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    N-Acetyl Cysteine

    N-Acetyl Cysteine

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    Uses

    NAC (N-acetyl cysteine) is an altered form of the amino acid cysteine , which is commonly found in food and synthesized by the body.

    What Are Star Ratings?

    Our proprietary "Star-Rating" system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    This supplement has been used in connection with the following health conditions:

    Used for Why
    3 Stars
    Bronchitis
    400 to 600 mg daily
    NAC, which appears to work by reducing the thickness of mucus, has been shown to be a safe and effective treatment for chronic bronchitis.

    A review of 39 clinical trials of NAC (N-acetyl cysteine) found that 400 to 600 mg per day was a safe and effective treatment for chronic bronchitis.1 NAC supplementation was found to reduce the number of aggravations of the illness in almost 50% of people taking the supplement, compared with only 31% of those taking placebo. Smokers have also been found to benefit from taking NAC.2 In addition to helping break up mucus, NAC may reduce the elevated bacterial counts that are often seen in the lungs of smokers with chronic bronchitis.3 In another double-blind study, people with chronic bronchitis who took NAC showed an improved ability to expectorate and a reduction in cough severity.4 These benefits may result from NAC's capacity to reduce the viscosity (thickness) of sputum.5

    3 Stars
    Chronic Obstructive Pulmonary Disease
    200 mg three times daily
    N-acetyl cysteine helps break down mucus and supplies antioxidant protection to lung tissue.

    NAC (N-acetyl cysteine) helps break down mucus. For that reason, inhaled NAC is used in hospitals to treat bronchitis. NAC may also protect lung tissue through its antioxidant activity.6 Oral NAC, 200 mg taken three times per day, is also effective and improved symptoms in people with bronchitis in double-blind research.7 , 8 In other double-blind studies, oral NAC in the amount of 600 mg twice a day for 1 year significantly decreased the number of disease exacerbations in patients with moderate-to-severe COPD.9 , 10 However, NAC was ineffective in one study.11 Results may take six months. NAC does not appear to be effective for people with COPD who are taking inhaled steroid medications.12

    2 Stars
    Angina
    600 mg three times daily (under medical supervision if taking nitroglycerin)
    Under a doctor's supervision, supplementing with NAC may improve the effects of nitroglycerin.

    NAC (N-acetyl cysteine) may improve the effects of nitroglycerin in people with angina.13 People with unstable angina who took 600 mg of NAC three times daily in combination with a nitroglycerin transdermal (skin) patch for four months had significantly lower rates of subsequent heart attacks than did people who used either therapy alone or placebo.14

    2 Stars
    Autism
    Use with a doctor's supervision
    A double-blind study found that supplementing with NAC for 12 weeks improved symptoms of irritability in children with autism.
    In a double-blind trial, supplementation with N-acetyl cysteine (NAC) for 12 weeks improved symptoms of irritability in children with autism.15 The amount of NAC used in the study was 900 mg per day for four weeks, then 900 mg twice a day for four weeks, then 900 mg three times per day for four weeks. Another double-blind study found an improvement in irritability using smaller amounts of NAC: 600 mg per day for children weighing less than 44 pounds and 900 mg per day for children weighing 44 pounds or more.16 Because those amounts are relatively large and the long-term safety of this treatment has not been examined, NAC treatment of autistic children should be monitored by a doctor.
    2 Stars
    Gastritis
    1 gram daily
    In one study, people with atrophic gastritis given NAC saw increased healing.

