N-Acetylcysteine (NAC), an analogue of the dietary amino acid cysteine, is known for its mucolytic (mucous breaking) and anti-inflammatory effects. NAC acts as a potent antioxidant (free radical quencher). NAC is a thiol compound thereby providing sulfhydryl groups which act as direct free radical scavengers and also stimulate the production of the endogenous (internal) antioxidant glutathione. Glutathione is a potent antioxidant that maintains vitamins C and E in there antioxidant state, and it also acts as a scavenging antioxidant that removes reactive oxygen species once they are formed. Glutathione is a critical phase 2 detoxification factor. Essentially it acts to conjugate fat soluble toxins (i.e. heavy metals), thereby converting them to neutral water soluble compounds that can easily be excreted out of the body. Glutathione has been suggested to be one of the most important anti-cancer and anti-aging nutrients.
The characteristic antioxidant properties of NAC help to stabilize the cellular redox status, thereby regulating cellular apoptosis, angiogenesis, cell growth and inflammatory response. Both in vivo and in vitro studies confirm the strong antioxidant properties of NAC. Interestingly, it reduces oxidative stress (free radicals in the body) at both high and low concentrations, and in both acute and chronic conditions. The unique antioxidant properties of NAC may explain its strong capacity to attenuate the adverse effects caused by toxic chemicals and drug reactions. The anti-inflammatory properties of this compound are experienced even at low dosages, with effects being dose-dependent. Greater dosages appear to improve bioavailability to exert greater therapeutic potentials.1
NAC is well recognized as an effective antidote for acetaminophen and carbon monoxide poisoning. Research also demonstrates that NAC exerts many other therapeutic potentials. For instance, NAC was found to prevent ethanol induced hypertension and adverse renal vascular changes in rats via its ability to bind blood acetaldehyde.2 NAC is also being considered as a treatment alternative to help with inflammatory conditions associated with Cystic Fibrosis. In a group of 18 Cystic Fibrosis (CF) patients with neutrophil airway inflammation (a pulmonary disorder), markers for CF pulmonary function were significantly improved as reflected by decreased sputum elastase activity, and decreased airway neutrophils. The authors stated that high dose oral NAC has the potential to correct antioxidant and inflammatory imbalances associated with CF thereby improving pulmonary health.3 NAC has also demonstrated hepatoprotective effects independent of its effects on elevating the antioxidant glutathione.4
Studies have shown both oral and intravenous administration of NAC significantly improves the management of unstable angina. A prior study conducted in the Journal of the American College of Cardiology (1997) reported that NAC combined with transdermal nitroglycerin was associated with only 13 % of outcome events (i.e. death, myocardial infarction, and refractory angina) verses 39 % and 31 % in placebo and nitroglycerin groups, respectively. The authors concluded that NAC potentiates the therapeutic effects of nitroglycerin.5
An open, randomized, controlled study published in Respiration (1999) using 169 patients, reported that 6 month standard therapy of Chronic Obstructive Pulmonary Disease (COPD) with NAC (600mg/day) showed a 41 % reduction of exacerbations. The number of sick days was substantially less (82) in the NAC group verses the standard therapy group alone (155). There were no reported adverse events with the supplemental intake of NAC. The authors concluded that NAC is well tolerated and improves the management of both moderate to severe COPD.6
The evidence shows that this antioxidant, detoxifying compound may also benefit many other health conditions including bronchopulmonary disorders, bronchitis, epilepsy, hyperhomocysteinemia, end stage renal disease and influenza.
Effective Dosage Protocols
The therapeutic dosage of NAC varies according to the condition being treated. For instance, for COPD the supplemental dose is 600mg daily while for reducing plasma homocysteine levels 1.2 grams daily have been used. Unfortunately, many products in the commercial market typically contain very low levels of NAC. For this reason Enerex Botanicals has developed a formula containing 1000mg of pharmaceutical grade NAC per caplet for improved therapeutic potentials. Consult with your natural health practitioner to determine the most effective dose to manage your particular health condition. Otherwise a daily dose of 1-2 caplets is a general health recommendation.
Adverse Reactions
Generally, NAC is well tolerated with occasional mild gastrointestinal upset reported at very high dosages.
Drug Interactions
Taking NAC with intravenous nitroglycerin may cause severe hypotension and intolerable headaches. Check with health care professional prior to supplemental intake.
References
- Sadowska AM et al. Antioxidant and Anti-inflammatory Efficacy of NAC in the Treatment of COPD: Discordant in Vitro and in Vivo Dose-Effects: A review. Pulm Pharmacol Ther. 2006 Feb 1.
- Vasdev S et al. N-Acetyl Cysteine Attenuates Ethanol Induced Hypertension in Rats. Artery. 1995; 21(6): 312-6.
- Tirouvanziam R et al. High-dose Oral N-Acetylcysteine, A Glutathione Prodrug, Modulates Inflammation in Cystic Fibrosis. Proc Natl Acad Sci. 2006 Mar 21; 103(12):4628-33.
- Zwingmann C and Bilodeau M. Metabolic Insights into the Hepatoprotective Role of N-Acetycysteine in Mouse Liver. Hepatology. 2006 Feb 22; 43(3): 454-463.
- Ardissino D et al. Effect of Transdermal Nitroglycerin or N-Acetylcysteine, or Both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol. 1997 Apr; 29(5): 941-7.
- Pela R et al. N-acetylcysteine reduces the exacerbation rate in patients with moderate to severe COPD. Respiration. 1999 Nov-Dec; 66(6): 491-2.
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