Open Access
Subscription Access
Open Access
Subscription Access
Mechanisms and Therapeutics of N-acetylcysteine:A Recent Update
Subscribe/Renew Journal
N-acetylcysteine (NAC), a precursor and a source of glutathione, which has been used for past four decades, with well-established safety, widely used for the treatment of acetaminophen poisoning and as a mucolytic. NAC also would be administered in combination with certain drugs, imparting beneficial effects and having a medical rationale. NAC is a molecule having a wider therapeutic index with a broad spectrum of prophylactic and therapeutic applications and has become an important social need. Research is ongoing to understand the various pharmacological and biochemical pathways by which NAC exhibits various therapeutic effects. Clinical uses of NAC is attributed, to the presence of thiol group, which acts as a direct antioxidant and also replenishes glutathione levels, which is decreased in various disease conditions. This review aims to understand the role of NAC in various clinical conditions. The article concludes that NAC may be beneficial in some conditions, especially in patients with depleted glutathione, or with oxidative stress, for which patients can be screened before prescribing NAC.
Keywords
N-Acetylcysteine, Oxidative Stress, Antioxidant, Glutathione, Free Radicals.
Subscription
Login to verify subscription
User
Font Size
Information
- Green J.L., Heard K.J., Reynolds K.M., Albert D. Oral and intravenous acetylcysteine for treatment of acetaminophen toxicity: a systematic review and meta-analysis West. J. Emerg. Med. 2013; 14 (3), 218–226
- Hurst, G. A., Shaw, P. B., and Le Maistre, C. A. Laboratory and clinical evaluation of the mucolytic properties of acetylcysteine. Am Rev Respir Dis. 1967;96, 962–970.
- Prescott, L. F., Park, J., Ballantyne, A., Adriaenssens, P., and Proudfoot, A. T. Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine. Br Med J 1977; 432–434.
- Samuni Y, Goldstein S, Dean OM, Berk M. The chemistry and biological activities of N- acetylcysteine. Biochim Biophys Acta. 2013 Aug;1830(8):4117–29.
- WO2010090611A2.pdf [Internet]. Available from: https://patentimages.storage.googleapis.com/69/cb/89/9d6adfa6c53396/WO2010090611A2.pdf Last accessed Nov 21, 2018
- Cattermole G. Should N-Acetylcysteine be Administered Orally or Intravenously for the Treatment of Paracetamol Overdose? Hong Kong Journal of Emergency Medicine. 2009 Apr;16(2):106–16.
- Cotgreave IA. N-acetylcysteine: pharmacological considerations and experimental and clinical applications. Adv Pharmacol. 1997; 38: 205–27.
- Borgström L, Kågedal B, Paulsen O. Pharmacokinetics of N-acetylcysteine in man. Eur J Clin Pharmacol. 1986;31(2):217–22.
- RxList website. https://www.rxlist.com/cetylev-drug.htm. Last accessed Nov 21, 2018
- Witschi A, Reddy S, Stofer B, Lauterburg BH. The systemic availability of oral glutathione. Eur J Clin Pharmacol. 1992;43(6):667–9.
- Sjödin K, Nilsson E, Hallberg A, Tunek A. Metabolism of N-acetyl-L-cysteine. Some structural requirements for the deacetylation and consequences for the oral bioavailability. Biochem Pharmacol. 1989 Nov 15;38(22):3981–5.
- Mallard WG, Ross AB, Helman WP. NIST Standard Reference Database 1998;40, Version 3.0, NIST, Gaithersburg, MD
- Trujillo M, Radi R. Peroxynitrite reaction with the reduced and the oxidized forms of lipoic acid: new insights into the reaction of peroxynitrite with thiols. Arch Biochem Biophys 2002; 397: 91–98.
- Omara FO, Blakley BR, Bermier J, Fournier M. Immunomodulatory and protective effects of N-acetylcysteine in mitogen-activated murine splenocytes in vitro. Toxicology 1997; 116: 219–226.
- Emet S, Memis D, Pamukçu Z. The influence of N-acetyl-L-cystein infusion on cytokine levels and gastric intramucosal pH during severe sepsis. Critical Care 2004; 8: 172–179.