    Various amino acids have shown promise for people with gastritis. In a double-blind trial, taking 200 mg of cysteine four times daily provided significant benefit for people with bleeding gastritis caused by NSAIDs (such as aspirin ).17 Cysteine is a sulfur-containing amino acid that stimulates healing of gastritis. In a preliminary trial, 1-4 grams per day of NAC (N-acetyl cysteine) given to people with atrophic gastritis for four weeks appeared to increase healing.18 Glutamine , another amino acid is a main energy source for cells in the stomach and supplementation may increase blood flow to this region.19 Patients in surgical intensive care units often develop gastrointestinal problems related to a glutamine deficiency.20 When burn victims were supplemented with glutamine, they did not develop stress ulcers, even after several operations.21 Nevertheless, it remains unclear to what extent glutamine supplementation might prevent or help existing gastritis. Preliminary evidence suggests the amino acid arginine may both protect the stomach and increase its blood flow,22 but research has yet to investigate the effects of arginine supplementation in people with gastritis.

    2 Stars
    Heart Attack
    Consult a qualified healthcare practitioner
    In one study, NAC injections decreased the amount of tissue damage in people who had suffered a heart attack.
    In one study, intravenous injections of NAC (N-acetyl cysteine) decreased the amount of tissue damage in people who had suffered a heart attack.[REF] Whether oral NAC would have the same effect is unknown.
    2 Stars
    HIV and AIDS Support
    800 mg daily
    Supplementing with NAC may slow the decline in immune function.

    The amino acid NAC (N-acetyl cysteine) has been shown to inhibit the replication of HIV in test tube studies.23 In a double-blind trial, supplementing with 800 mg per day of NAC slowed the rate of decline in immune function in people with HIV infection. NAC also promotes the synthesis of glutathione , a naturally-occurring antioxidant that is believed to be protective in people with HIV infection and AIDS.24

    2 Stars
    Unverricht-Lundborg Disease
    Requires a doctor's supervision
     
    1 Star
    Bipolar Disorder
    Refer to label instructions
    In a preliminary trial, depression in patients with bipolar disorder significantly improved after NAC treatment.
    In a preliminary trial, depression in patients with bipolar disorder significantly improved after N-acetyl cysteine treatment (1,000 mg twice a day for eight weeks).25 Double-blind trials are needed to confirm this benefit.
    1 Star
    Lupus
    600 mg three times per day
    In a case report, a woman with kidney disease due to SLE (lupus nephritis) may have had an improvement in her kidney function due to treatment with N-acetylcysteine (NAC).
    In a case report, a woman with kidney disease due to SLE (lupus nephritis) had an improvement in her kidney function and was able to taper off of her steroid medicine after starting treatment with N-acetylcysteine (NAC) in the amount of 600 mg 3 times per day. She continued NAC, and after a total of 13 months her disease was considered inactive.26

    How It Works

    How to Use It

    Healthy people do not need to supplement NAC. Optimal levels of supplementation remain unknown, though much of the research uses 250-1,500 mg per day.

    Where to Find It

    Cysteine , the amino acid from which NAC is derived, is found in most high-protein foods. NAC is not found in the diet.

    Possible Deficiencies

    Deficiencies of NAC have not been defined and may not exist. Deficiencies of the related amino acid cysteine have been reported in HIV-infected patients.27

    Interactions

    Interactions with Supplements, Foods, & Other Compounds

    At the time of writing, there were no well-known supplement or food interactions with this supplement.

    Interactions with Medicines

    Certain medicines interact with this supplement.

    Types of interactions: Beneficial Adverse Check

    Replenish Depleted Nutrients

    • Methotrexate

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.  Vitamin C appears to increase the effectiveness of chemotherapy in animals and with human breast cancer cells in test tube research.239 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.240

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but it clearly shows that antioxidants need not be avoided for fear that the actions of chemotherapy are interfered with.241 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    Reduce Side Effects

    • Acetaminophen with Codeine

      Hospitals use oral and intravenous N-acetyl cysteine (NAC) to treat liver damage induced by acetaminophen overdose poisoning.28 NAC is often administered intravenously by emergency room doctors. Oral NAC appears to be effective for acetaminophen toxicity.

      An uncontrolled trial compared intravenous NAC with oral NAC in children with acetaminophen poisoning and found that both methods were equally effective in reversing acetaminophen-induced liver toxicity.29 However, acetaminophen toxicity is a potential medical emergency, and should only be managed by qualified healthcare professionals.

