immune function in people with HIV who have low levels of glutathione, a chemical in the body that is formed from N-acetyl cysteine.
- Low blood pressure. Taking N-acetyl cysteine by mouth doesn't seem to reduce the risk of kidney failure in people with long-term low blood pressure.
- Inability to become pregnant within a year of trying to conceive (infertility). In women with fertility problems who are taking the fertility drug clomiphene citrate, taking N-acetyl cysteine by mouth does not seem to improve pregnancy rate or miscarriage rate.
- Liver transplant. Injecting N-acetyl cysteine intravenously (by IV) during surgery to donate a liver and keeping the liver in a cold liquid containing N-acetyl cysteine before the liver transplant doesn't seem to prevent transplant rejection in liver transplant recipients.
- Swelling (inflammation) of the pancreas (pancreatitis). Taking N-acetyl cysteine by mouth doesn't prevent pancreatitis in people undergoing a certain diagnostic procedure that can cause pancreas swelling. Also, injecting N-acetyl cysteine intravenously along with selenium and vitamin C doesn't seem to prevent pancreas dysfunction in people with serious pancreatitis.
- Recovery after surgery. Taking N-acetyl cysteine by mouth or injecting it intravenously (by IV) doesn't seem to reduce the risk of heart attack, stroke, kidney injury, or death after heart surgery. N-acetyl cysteine might help prevent abnormal heartbeats after heart surgery, but results are conflicting. N-acetyl cysteine by IV doesn't seem to reduce the risk of complications after liver surgery.
Likely InEffective for
- Head and neck cancer. Taking N-acetyl cysteine by mouth doesn't prevent new tumors or improve survival in people with head and neck cancer.
- Lung cancer. Taking N-acetyl cysteine by mouth doesn't prevent new tumors or improve survival in people with lung cancer.
- Multiple organ failure. Injecting N-acetyl cysteine intravenously (by IV) might increase the risk of death in people with multiple organ failure.
Insufficient Evidence for
- A sudden and serious lung condition (acute respiratory distress syndrome or ARDS). Some research shows that injecting N-acetyl cysteine intravenously (by IV) reduces the risk of death and improves some aspects of lung function in people with ARDS. However, conflicting research exists.
- An inherited disorder that affects the nervous system and adrenal glands (adrenoleukodystrophy or ALD). Early research suggests that taking N-acetyl cysteine by mouth or injecting it intravenously (by IV) might improve survival and stabilize brain function in some people with ALD.
- Altitude sickness. Early research suggests that taking N-acetyl cysteine doesn't prevent eating problems associated with altitude sickness.
- Alzheimer disease. Early research shows that taking N-acetyl cysteine by mouth doesn't improve symptoms of Alzheimer disease.
- Hearing loss caused by drugs called aminoglycosides. Taking N-acetyl cysteine while receiving aminoglycosides might prevent hearing loss in some people.
- Asthma. Early research suggests that inhaling a combination of N-acetyl cysteine plus isoproterenol improves lung function and decreases sputum (phlegm) thickness in people with asthma.
- Athletic performance. Some early research shows that injecting N-acetyl cysteine intravenously (by IV) before and during exercise, or taking N-acetyl cysteine by mouth for a few days prior to exercise, might improve the performance of well-trained athletes. But taking just one dose of N-acetyl cysteine by mouth before exercise does not seem to improve the performance of well-trained cyclists.
- Disorders affecting bile flow in the liver. Early research shows that receiving N-acetyl cysteine by IV after surgery for liver obstruction might help to speed up how quickly liver health improves.
- Bipolar disorder. Early research shows that taking N-acetyl cysteine by mouth does not improve symptoms of mania but might reduce depression in people with bipolar disorder.
- A lung condition in which the airways become enlarged and scarred (bronchiectasis). Early research shows that taking N-acetyl cysteine seems to reduce the risk for a flare-up of symptoms in people with bronchiectasis.
- Canker sores. Early research shows that rinsing the mouth with N-acetyl cysteine in water for 30 seconds might help with pain and healing of canker sores.
- Liver damage caused by cancer drug treatment. Early research shows that receiving N-acetyl cysteine by IV might help with liver healing in children with liver damage from cancer drug treatment.
- Nerve damage in the hands and feet caused by cancer drug treatment. Early research shows that taking N-acetyl cysteine by mouth reduces the risk of nerve damage in people receiving oxaliplatin, a drug used to treat certain types of cancer.
- Long-term kidney disease (chronic kidney disease or CKD). Taking N-acetyl cysteine doesn't seem to reduce kidney injury in people with CKD. However, N-acetyl cysteine given by IV seems to reduce kidney injury and heart problems in people with CKD that are having heart surgery.
