Talk:Acetylcysteine

Broken Link okay now

Apologies for adding this to the "talk" page, but I can't seem to make edits. Citation number 42 is currently a broken link, should be redirected to: http://www.wjgnet.com/1007-9327/9/125.pdf

--Quickfastgoninja (talk) 21:26, 22 April 2012 (UTC)

Change made and unmade -- PMID ref working now. -- Jo3sampl (talk) 22:28, 15 May 2012 (UTC)

Use in patients with COPD

It is my understanding that this is no longer investigational. At least where I come from use is indicated in patients with COPD, recurring exacerbations and chronic bronchitis (productive cough at least three months/year). Reference no 22 is a RCT with clear results and no obvious weakness, or am I missing something? --GustenNyberg (talk) 13:28, 7 January 2010 (UTC)

Contesting boost of immune system

The article states that NAC helps boost the immune system. I contest this statement. I'm taking it out now. If someone wants to add it back, please give a reference.

I provided reference from two RCTs showing that it increases immunity in AIDS. I invite you (or other contributors) to put back a similar statement (to "NAC helps boost the immune system") at the same place it was. You might wish to limit the sentence to AIDS. In the meantime, I'll try and find other research and trials on immunity at large (but you may want to check it out yourself). Pierre-Alain Gouanvic 17:01, 12 March 2007 (UTC) (I see that your intervention is 3 years old, so I'll probably have do the job (since you're perhaps not around anymore!). BTW, the study I provide dates to 2000.)

UPDATE

See research results at http://www.sciencedaily.com/releases/2011/02/110215102836.htm . I'm not familiar with Wiki standards for research results. Should anything be added to this article? — Preceding unsigned comment added by Jo3sampl (talk • contribs) 00:26, 1 March 2011 (UTC)

More references

I added a couple references. If someone wants to really expand this article, these should be a good jump-off point. :-) Ksheka 23:48, May 9, 2004 (UTC)

Ah, yes, the references. I could make head nor tails of the 30 references of all stripes and colours... I felt the sensible thing to do was to slash them all and start again. I've also expanded the drugbox. JFW | T@lk 21:32, 28 Nov 2004 (UTC)

I wonder if this paper - "Clinical trials of N-acetylcysteine in psychiatry and neurology: A systematic review." would be a good candidate to address the "[medical citation needed]" in the first paragraph? Smartial arts (talk) 00:36, 22 May 2015 (UTC)

Move to acetylcysteine

In accordance with Wikipedia:WikiProject_Drugs naming policy, I propose we move this page to the INN acetylcysteine. If you have any concern with this proposal, please discuss it on this page. Matt 23:07, 21 Dec 2004 (UTC)

Merging Mucomyst into acetylcysteine

The content in Mucomyst is essentially duplicated in acetylcysteine. Andrew73 02:16, 23 October 2005 (UTC)

I just happened by here by accident, but I think this is a good candidate for a merge. Kit 19:13, 10 November 2005 (UTC)

Done. JFW | T@lk 13:26, 11 November 2005 (UTC)

Looks good to me! Kit 19:01, 11 November 2005 (UTC)

Liver failure

I've been told several times by our local liver unit to use NAc even in liver failure of non-paracetamol etiology. PMID 1904133 already mentions this (small series in 8 patients). PMID 14742832 disagrees. It's being trialled for acute liver failure. JFW | T@lk 19:37, 20 September 2006 (UTC)

Negative effects

Does this drug have any negative effects? I'm allergic to plane trees, and live between 2 of the biggest I've ever seen. Come Autumn I regularly get a mucus build-up in my sinuses which, if not treated results in a very frustrating and repetitive cough. I discovered Acetylcysteine on my travels to Italy and now keep a ready supply of it at home in Australia where it's a prescription only drug. Am I likely to be exposing myself to any side effects by using this drug every time I get a cold? 58.104.24.81 00:01, 8 June 2007 (UTC)

Normal dosage by nebulization or direct tracheal instillation appears to be a couple of grams a day, sustained indefinitely. (The fraction absorbed into the metabolism is unclear.) So as long as you're not exceeding that level, it seems safe enough.