    • AZT

      Animal research suggests that zinc and N-acetyl cysteine supplementation may protect against AZT toxicity.30 It is not known whether oral supplementation with these nutrients would have similar effects in people taking AZT.

    • Bicalutamide

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.31 , 32 , 33 , 34 These studies used 1-2 grams NAC four times per day. Th+N110ere was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.35

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.  Vitamin C appears to increase the effectiveness of chemotherapy in animals and with human breast cancer cells in test tube research.36 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.37

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.38 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Busulfan

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.44 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.45 Vitamin C appears to increase the effectiveness of chemotherapy in animals46 and with human breast cancer cells in test tube research.47 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.48

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.49 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Capecitabine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.50 , 51 , 52 , 53 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.54

    • Carboplatin

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.60 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.61 Vitamin C appears to increase the effectiveness of chemotherapy in animals62 and with human breast cancer cells in test tube research.63 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.64

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.65 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Carmustine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.72 , 73 , 74 , 75 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.76

    • Chlorambucil

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.83 , 84 , 85 , 86 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.87

    • Cladribine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.94 , 95 , 96 , 97 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.98

    • Clozapine

      Clozapine can inhibit the formation of immune cells that protect the body from invading organisms. Test tube studies show that N-acetyl-cysteine and vitamin C block the formation of immune cell-damaging compounds produced when clozapine is broken down.99 Controlled studies are necessary to determine whether supplementing N-acetyl-cysteine and vitamin C might prevent harmful side effects in people taking clozapine.

    • Cyclophosphamide

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.101 , 102 , 103 , 104 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC, at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.105

    • Cytarabine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.106 , 107 , 108 , 109 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.110

    • Docetaxel

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.119 , 120 , 121 , 122 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC, at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.123

    • Erlotinib

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.129 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.130 Vitamin C appears to increase the effectiveness of chemotherapy in animals131 and with human breast cancer cells in test tube research.132 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.133

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.134 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Etoposide

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.135 , 136 , 137 , 138 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.139

    • Floxuridine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.146 , 147 , 148 , 149 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.150

    • Fludarabine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.157 , 158 , 159 , 160 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.161

    • Fluorouracil

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.162 , 163 , 164 , 165 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC, at 1,800 mg per day, may reduce nausea and vomiting caused by chemotherapy.166

    • Flurbiprofen

      Nonsteroidal anti-inflammatory drugs commonly cause damage to stomach and intestinal tissue. Though the mechanism by which NSAIDs cause this side effect is unknown, some researchers believe that free-radical damage is involved. A test tube study showed that flurbiprofen increases free-radical activity in stomach cells, which is blocked by the antioxidant N-acetyl cysteine.167 Additional research is needed to determine whether people taking flurbiprofen together with N-acetyl cysteine might experience fewer gastrointestinal side effects.

    • Gentamicin

      In another animal study, injections of N-Acetyl cysteine (10 mg per 2.2 pounds of body weight per day for five days) reduced the severity of kidney damage resulting from administration of gentamicin.168

    • Hydrocodone-Acetaminophen

      Hospitals use oral and intravenous N-acetyl cysteine (NAC) to treat liver damage induced by acetaminophen overdose poisoning.169 NAC is often administered intravenously by emergency room doctors. Oral NAC appears to be effective for acetaminophen toxicity.

      An uncontrolled trial compared intravenous NAC with oral NAC in children with acetaminophen poisoning and found that both methods were equally effective in reversing acetaminophen-induced liver toxicity.170 However, acetaminophen toxicity is a potential medical emergency, and should only be managed by qualified healthcare professionals.