- Surgery to improve blood flow to the heart (CABG surgery). Early research suggests that N-acetyl cysteine does not prevent death or improve outcomes after surgery in patients undergoing heart bypass surgery.
- Cocaine use disorder. Some early research shows that taking N-acetyl cysteine by mouth reduces the desire to use cocaine in people who are cocaine dependent. But conflicting results exist.
- Colon cancer, rectal cancer. Taking N-acetyl cysteine by mouth may reduce the likelihood of colon and rectal cancer in patients with a history of adenomatous colon polyps.
- Tooth plaque. Early research shows that using a mouthwash containing 10% N-acetyl cysteine may reduce plaque. But using a mouthwash containing only 1.25% N-acetyl cysteine doesn't seem to work.
- Dry eye. Early research suggests that using a tear solution containing 20% acetyl cysteine improves some but not all symptoms of dry eye syndrome.
- Muscle damage caused by exercise. Early research suggests that taking N-acetyl cysteine by mouth does not help prevent muscle damage after exercise.
- A mild form of gum disease (gingivitis). Rinsing the mouth with N-acetyl cysteine might help to prevent gingivitis. But it doesn't seem to help treat it.
- Hearing loss. Early research suggests that taking N-acetyl cysteine by mouth decreases the chance of hearing loss in people who work in loud conditions, such as factory workers.
- Kidney failure in people with liver disease (hepatorenal syndrome). Early research suggests that injecting N-acetyl cysteine intravenously (by IV) might improve kidney function in people with this condition.
- An inherited disorder that affects the formation of blood vessels (hereditary hemorrhagic telangiectasia or HHT). Early research suggests that taking N-acetyl cysteine decreases the number and severity of nosebleeds during the day in people with HHT. But it doesn't seem to reduce the number of nighttime nosebleeds.
- A lung disease that leads to scarring and thickening of the lung (idiopathic interstitial pneumonia). Taking N-acetyl cysteine by mouth seems to improve lung function in people with interstitial pneumonia. However, N-acetyl cysteine does not improve lung function in people with a specific type of interstitial pneumonia called idiopathic pulmonary fibrosis.
- Malaria. Early research suggests that injecting N-acetyl cysteine intravenously (by IV) along with the antimalarial drug artesunate does not reduce symptoms or prevent death in people with severe malaria.
- Conditions in a man that prevent him from getting a woman pregnant within a year of trying to conceive (male infertility). Taking N-acetyl cysteine by mouth seems to improve sperm concentration in infertile men. It is not clear if N-acetyl cysteine improves sperm movement and shape in these men.
- Miscarriage. Early research suggests that taking N-acetyl cysteine by mouth along with folic acid helps prevent early miscarriages in women with a history of multiple early miscarriages compared to taking only folic acid.
- Multiple sclerosis (MS). Early research shows that receiving N-acetyl cysteine by IV and taking it by mouth might help with memory, thinking skills, and attention in people with MS who are also given standard care.
- Reduced benefit of nitrate therapy that happens when nitrates are used all day (nitrate tolerance). Early research suggests that injecting N-acetyl cysteine intravenously (by IV) seems to help prevent tolerance to nitrate. Oral N-acetyl cysteine might help prevent nitrate tolerance, but results are conflicting.
- Swelling (inflammation) and build up of fat in the liver in people who drink little or no alcohol (nonalcoholic steatohepatitis or NASH). Some early research shows that taking N-acetyl cysteine with metformin might improve some, but not all, measures of liver health in people with NASH.
- A type of anxiety marked by recurrent thoughts and repetitive behaviors (obsessive-compulsive disorder or OCD). Some early research shows that N-acetyl cysteine can improve some symptoms of OCD. But other early research has found no benefit.
- A hormonal disorder that causes enlarged ovaries with cysts (polycystic ovary syndrome or PCOS). Research shows that taking N-acetyl cysteine by mouth increases the odds of ovulation, getting pregnant, and having a live birth in women with PCOS. It seems to work best in women who are resistant to the fertility drug clomiphene citrate. But metformin seems to work better than N-acetyl cysteine. N-acetyl cysteine doesn't seem to improve irregular menstruation or decrease acne or male-pattern hair growth in women with PCOS.
- A type of anxiety that often develops after a terrifying event (post-traumatic stress disorder or PTSD). Early research shows that taking N-acetyl cysteine daily for 8 weeks along with a form of talk therapy can reduce the symptoms of PTSD and depression. However, this was only studied in war veterans with PTSD and a history of substance use disorders. Taking N-acetyl cysteine can also reduce the craving to use drugs or alcohol in these veterans.
- Health problems after menopause. Early research shows that taking N-acetyl cysteine by mouth doesn't seem to prevent bone loss after menopause.