The side effects listed for heavy users at http://www.cystic-fibrosis-symptom.com/mucosil.htm look pretty benign. Here's an article on Adverse reactions to acetylcysteine and effects of overdose, which includes two deaths, but they were already suffering from severe paracetamol overdose, so it's not clear what's to blame. Due to an easily-misread label, sometimes people got 10x the correct dose (60-80 grams IV rather than 6-8 g), and while this tended to make side effects more severe, some people had no adverse reactions at all.

It's taken orally without prescription as a dietary supplement, and there are folks who take grams a week long-term due to its anti-oxidant properties. Boluses of 1200 mg/day are used to protect kidneys from radiocontrast substances.

Oh! And here's the abstract of a paper Treatment of four siblings with progressive myoclonus epilepsy of the Unverricht-Lundborg type with N-acetylcysteine describing therapeutic use in humans at 4-6 g/day for 30 months. That was for a serious disorder which would make side effects tolerable, but it appears to be very hard to badly overdose.

71.41.210.146 06:09, 10 July 2007 (UTC)

PULMONARY HYPERTENSION IN MICE AT HIGH DOSE: Probably an overdose effect

Palmer et al ran a mouse study that showed that high dose NAC administration (19X the equivalent human dose) has an adverse effect of raising pulmonary artery blood pressure about 25%. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17786245 (Palmer. S-Nitrosothiols signal hypoxia-mimetic vascular pathology. J Clin Invest. 2007 September 4; 117(9): 2592–2601)

At 203x the equivalent dose it caused right sided heart enlargement. I doubt that this should be problematic given such high doses. I calculated that the usual dose of 600 mg would only raise PA blood pressure 1.3%, a trivial amount.

Mouse normal daily water consumption 15 ml/100 gm body weight/day Weight of a mouse 25g Daily water consumption of mouse =25g * .15 ml/g = 3.75 ml Dose NAC high 10 mg/ml * 3.75 ml = 37 mg. 37 mg * 0.001 g/mg * 1/25 g * 100 = 0.158% Low 1 mg/ml * 3.75 ml = 3.7 mg = 0.015 % body weight Human dose NAC 600 mg 600 mg * 0.001 g/mg * 1/77,110g * 100 = 0.000778% Dose comparison mouse to human high dose mouse = 203x human dose Low dose mouse = 19x human dose Low dose effect noted was to raise PA BP 23 points 19x dose raised BP 25% Adjusted dose would raise PA BP by only 1.3%. Not clinically significant because the diagnostic criteria PA in humans: = >25 mm Hg at rest. Normal is 14 mm Hg. PA hypertension is 50% increase. Abotnick

Cysteine is amazing, from the glial xCT cysteine antiporter, to glutathione, methylation eg. for norepinephrine -> epinephrine ... which needs SAMe (made from cysteine) and produces homocysteine ..

The cardio issues are due to homocysteine. to each person that called it a drug, _WAKEUP_ , bigpharma doesnt own aminoacids... ffs. Also the "side effects" are not due to the cysteine, its not just a single action with a single dimensional response occurring due to administration of a single chemical. We need to change our use of language if we're ever going to move beyond the commercialisation of our health. its a _NUTRIENT_, and there is nothing unusual, wrong or unnatural about a human becoming informed and making decisions about their diet. in this respect wiki is an excellent way to become more informed.