    • Ifosfamide

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.176 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.177 Vitamin C appears to increase the effectiveness of chemotherapy in animals178 and with human breast cancer cells in test tube research.179 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.180

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.181 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Irinotecan

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.188 , 189 , 190 , 191 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.192

    • Isoniazid
      In patients being treated with a combination of drugs for tuberculosis (including isoniazid), supplementation with N-acetylcysteine (600 mg twice a day) reduced the amount of liver damage caused by the drugs193.
    • Isoniazid-Rifampin
      In patients being treated with a combination of drugs for tuberculosis (including isoniazid and rifampin), supplementation with N-acetylcysteine (600 mg twice a day) reduced the amount of liver damage caused by the drugs194.
    • Isoniazid-Rifamp-Pyrazinamide
      In patients being treated with a combination of drugs for tuberculosis (including isoniazid, rifampin, and pyrazinamide), supplementation with N-acetylcysteine (600 mg twice a day) reduced the amount of liver damage caused by the drugs195.
    • Lomustine

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.205 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.206 Vitamin C appears to increase the effectiveness of chemotherapy in animals207 and with human breast cancer cells in test tube research.208 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.209

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.210 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Mechlorethamine

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.211 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.212 Vitamin C appears to increase the effectiveness of chemotherapy in animals213 and with human breast cancer cells in test tube research.214 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.215

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.216 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Melphalan

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.223 , 224 , 225 , 226 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.227

    • Mercaptopurine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.234 , 235 , 236 , 237 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.238

    • Paclitaxel

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.243 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.244 Vitamin C appears to increase the effectiveness of chemotherapy in animals245 and with human breast cancer cells in test tube research.246 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.247

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but the article strongly suggests that antioxidants need not be avoided for fear that the actions of chemotherapy would be interfered with.248

      A new formulation of selenium (Seleno-Kappacarrageenan) was found to reduce kidney damage and white blood cell-lowering effects of cisplatin in one human study. However, the level used in this study (4,000 mcg per day) is potentially toxic and should only be used under the supervision of a doctor.249

      Glutathione , the main antioxidant found within cells, is frequently depleted in individuals on chemotherapy and/or radiation. Preliminary studies have found that intravenously injected glutathione may decrease some of the adverse effects of chemotherapy and radiation, such as diarrhea .250

    • Polifeprosan 20 with Carmustine

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.256 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.257 Vitamin C appears to increase the effectiveness of chemotherapy in animals258 and with human breast cancer cells in test tube research.259 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.260

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.261 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Thioguanine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.270 , 271 , 272 , 273 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.274

    • Thiotepa

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.281 , 282 , 283 , 284 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.285

    • Uracil Mustard

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.292 , 293 , 294 , 295 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.296

    • Vinblastine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.297 , 298 , 299 , 300 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.301

    • Vincristine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.308 , 309 , 310 , 311 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.312

    Support Medicine

    • Cortisone

      One preliminary study found that in people with fibrosing alveolitis (a rare lung disease), supplementation with 600 mg N-acetyl cysteine three times per day increased the effectiveness of prednisone therapy.100

    • Dexamethasone

      One preliminary study found that in people with fibrosing alveolitis (a rare lung disease), supplementation with 600 mg N-acetyl cysteine three times per day increased the effectiveness of prednisone therapy.111

    • Docetaxel

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.112 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.113 Vitamin C appears to increase the effectiveness of chemotherapy in animals114 and with human breast cancer cells in test tube research.115 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.116

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but it clearly shows that antioxidants need not be avoided for fear that the actions of chemotherapy are interfered with.117 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

      A new formulation of selenium (Seleno-Kappacarrageenan) was found to reduce kidney damage and white blood cell-lowering effects of cisplatin in one human study. However, the level used in this study (4,000 mcg per day) is potentially toxic and should only be used under the supervision of a doctor.118

    • Isosorbide Dinitrate

      The beneficial effects of ISDN are reduced following long-term treatment with the drug through a process known as tolerance. Controlled studies have shown that using intravenous and oral N-acetyl cysteine (NAC) reverses or prevents tolerance to nitrates.196 , 197 Another controlled study revealed that intravenous NAC enhanced the beneficial effects of ISDN on heart function.198 Therefore, people taking isosorbide dinitrate might benefit from supplemental NAC.