- Pajonk F, Riess K, Sommer A, McBride WH. N-acetyl-L-cysteine inhibits 26S proteosome function: implications for effects on NF-kappaB activation. Free Radical Biol Med 2002; 32 (6): 536–543.
- Astiz M, de Alaniz MJT, Marra CA. The oxidative damage and inflammation caused by pesticides are reverted by lipoic acid in rat brain. Neurochemistry International 2012; 61: 1231–1241
- Ullian, M. E., Gelasco, A. K., Fitzgibbon, W. R., Beck, C. N., and Morinelli, T. A. (2005). N-acetylcysteine decreases angiotensin II receptor binding in vascular smooth muscle cells. J Am Soc Nephrol. 2005;16, 2346–2353.
- Hayakawa M, Miyashita H, Sakamoto I, Kitagawa M, Tanaka H, Yasuda H, Karin M, Kikugawa K. Evidence that reactive oxygen species do not mediate NF‐κB activation. The EMBO journal. 2003;22(13):3356-66.
- Greene SC, Noonan PK, Sanabria C, Peacock WF. Effervescent N-Acetylcysteine Tablets versus Oral Solution N-Acetylcysteine in Fasting Healthy Adults: An Open-Label, Randomized, Single-Dose, Crossover, Relative Bioavailability Study. Curr Ther Res Clin Exp. 2016 Jun 27; 83:1–7.
- Blackford MG, Felter T, Gothard MD, Reed MD. Assessment of the clinical use of intravenous and oral N-acetylcysteine in the treatment of acute acetami- nophen poisoning in children: a retrospective review. Clin Ther. 2011;33: 1322–30.
- WO2011128230A1.pdf [Internet]. [cited 2018 Nov 7]. Available from: https://patentimages.storage.googleapis.com/20/df/2c/060b487cff1426/WO2011128230A1.pdf
- Mahmut B. Stable, taste and odor masked pharmaceutical compositions comprising acetylcystein and vitamin c [Internet]. WO2010090612A1, 2010 [cited 2018 Nov 7]. Available from https://patents.google.com/patent/WO2010090612A1/en?oq=WO2010%2f090612;+Bilgic+Mahmut%2c+2010).+
- Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med 1988; 319:1557.
- Smilkstein MJ, Bronstein AC, Linden C, et al. Acetaminophen overdose: a 48-hour intravenous N-acetylcysteine treatment protocol. Ann Emerg Med 1991; 20:1058.
- Prescott LF, Park J, Ballantyne A, et al. Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine. Lancet 1977; 2:432.
- Prescott LF. Treatment of severe acetaminophen poisoning with intravenous acetylcysteine. Arch Intern Med 1981; 141:386.
- Nambiar NJ. Management of Paracetamol Poisoning: The Old and the New. Journal of Clinical and Diagnostic Research. 2012;6(6).
- Chyka PA, Butler AY, Holliman BJ, Herman MI. Utility of acetylcysteine in treating poisonings and adverse drug reactions. Drug safety. 2000;22(2):123-48.
- Rowe SM, Clancy JP. Advances in cystic fibrosis therapies. Current opinion in pediatrics. 2006;18(6):604-13.
- Sheffner AL, Medler EM, Jacobs LW, Sarett HP. The in vitro reduction in viscosity of human tracheobronchial secretions by acetylcysteine. American Review of Respiratory Disease. 1964;90(5):721-9.
- Rahman I, MacNee W. Regulation of redox glutathione levels and gene transcription in lung inflammation: therapeutic approaches. Free Radical Biology and Medicine. 2000;28(9):1405-20.
- Ratjen F, Grasemann H. New therapies in cystic fibrosis. Current pharmaceutical design. 2012;18(5):614-27. I have removed this reference
- Grassi C. Long-term oral acetylcysteine in chronic bronchitis. A double- blind controlled study. Eur. J. Respir. Dis. 1980; 61:93-108.
- Dworski R. Oxidant stress in asthma. Thorax. 2000;55(suppl 2): S51-3.
- Carbonell N, Sanjuán R, Blasco M, Jordá Á, Miguel A. N-acetylcysteine: short-term clinical benefits after coronary angiography in high-risk renal patients. Revista Española de Cardiología (English Edition). 2010;63(1):12-9.