The "harmful effect" is due to the accumulation of homocysteine which is in turn reduced in a cycle in the body which requires certain vitamins. So taking large amounts of cysteine may deplete these cofactors leading to "side-effects" ... But its not just a single action, its part of an system, a complex dynamical system. ;P

I'll provide references later but perhaps others might help to incorporate more of these issues into the article as well as to link to other wiki pages that cover each particular role in more detail, many of which already exist.

basically the homocysteine builds up. so while cysteine has fantastic effects on the body large amounts without the necessary cofactors will lead to an accumulation of homocysteine and at high levels this leads to problems.

to reduce homocysteine accumulation you need B6,B9,B12 and trimethylglycine will help by supporting an additional minor methylation pathway. Having said the above the caveat is that this may only reduce the homocysteine accumulation so if you use multigram quantities daily it will build up, but not as much. This may necessitate dosing in cycles with time off cysteine during which the B6 B12 folic acid and TMG are continued to keep homocysteine levels in check longterm.

high levels of homocysteine is risk factor for cardiovascular disease. also the reference bloodranges rises throughout your life so someone >60 typically has twice the homocysteine levels as someone <20.

Brazil nuts have high levels of cysteine and methionine, and many other nuts are great sources of protein including cysteine. Perhaps try some crushed in a stirfry with leafy greens and mushrooms ?

 — Preceding unsigned comment added by 220.101.100.14 (talk) 10:23, 23 May 2012 (UTC) 

Might give stomach upsets and bloating in large doses to some people. The article says it has a foul taste and smell. It does not have any smell. It has a citric taste which can be moderated with more water. — Preceding unsigned comment added by 2A01:4B00:88B6:8200:BCCD:57B5:525C:8DC8 (talk) 16:56, 24 April 2023 (UTC)

Ocular use

i use this stuff in my eyes for the mucus. perhaps someone with more knowledge than i could add something--Mongreilf (talk) 08:58, 25 May 2009 (UTC)

Oral versus Parenteral

I don'd understand the fetish that the average person editing this page has with IV acetylcysteine. The reality is there are major complications that can be completely avoided by giving the oral furmulation. If you mix it with cola of the patients choice, put it on ice, and make patients drink it out of a straw from a cap with a lid, you will get over 90% of patients to take their entire dose by mouth which avoids all of the nasty potential complications with IV. —Preceding unsigned comment added by 144.30.70.85 (talk) 19:53, 23 June 2010 (UTC)

the use of the acetyl moeity

does anybody know what it does to the SAR? —Preceding unsigned comment added by 41.34.29.84 (talk) 02:54, 11 January 2011 (UTC)

Is there a naturally occuring acetylcysteine at the body

Im wondering if there is a body enzyme system that produces N acetyl cysteine at the body. If theres cysteine certainly there are acetylation enzymes I just wondered if there was a biochemical path that actually made N acetylcysteine at the body

The idea is that genetic variants of that enzymes genes might go with greater longevity as well as less disease — Preceding unsigned comment added by 163.41.136.51 (talk) 20:00, 9 June 2011 (UTC)

Sources for veisalgia claim

I think the claim for veisalgia attenuating should get some direct sources to support it's claim. The first one is second hand and the other one (Resat Ozaras et al., 2003) doesn't seem to support the direct claim to attenuate veisalgia, mere that "[...] ethanol- induced liver damage is associated with oxidative stress, and co-administration of n-acetylcysteine attenuates this damage effectively in rat model.". 81.232.6.92 (talk) 22:47, 3 November 2011 (UTC)

Hangover

There used to be an entry related to hangover prevention. Why was it removed? (Personally, I swear by it for preventing hangovers--obviously that doesn't merit inclusion absent a source.) — Preceding unsigned comment added by 71.163.49.29 (talk) 17:33, 1 September 2012 (UTC)

Research

I see a whole list of "potential" uses for acetylcysteine. Many are early stage animal experiments. Given that this is a medical article I suppose that only clinical studies should get a mention. Desoto10 (talk) 05:00, 8 May 2013 (UTC)

I think that the Research section should be deleted except for completed clinical trials, and those should be listed according to whatever disease was being examined. As it is, the Research section is just a hodgepoge of case studies, animal experiments (mostly removed) and on-going trials. It is my understanding that we should be reporting on the results of these trials as they are covered in secondary sources, such as review articles and not just list them all. Desoto10 (talk) 02:41, 11 May 2013 (UTC)