    • Isosorbide Mononitrate

      In a double-blind trial, sustained-release ISMN plus oral NAC (2,400 mg twice per day) for two days led to significantly longer exercise time than ISMN plus placebo.199 This outcome suggests that NAC may have increased the efficacy of ISMN. There were no differences in side effects between the two groups.

    • Methylprednisolone

      One preliminary study found that in people with fibrosing alveolitis (a rare lung disease), supplementation with 600 mg N-acetyl cysteine three times per day increased the effectiveness of prednisone therapy.242

    • Prednisolone

      One preliminary study found that in people with fibrosing alveolitis (a rare lung disease), supplementation with 600 mg N-acetyl cysteine three times per day increased the effectiveness of prednisone therapy.262

    • Prednisone

      One preliminary study found that in people with fibrosing alveolitis (a rare lung disease), supplementation with 600 mg N-acetyl cysteine three times per day increased the effectiveness of prednisone therapy.263

    Reduces Effectiveness

    • none

    Potential Negative Interaction

    • Acetaminophen

      Hospitals use oral and intravenous NAC to treat liver damage induced by acetaminophen overdose poisoning.313 NAC is often administered intravenously by emergency room doctors. Oral NAC appears to be effective for acetaminophen toxicity.

      An uncontrolled trial compared intravenous NAC with oral NAC in children with acetaminophen poisoning and found that both methods were equally effective in reversing acetaminophen-induced liver toxicity.314 However, acetaminophen toxicity is a potential medical emergency, and should only be managed by qualified healthcare professionals.

    • Metoclopramide

      A single case report described a 15-year-old girl who suffered oxygen deprivation in her body tissues after being given high amounts of metoclopramide and N-acetyl-cysteine to treat her for an overdose of acetaminophen .315 It is unknown whether N-acetyl-cysteine supplementation in the absence of acetaminophen overdose could cause similar effects in people taking metoclopramide. Until controlled research determines the safety of this combination, it should be used only under the supervision of a qualified physician.

    Explanation Required

    • Capecitabine

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.316 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.317 Vitamin C appears to increase the effectiveness of chemotherapy in animals318 and with human breast cancer cells in test tube research.319 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.320

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.321 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Cisplatin

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.322 , 323 , 324 , 325 These studies used 1-2 grams NAC four times per day. Th+N110ere was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.326

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.  Vitamin C appears to increase the effectiveness of chemotherapy in animals and with human breast cancer cells in test tube research.327 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.328

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.329 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Cytarabine

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.330 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.331 Vitamin C appears to increase the effectiveness of chemotherapy in animals332 and with human breast cancer cells in test tube research.333 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.334

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.335 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Doxorubicin

      The antioxidant supplement N-acetyl cysteine (NAC) has protected animals from the cardiotoxicity of doxorubicin,336 although human research has not been able to confirm these results.337 Most doctors do not yet suggest NAC for people taking doxorubicin.

    • Etoposide

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.338 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.339 Vitamin C appears to increase the effectiveness of chemotherapy in animals340 and with human breast cancer cells in test tube research.341 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.342

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.343 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    • Fluorouracil

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.344 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.345 Vitamin C appears to increase the effectiveness of chemotherapy in animals346 and with human breast cancer cells in test tube research.347 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.348

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but the article strongly suggests that antioxidants need not be avoided for fear that the actions of chemotherapy would be interfered with.349

    • Hydroxyurea

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.356 , 357 , 358 , 359 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.360

    • Mechlorethamine

      NAC, an amino acid-like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.361 , 362 , 363 , 364 These studies used 1-2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.