- Koc F, Ozdemir K, Kaya MG, Dogdu O, Vatankulu MA, Ayhan S, Erkorkmaz U, Sonmez O, Aygul MU, Kalay N, Kayrak M. Intravenous N-acetylcysteine plus high-dose hydration versus high-dose hydration and standard hydration for the prevention of contrast-induced nephropathy: CASIS—a multicenter prospective controlled trial. International journal of cardiology. 2012;155(3):418-23.
- Goldenberg I, Shechter M, Matetzky S, Jonas M, Adam M, Pres H, Elian D, Agranat O, Schwammenthal E, Guetta V. Oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy following coronary angiography: a randomized controlled trial and review of the current literature. European heart journal. 2004;25(3):212-8.
- Gurm HS, Smith DE, Berwanger O, Share D, Schreiber T, Moscucci M, Nallamothu BK, BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Contemporary use and effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy among patients undergoing percutaneous coronary intervention. JACC: Cardiovascular Interventions. 2012;5(1):98-104.
- Sun Z, Fu Q, Cao L, Jin W, Cheng L, Li Z. Intravenous N-acetylcysteine for prevention of contrast-induced nephropathy: a meta-analysis of randomized, controlled trials. PloS one. 2013;8(1):55124.
- Lapenna D, de Gioia S, Ciofani G, Mezzetti A, Ucchino S, Calafiore AM, Napolitano AM, Di Ilio C, Cuccurullo F. Glutathione-related antioxidant defenses in human atherosclerotic plaques. Circulation. 1998 May;97(19):1930-4.
- Mazzanti L, Mutus B. Diabetes-induced alterations in platelet metabolism. Clinical biochemistry. 1997;30(7):509-15.
- Martina V, Masha A, Gigliardi VR, Brocato L, Manzato E, Berchio A, et al. Long-term N-acetylcysteine and L-arginine administration reduces endothelial activation and systolic blood pressure in hypertensive patients with type 2 diabetes. Diabetes Care. 2008;31, 940–944.
- Treweeke AT, Winterburn TJ, Mackenzie I, Barrett F, Barr C, Rushworth GF, Dransfield I, Mac Rury SM, Megson IL. N-Acetylcysteine inhibits platelet–monocyte conjugation in patients with type 2 diabetes with depleted intraplatelet glutathione: a randomised controlled trial. Diabetologia. 2012;55(11):2920-8.
- De Flora S, Izzotti A, D'agostini F, Balansky RM. Mechanisms of N-acetylcysteine in the prevention of DNA damage and cancer, with special reference to smoking-related end-points. Carcinogenesis. 2001;22(7):999-1013.
- Van Zandwijk N, Dalesio O, Pastorino U, De Vries N, Van Tinteren H. EUROSCAN, a randomized trial of vitamin A and N-acetylcysteine in patients with head and neck cancer or lung cancer. Journal of the National Cancer Institute. 2000;92(12):977-86.
- Wanamarta AH, van Rijn J, Blank LE, Haveman J, van Zandwijk N, Joenje H. Effect of N-acetyl cysteine on the antiproliferative action of X-rays or bleomycin in cultured human lung tumor cells. J Cancer Res Clin Oncol. 1989; 115(4): 340-344.
- Dean O, Giorlando F, Berk M. N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action. Journal of psychiatry and neuroscience: JPN. 2011;36(2):78.
- Martinez-Banclocha MA. N-acetyl cysteine in the treatment of Parkinson’s disease. What are we waiting for? Med Hypotheses. 2012; 79(1): 8-12.
- Hardan AY, Fung LK, Libove RA, Obukhanych TV, Nair S, Herzenberg LA, Frazier TW, Tirouvanziam R. A randomized controlled pilot trial of oral N-acetylcysteine in children with autism. Biological psychiatry. 2012;71(11):956-61.
- Nasr A. Effect of N-acetyl cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study. Reprod Biomed Online. 2010; 20(3): 403-409.
- Fulghesu AM, Ciampelli M, Muzj G, Belosi C, Selvaggi L, Ayala GF, et al. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertil Steril 2002;77:1128–35.
Abstract Views: 241
PDF Views: 0