DrugBox

As acetylcysteine is primarily used as a medicine I believe we should change the chembox to drugbox. Fuse809 (talk) 04:56, 8 November 2013 (UTC)

Incorrect image in description (revolving 3D animated GIF)

Pardon me, but it appears that the 3D-rendered animation used (Acetylcysteine3Dan2.gif) is actually that of ordinary L-cysteine. The stereochemistry's correct, at least. dlainhart (talk) 02:40, 9 December 2013 (UTC)

Oh, hehe, sorry wrong file. Thanks for the correction. Fuse809 (talk) 02:52, 9 December 2013 (UTC)

bad for you

The antioxidants caused a 2.8-fold increase in lung tumors, made the tumors more invasive and aggressive, and caused the mice to die twice as quickly - all compared to mice not given antioxidants.

The only article I see about uses both NAC and vitamin E, couldn't it be just vit E's problem? Bowtartar (talk) 12:49, 29 October 2017 (UTC)

contradictory information

there is contradictory information on this page stating that research both supports and rejects the drug as a viable treatment for nicotine, both marked with the same citation (as of jul 15, citation 38).

http://news.yahoo.com/antioxidants-including-vitamin-e-promote-lung-cancer-study-190119863--finance.html — Preceding unsigned comment added by 76.176.108.8 (talk) 12:27, 30 January 2014 (UTC)

Non-prescription in U.S.

I can buy NAC at retailers such as "natural food" stores. I perceive this as a supplement (in terms of regulation), and thus wouldn't the info in the side panel be incorrect? I believe it says rx-only in U.S. right now.

172.58.136.98 (talk) 19:05, 19 December 2015 (UTC)

Human-equivalent dosage for heart/lung damage in mice?

The article says: "Large doses in a mouse model showed that acetylcysteine could potentially cause damage to the heart and lungs... The dose used by Palmer and colleagues was dramatically higher than that used in humans, the equivalent of about 20 grams per day." However, Examine.com https://examine.com/supplements/N-Acetylcysteine/ says: "In mice given 10mg/mL N-acetylcysteine (to get a serum level of 16.2+/-4.3μM[70] comparable to a peak concentrations in a human study using thrice daily dosing of 600mg[71])... this is thought to occur at concentrations reasonable close to pharmacological doses of NAC (for cognitive effects)" What gives?--Clevera (talk) 05:50, 20 March 2017 (UTC)

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Chemical compound not needed in first sentence IMO

All medications are chemical compounds. The only thing that is not a chemical compound is an element. It is to generic and thus IMO is not needed in the first sentence. Others thoughts? Doc James (talk · contribs · email) 23:03, 9 July 2017 (UTC)

@Doc James: you have now used your admin bit to edit through a full-protection added to prevent an edit-war, continuing your edit-warring of what you well know is disputed content. Please self-revert to demonstrate your desire to return to good-faith editing here. DMacks (talk) 02:10, 10 July 2017 (UTC)

Not sure you're still awake, so I undid your edit to get back to the WP:WRONGVERSION pending resolution of WP:DR. DMacks (talk) 02:23, 10 July 2017 (UTC)

Apologies User:DMacks. Missed that it was fully protected. One however usually restores an article to its pre dispute state.