- Preterm birth. Taking N-acetyl cysteine by mouth along with a certain steroid hormone beginning at 16-18 weeks pregnancy and continuing until labor seems to help prevent preterm labor better than taking the steroid hormone alone. However, taking N-acetyl cysteine by mouth beginning at 25-33 weeks pregnancy and continuing until labor does not seem to improve preterm delivery rates in women with severe high blood pressure during pregnancy (pre-eclampsia) or those with HELLP syndrome.
- Problems making saliva due to radiation therapy. Early research shows that rinsing the mouth with 500 mg of N-acetyl cysteine during and after radiation therapy helps to improve dry mouth.
- Schizophrenia. Taking N-acetyl cysteine by mouth for at least 6 months seems to reduce negative symptoms in people with schizophrenia. But taking N-acetyl cysteine for a shorter period of 2 months doesn't seem to work. N-acetyl cysteine might also improve other symptoms, such as positive symptoms, thinking, or social ability in people with schizophrenia. But more research is needed to confirm.
- Blood infection (sepsis). Receiving N-acetyl cysteine by IV might help improve the ability to breathe in people with septic shock. But it doesn't seem to help prevent death due to septic shock.
- An autoimmune disorder in which the glands that produce tears and saliva are damaged (Sjogren syndrome). Taking N-acetyl cysteine by mouth might reduce eye soreness and irritation, bad breath, and daytime thirst in people with this condition. But it doesn't seem to reduce eye dryness.
- An autoimmune disease that causes widespread swelling (systemic lupus erythematosus or SLE). Early research shows that taking N-acetyl cysteine by mouth reduces disease activity and tiredness in people with lupus.
- Tourette syndrome. Early research shows that taking N-acetyl cysteine does not improve the symptoms of Tourette syndrome in children 8-17 years of age.
- Hair pulling (trichotillomania). Taking N-acetyl cysteine by mouth seems to decrease hair pulling in adults by up to 40%. But it doesn't seem to reduce hair pulling in children.
- A type of inflammatory bowel disease (ulcerative colitis). Early research suggests that taking N-acetyl cysteine by mouth doesn't help prevent flare-ups in people with ulcerative colitis who are taking the anti-inflammatory drug mesalamine.
- A painful uterine disorder (endometriosis).
- Chronic fatigue syndrome (CFS).
- Ear infection (otitis media).
- Hay fever.
- Infections of the kidney, bladder, or urethra (urinary tract infections or UTIs).
- Lead poisoning.
- Liver disease in people who drink alcohol.
- Mercury poisoning.
- Other conditions.
When given by IV: N-acetyl cysteine is LIKELY SAFE for most adults, when given by IV as a prescription medication. Rarely, it can cause rashes, fever, headache, drowsiness, low blood pressure, and liver problems.
When inhaled: N-acetyl cysteine is LIKELY SAFE for most adults, when used as a prescription medication. When inhaled (breathed into the lungs), it can also cause swelling in the mouth, runny nose, drowsiness, clamminess, and chest tightness.
Special Precautions and Warnings
There is not enough reliable information about the safety of taking N-acetyl cysteine if you are breast-feeding. Stay on the safe side and avoid use.
Children: N-acetyl cysteine is LIKELY SAFE when taken by mouth in doses of 900-2700 mg daily for up to 12 weeks or when given by IV as a prescription medication.
Allergy: Don't use N-acetyl cysteine if you are allergic to acetyl cysteine.
Asthma: There is a concern that N-acetyl cysteine might cause bronchospasm in people with asthma if inhaled or taken by mouth or through a tube in the windpipe. If you take N-acetyl cysteine and have asthma, you should be monitored by your healthcare provider.
Bleeding disorder. N-acetyl cysteine might slow blood clotting. There is concern that N-acetyl cysteine might increase the risk of bruising and bleeding in people with bleeding disorders.
Surgery. N-acetyl cysteine might slow blood clotting. This might increase the risk of bleeding during and after surgery. Stop taking N-acetyl cysteine at least 2 weeks before a scheduled surgery.
Nitroglycerin interacts with N-ACETYL CYSTEINE (NAC)
Nitroglycerin can dilate blood vessels and increase blood flow. Taking N-acetyl cysteine seems to increase the effects of nitroglycerin. This could cause increased chance of side effects including headache, dizziness, and lightheadedness.
Do not take this combination
Activated charcoal interacts with N-ACETYL CYSTEINE (NAC)
Activated charcoal is sometimes used to prevent poisoning in people who take too much acetaminophen and other medications. Activated charcoal can bind up these medications in the stomach and prevent them from being absorbed by the body. Taking N-acetyl cysteine at the same time as activated charcoal might decrease how well it works for preventing poisoning.
