N-acetylcysteine -- passe-partout or much ado about nothing?
In experimental studies, the old mucolytic agent N-acetylcysteine (NAC) has had beneficial effects in disorders supposedly linked to oxidative stress. Numerous, mainly small clinical trials with variable doses have yielded inconsistent results in a wide variety of diseases. NAC added to the conventional therapy of human immunodeficiency virus infection might be of benefit; in respect of chronic obstructive pulmonary disease, systematic reviews and meta-analyses suggested that prolonged treatment with NAC is efficacious, but a recent multicentre study has questioned this. In a large intervention trial on cancer recurrence, NAC was ineffective. NAC infusions have been widely used in acute hepatic failure but convincing evidence of its benefits is lacking. A preliminary study reported that NAC is effective in preventing radiocontrast-induced nephropathy but thereafter highly mixed results have been published, and even meta-analyses disagree on its efficacy. In intensive care NAC has mostly been a disappointment but recently it has 'given promises' in surgery with cardiopulmonary bypass. NAC therapy is routine only in paracetamol intoxication.
Aitio
Mirja-Liisa
ML
Nyon, Switzerland. m.aitio@deckpoint.ch
D000111:Acetylcysteine / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005100:Expectorants / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000517:prevention & control; D008107:Liver Diseases / Q000188:drug therapy; D008171:Lung Diseases / Q000188:drug therapy; D009369:Neoplasms / Q000188:drug therapy; D018384:Oxidative Stress / Q000187:drug effects; D017382:Reactive Oxygen Species / Q000378:metabolism
D019380:Anti-HIV Agents; D000975:Antioxidants; D005100:Expectorants; D017382:Reactive Oxygen Species; D000111:Acetylcysteine