      The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.365

    • Nitroglycerin

      Continuous nitroglycerin use leads to development of nitroglycerin tolerance and loss of effectiveness. Intravenous (iv) N-acetyl cysteine (NAC), during short-term studies of people receiving continuous nitroglycerin, was reported to reverse nitroglycerin tolerance.366 , 367 In a double-blind study of patients with unstable angina, transdermal nitroglycerin plus oral NAC (600 mg three times per day) was associated with fewer failures of medical treatment than placebo, NAC, or nitroglycerin alone. However, when combined with nitroglycerin use, NAC has led to intolerable headaches.368 , 369 In two double-blind, randomized trials of angina patients treated with transdermal nitroglycerin, oral NAC 200 mg or 400 mg three times per day failed to prevent nitroglycerin tolerance.370 , 371

    • Vinblastine

      Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.372 However, most scientific research does not support this supposition.

      A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.373 Vitamin C appears to increase the effectiveness of chemotherapy in animals374 and with human breast cancer cells in test tube research.375 In a double-blind study, Japanese researchers found that the combination of vitamin E , vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.376

      A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with.377 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers' package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

    Side Effects

    Side Effects

    One study reported that 19% of people taking NAC orally experienced nausea, vomiting, headache, dry mouth, dizziness, or abdominal pain.378 These symptoms have not been consistently reported by other researchers, however.

    Although a great deal of research has shown that NAC has antioxidant activity, one small study found that daily amounts of 1.2 grams or more could lead to increased oxidative stress.379 Extremely large amounts of cysteine , the amino acid from which NAC is derived, may be toxic to nerve cells in rats.

    NAC may increase urinary zinc excretion.380 Therefore, supplemental zinc and copper should be added when supplementing with NAC for extended periods.

    References

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    3. Riise GC, Larsson S, Larsson P, et al. The intrabronchial microbial flora in chronic bronchitis patients: a target for N-acetylcysteine therapy? Eur Respir J 1994;7:94-101.

    4. Jackson IM, Barnes J, Cooksey P. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res 1984;12:198-206.

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    7. Boman G, Backer U, Larsson S, et al. Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases. Eur J Respir Dis 1983;64:405-15.

    8. Multicenter Study Group. Long-term oral acetylcysteine in chronic bronchitis. A double-blind controlled study. Eur J Respir Dis 1980;61:111:93-108.

    9. Zheng JP, Wen FQ, Bai CX, et al. Twice daily N-acetyl cysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial.Lancet Respir Med2014;2:187-94.

    10. Tse HN, Raiteri L, Wong KY, et al. Benefits of high-dose N-acetylcysteine to exacerbation-prone patients with COPD. Chest. 2014;146:611-23.

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    12. Decramer M, Rutten-van Molken M, Dekhuijzen PN, et al. Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet2005;365:1552-60.

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    19. Houdijk AP, Van Leeuwen PA, Boermeester MA, et al. Glutamine-enriched enteral diet increases splanchnic blood flow in the rat. Am J Physiol 1994;267(6 Pt 1):G1035-40.

    20. Wilmore DW, Smith RJ, O'Dwyer ST, et al. The gut: a central organ after surgical stress. Surgery 1988;104:917-23.

    21. Yan R, Sun Y, Sun R. Early enteral feeding and supplement of glutamine prevent occurrence of stress ulcer following severe thermal injury. Chung Hua Cheng Hsing Shao Shang Wai Ko Tsa Chih 1995;11(3):189-92.

    22. Brzozowski T, Konturek SJ, Sliwowski Z, et al. Role of L-arginine, a substrate for nitric oxide-synthase, in gastroprotection and ulcer healing. J Gastroenterol 1997;32(4):442-52.

    23. Roederer M, Staal FJ, Raju PA, et al. Cytokine-stimulated human immunodeficiency virus replication is inhibited by N-acetyl-L-cysteine. Proc Natl Acad Sci 1990;87:4884-8.

    24. Herzenberg LA, De Rosa SC, Dubs JG, et al. Glutathione deficiency is associated with impaired survival in HIV disease. Proc Natl Acad Sci 1997;94:1967-72.

    25. Berk M, Dean O, Cotton SM, et al. The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: an open label trial. J Affect Disord 2011;135:389-94.