By the way did you notice that the refs added was simply a pubmed search "pubmeddev. "acetylcysteine dietary supplement - PubMed - NCBI". www.ncbi.nlm.nih.gov. Retrieved 2017-07-09."[1]? Doc James (talk · contribs · email) 02:31, 10 July 2017 (UTC)

I did not look beyond noticing there was no policy violation, just content dispute (quality of sourcing, value of mentioning so early in article, drug-vs-chemical, etc). Science articles are one of my usual content areas, but I'm going to sit out this discussion (except as moderator if necessary). DMacks (talk) 02:38, 10 July 2017 (UTC)

Two issues

In this edit

1. A pubmed search was added as a reference for a statement I had already referenced with a textbook. Thus unneeded.
2. Basically all medications are chemical compounds. It is more useful to state that acetylcysteine is a medication than it is a chemical compound in the first sentence IMO. Expecially as this is one of the worlds most important medications per WHO.Doc James (talk · contribs · email) 02:40, 10 July 2017 (UTC)

Issue one

• Support removing a pubmed search as a reference as it is not appropriate. Doc James (talk · contribs · email) 02:40, 10 July 2017 (UTC)
• Support deleting fake source. A PubMed search does not link to a direct source. Extra citations are not needed. QuackGuru (talk) 04:06, 10 July 2017 (UTC)
• support search results are not sources. Jytdog (talk) 05:06, 10 July 2017 (UTC)
• Support for the same reasons. A PubMed search is inappropriate and a specific secondary source should be used as support instead. TylerDurden8823 (talk) 05:32, 10 July 2017 (UTC)
• Support: Our content guideline, WP:SAYWHERE makes it clear that citations have to be to the source which supports the text, not to the search engine that led to the source. --RexxS (talk) 14:41, 10 July 2017 (UTC)
• support per RexxS--Ozzie10aaaa (talk) 19:52, 10 July 2017 (UTC)
• Support - A pubmed search is not an adequate citation for any content on Wikipedia. Citing a specific pubmed-indexed secondary source via its PMID, however, is okay (WP:MEDRS). Seppi333 (Insert 2¢) 21:30, 13 July 2017 (UTC)

Issue two

• Support calling it a medication in the first sentence. Nearly every medication is a chemical compound (maybe all) and thus calling it that is not needed in the first sentence. Doc James (talk · contribs · email) 02:40, 10 July 2017 (UTC)
• Support saying it is a medication in the intro sentence. It is more specific to call it a medication. Any ambiguity is not an improvement. QuackGuru (talk) 04:06, 10 July 2017 (UTC)
• support this too. Jytdog (talk) 05:06, 10 July 2017 (UTC)
• Support-referring to acetylcysteine as a medication is far more specific than referring to it simply as a chemical compound. There are numerous chemical compounds would be too toxic to use as medications. The argument in the edit summary that it is a chemical compound first and a medication second doesn't really make sense to me. If it had numerous non-medical uses, then that might be something to consider but nearly all of the listed uses here are medical. All medications are chemical compounds (everything is made of chemicals so...yeah). TylerDurden8823 (talk) 05:34, 10 July 2017 (UTC)
• Support: The only medications which are not chemical compounds are those which are elements, such as sulphur or oxygen, so either term would be an acceptable description in this case. However, in the lead, we are encouraged to be precise, particularly in the opening sentence, and – as TylerDurden8823 points out – acetylcysteine has no usage apart from as a medication, so "medication" being the more precise term should be preferred. --RexxS (talk) 14:54, 10 July 2017 (UTC)
• support per more useful to state that acetylcysteine is a medication than it is a chemical compound[2]--Ozzie10aaaa (talk) 19:55, 10 July 2017 (UTC)
• Re: Wikipedia talk:WikiProject Pharmacology/Archive 12#Lead in drug articles - I can't reiterate this point enough:
  "[Drug name] is a [biochemical/pharmacological classification] that is used as a medication for the treatment of [medical condition(s)]" is the most appropriate way to introduce what a pharmaceutical is, in proper context, in the 1st lead sentence of a drug article. The current lead sentence needs slight modification to conform to this template sentence. Seppi333 (Insert 2¢) 21:35, 13 July 2017 (UTC)

  In line with this format, I'd suggest that the lead sentence be changed from:

  Current revision: "Acetylcysteine, also known as N-acetylcysteine or N-acetyl-L-cysteine (NAC), is a chemical compound used to treat paracetamol (acetaminophen) overdose and to loosen thick mucus such as in cystic fibrosis or chronic obstructive pulmonary disease."

  to the following:

  Proposed revision: "Acetylcysteine, also known as N-acetylcysteine (NAC) or N-acetyl-L-cysteine, is a mucolytic compound that is used as a medication for the treatment of paracetamol (acetaminophen) overdose and to loosen excessively thick mucus in individuals with cystic fibrosis or chronic obstructive pulmonary disease."