Be cautious with this combination
- For acetaminophen (Tylenol) overdose: 140 mg/kg of N-acetyl cysteine at first, followed by 70 mg/kg every 4 hours for 3 days or until acetaminophen is no longer detected in the blood.
- For swelling (inflammation) of the main airways in the lung (bronchitis): Doses of 200 mg twice daily, 200 mg three times daily, 300 mg slow-release twice daily, and 600 mg controlled-release twice daily have been used for up to 6 months. Doses up to 1.5 grams per day for up to 4 months have also been used.
- For a lung disease that makes it harder to breathe (chronic obstructive pulmonary disease or COPD): 400-1200 mg of N-acetyl cysteine daily in divided doses, in addition to standard care, has been used for up to 6 months.
- For preventing kidney damage caused by contrast dyes (contrast induced nephropathy): 400-600 mg of N-acetyl cysteine twice daily on the day before and on the day of iopromide administration, with IV saline for 12 hours before and 12 hours after iopromide administration. Also, a starting dose of 1200 mg of N-acetyl cysteine, followed by 1200 mg twice daily thereafter for 48 hours after dye has also been used.
- For a lung disease that leads to scarring and thickening of the lung (idiopathic interstitial pneumonia): 600 mg of N-acetyl cysteine three times daily for 12 weeks.
- For preventing toxicity in people taking the cancer drug ifosfamide (Ifex): 1-3 grams of N-acetyl cysteine every 6 hours beginning one hour before ifosfamide treatment and continuing for up to 5 days after treatment.
- For reducing high levels of homocysteine in the blood (hyperhomocysteinemia): 600-1200 mg of N-acetyl cysteine daily.
- For flu (influenza): 600 mg twice daily for up to 30 months.
- For kidney failure: 600 mg twice daily.
- For high levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia): 1.2 grams daily for 6 weeks or 2 grams daily for 4 weeks followed by 4 grams daily for another 4 weeks.
- For complete or partial lung collapse (atelectasis): 3-5 mL of 20% solution or 6-10 mL of 10% solution administered using a nebulizer 3-4 times per day. The solution may also be administered through a tracheostomy at a dose of 1-2 mL of 10% or 20% solution every 1-4 hours. The solution may also be administered through a tracheal catheter at a dose of 1-2 mL of 20% solution or 2-4 mL of 10% solution every 1-4 hours.
- For lung tests: 1-2 mL of 20% solution or 2-4 mL of 10% solution administered via intratracheal instillation 2-3 times prior to the diagnostic test.
- For a lung disease that makes it harder to breathe (chronic obstructive pulmonary disease or COPD): 20% solution administered via a nebulizer for at least 4 days.
- For care of people with a tube placed in their windpipe (tracheostomy care): 1-2 mL of 10-20% solution administered via intratracheal instillation.
- For acetaminophen (Tylenol) overdose: Healthcare providers give N-acetyl cysteine intravenously (by IV) for acetaminophen poisoning. Dosing is usually 150 mg/kg initially followed by 50 mg/kg over 4 hours, followed by 100 mg/kg over 16 hours or until acetaminophen levels are no longer detected.
- For preventing kidney damage caused by contrast dyes (contrast induced nephropathy): 900 mg before and after dye. Also, 1200 mg by IV before giving an oral dose of N-acetyl cysteine 1200 mg twice daily has also been used.
- For heart attack: 100 mg/kg six times daily with the drug streptokinase. Also, 10 mg/min for the first hour, followed by 20 mg/min for 23 hours with nitroglycerin has also been used, with or without streptokinase. In addition, 15 grams along with streptokinase over 24 hours has been used.
- For acetaminophen (Tylenol) overdose: 140 mg/kg initially followed by 70 mg/kg every 4 hours for 72 hours or until acetaminophen is no longer detected in the body.
- For autism: 900 mg daily for 4 weeks followed by 900 mg twice daily for 4 weeks followed by 900 mg three times daily for 4 weeks. Taking 1200 mg daily with the drug risperidone for 8 weeks has also been used.
- For complete or partial lung collapse (atelectasis): 3-5 mL of 20% solution or 6-10 mL of 10% solution administered using a nebulizer three to four times per day. The solution may also be administered through a tracheostomy at a dose of 1-2 mL of 10% or 20% solution every 1-4 hours. The solution may also be administered through a tracheal catheter at a dose of 1-2 mL of 20% solution or 2-4 mL of 10% solution every 1-4 hours.
- For lung tests: 1-2 mL of 20% solution or 2-4 mL of 10% solution administered via intratracheal instillation 2-3 times prior to the diagnostic test.
- For care of people with a tube placed in their windpipe (tracheostomy care): 1-2 mL of 10% or 20% solution administered via intratracheal instillation.
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