    26. Tewthanom K, Janwitayanujit S, Totemchockcyakarn K, et al. The effect of high dose of N-acetylcysteine in lupus nephritis: a case report and literature review. J Clin Pharm Ther 2010;35:483-5.

    27. De Quay B, Malinverni R, Lauterburg BH. Glutathione depletion in HIV-infected patients: role of cysteine deficiency and effect of oral N-acetylcysteine. AIDS 1992;6:815-9.

    28. Vale JA, Proudfoot AT. Paracetamol (acetaminophen) poisoning. Lancet 1995;346:547-52.

    29. Perry HE, Shannon MW. J Pediatr 1998;132:149-52.

    30. Gogu SR, Agrawal KC. The protective role of zinc and N-acetylcysteine in modulating zidovudine induced hematopoietic toxicity. Life Sci 1996;59:1323-9.

    31. Holoya PY, Duelge J, Hansen RM, et al. Prophylaxis of ifosfamide toxicity with oral acetylcysteine. Sem Oncol 1983;10(suppl 1):66-71.

    32. Slavik M, Saiers JH. Phase I clinical study of acetylcysteine's preventing ifosfamide-induced hematuria. Sem Oncol 1983;10(suppl 1):62-5.

    33. Loehrer PJ, Williams SD, Einhorn LH. N-Acetylcysteine and ifosfamide in the treatment of unresectable pancreatic adenocarcinoma and refractory testicular cancer. Sem Oncol 1983;10(suppl 1):72-5.

    34. Morgan LR, Donley PJ, Harrison EF. The control of ifosfamide induced hematuria with N-acetylcysteine. Proc Am Assoc Cancer Res 1981;22:190.

    35. De Blasio F, et al. N-acetyl cysteine (NAC) in preventing nausea and vomiting induced by chemotherapy in patients suffering from inoperable non small cell lung cancer (NSCLC). Chest 1996;110(4, Suppl):103S.

    36. Kurbacher CM, Wagner U, Kolster B, et al. Ascorbic acid (vitamin C) improves the antineoplastic activity of doxorubicin, cisplatin, and paclitaxel in human breast carcinoma cells in vitro. Cancer Letters 1996:103-19.

    37. Wagdi P, Fluri M, Aeschbacher B, et al. Cardioprotection in patients undergoing chemo- and/or radiotherapy for neoplastic disease. Jpn Heart J 1996;37:353-9.

    38. Weijl NI, Cleton FJ, Osanto S. Free radicals and antioxidants in chemotherapy-induced toxicity. Cancer Treatment Rev 1997;23:209-40 [review].

    39. Holoya PY, Duelge J, Hansen RM, et al. Prophylaxis of ifosfamide toxicity with oral acetylcysteine. Sem Oncol 1983;10(suppl 1):66-71.

    40. Slavik M, Saiers JH. Phase I clinical study of acetylcysteine's preventing ifosfamide-induced hematuria. Sem Oncol 1983;10(suppl 1):62-5.

    41. Loehrer PJ, Williams SD, Einhorn LH. N-Acetylcysteine and ifosfamide in the treatment of unresectable pancreatic adenocarcinoma and refractory testicular cancer. Sem Oncol 1983;10(suppl 1):72-5.

    42. Morgan LR, Donley PJ, Harrison EF. The control of ifosfamide induced hematuria with N-acetylcysteine. Proc Am Assoc Cancer Res 1981;22:190.

    43. De Blasio F, et al. N-acetyl cysteine (NAC) in preventing nausea and vomiting induced by chemotherapy in patients suffering from inoperable non small cell lung cancer (NSCLC). Chest 1996;110(4, Suppl):103S.

    44. Witenberg B, Kalir HH, Raviv Z, et al. Inhibition by ascorbic acid of apoptosis induced by oxidative stress in HL-60 myeloid leukemia cells. Biochem Pharmacol 1999;57:823-32.

    45. Sacks PG, Harris D, Chou T-C. Modulation of growth and proliferation in squamous cell carcinoma by retinoic acid: A rationale for combination therapy with chemotherapeutic agents. Int J Cancer 1995;61:409-15.

    46. Taper HS et al. Non-toxic potentiation of cancer chemotherapy by combined C and K3 vitamin pre-treatment. Int J Cancer 1987;40:575-9.

    47. Kurbacher CM, Wagner U, Kolster B, et al. Ascorbic acid (vitamin C) improves the antineoplastic activity of doxorubicin, cisplatin, and paclitaxel in human breast carcinoma cells in vitro. Cancer Letters 1996:103-19.

    48. Wagdi P, Fluri M, Aeschbacher B, et al. Cardioprotection in patients undergoing chemo- and/or radiotherapy for neoplastic disease. Jpn Heart J 1996;37:353-9.

    49. Weijl NI, Cleton FJ, Osanto S. Free radicals and antioxidants in chemotherapy-induced toxicity. Cancer Treatment Rev 1997;23:209-40 [review].

    50. Holoya PY, Duelge J, Hansen RM, et al. Prophylaxis of ifosfamide toxicity with oral acetylcysteine. Sem Oncol 1983;10(suppl 1):66-71.

    51. Slavik M, Saiers JH. Phase I clinical study of acetylcysteine's preventing ifosfamide-induced hematuria. Sem Oncol 1983;10(suppl 1):62-5.

    52. Loehrer PJ, Williams SD, Einhorn LH. N-Acetylcysteine and ifosfamide in the treatment of unresectable pancreatic adenocarcinoma and refractory testicular cancer. Sem Oncol 1983;10(suppl 1):72-5.

    53. Morgan LR, Donley PJ, Harrison EF. The control of ifosfamide induced hematuria with N-acetylcysteine. Proc Am Assoc Cancer Res 1981;22:190.

    54. De Blasio F, et al. N-acetyl cysteine (NAC) in preventing nausea and vomiting induced by chemotherapy in patients suffering from inoperable non small cell lung cancer (NSCLC). Chest 1996;110(4, Suppl):103S.

    55. Holoya PY, Duelge J, Hansen RM, et al. Prophylaxis of ifosfamide toxicity with oral acetylcysteine. Sem Oncol 1983;10(suppl 1):66-71.

    56. Slavik M, Saiers JH. Phase I clinical study of acetylcysteine's preventing ifosfamide-induced hematuria. Sem Oncol 1983;10(suppl 1):62-5.

    57. Loehrer PJ, Williams SD, Einhorn LH. N-Acetylcysteine and ifosfamide in the treatment of unresectable pancreatic adenocarcinoma and refractory testicular cancer. Sem Oncol 1983;10(suppl 1):72-5.

    58. Morgan LR, Donley PJ, Harrison EF. The control of ifosfamide induced hematuria with N-acetylcysteine. Proc Am Assoc Cancer Res 1981;22:190.

    59. De Blasio F, et al. N-acetyl cysteine (NAC) in preventing nausea and vomiting induced by chemotherapy in patients suffering from inoperable non small cell lung cancer (NSCLC). Chest 1996;110(4, Suppl):103S.

    60. Witenberg B, Kalir HH, Raviv Z, et al. Inhibition by ascorbic acid of apoptosis induced by oxidative stress in HL-60 myeloid leukemia cells. Biochem Pharmacol 1999;57:823-32.

    61. Sacks PG, Harris D, Chou T-C. Modulation of growth and proliferation in squamous cell carcinoma by retinoic acid: A rationale for combination therapy with chemotherapeutic agents. Int J Cancer 1995;61:409-15.

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    63. Kurbacher CM, Wagner U, Kolster B, et al. Ascorbic acid (vitamin C) improves the antineoplastic activity of doxorubicin, cisplatin, and paclitaxel in human breast carcinoma cells in vitro. Cancer Letters 1996:103-19.

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