  Seppi333 (Insert 2¢) 21:45, 13 July 2017 (UTC)

Seconded. TylerDurden8823 (talk) 06:29, 14 July 2017 (UTC)

We should keep the lead in simpler language. Mucolytic is a secondary and less well supported use compared to paracetamol overdose. It basic means "loosens thick mucus". Belong in the body. Doc James (talk · contribs · email) 00:48, 15 July 2017 (UTC)

Section reflist

References

On Nephroprotective agent

Out of the blue this statement is inserted, without reference. "A clinical trial from 2010, however, found that acetylcysteine is ineffective for the prevention of contrast-induced nephropathy." This needs citation! Otherwise, I suggest to remove. — Preceding unsigned comment added by 86.88.106.133 (talk) 04:24, 2 August 2017 (UTC)

I added a recent reference strengthening the proof of ineffectiveness of Acetylcesteine in prevention for contrast-induced nephrotoxicity. This is my first Wikipedia entry, so if someone could check it for me and give me some tips that would be greatly appreciated. - Kind regards, Arwin --DrowningDuck (talk) 08:51, 19 February 2018 (UTC)

Supposed interaction of NAC supplements with Adderall/(some? )amphetamines?

I heard from someone who takes adderall that there's a common idea in the online nootropic crowd that taking NAC supplements with adderall has some sort of desirable interaction? (ie, somehow changing the effect of the adderall (boosting it? mediating it?)

Obviously, I'd guess that there's most likely no evidence for this, but I came here to this article trying to find info on what exactly this supposed effect is (and who believes in it), so... Kayseychow (talk) 03:34, 15 August 2021 (UTC)

Posters on various drug harm prevention pages (e.g the Reddit page for MDMA) claim that NAC helps restore the quality of the mdma experience. Everybody got to be somewhere! (talk) 22:57, 3 June 2023 (UTC)

Where does it come from ?

Does it exist in nature, or is it a synthetic compound ? —Jerome Potts (talk) 16:05, 18 February 2022 (UTC)

When people buy it, it's usually synthesized, but the compound does exist in nature as well, for example in onions. -2003:CA:8729:D2B1:D129:85F:66C4:61CF (talk) 14:27, 26 July 2022 (UTC)

Long covid.

I've restored the section on long covid, which was removed despite being well cited. The preliminary study from Yale has been extensively covered in the media. -2003:CA:870A:8914:40A5:5D26:257B:B4C5 (talk) 20:33, 22 December 2022 (UTC)

That doesn't sound like WP:MEDRS to me. Human-medical reporting needs a high threshold. DMacks (talk) 20:43, 22 December 2022 (UTC)

I've added three additional sources, so there are now three secondary sources, plus the primary source of the Yale Medical School researchers themselves. I therefore see no valid reason for excluding this research, which has received quite extensive coverage. -2003:CA:870A:8921:9916:EB50:F1C1:7542 (talk) 18:46, 23 December 2022 (UTC)

MEDRS explicitly rejects popular-press reports on primary research as being valid secondary sourcing, even if the study weren't so preliminary as a 12-patient non-blinded one with no control group. MEDRS consider a case study as even below primary sourcing. DMacks (talk) 18:58, 23 December 2022 (UTC)

Broad spectrum antidote

Well, NAC pushes the concentration of glutathione. But it will react directly with ((NAPQI)) like any other thiol (glutathione e.g.) does. AND NAC scavenges not only radicals, but heavy metals too. --FK1954 (talk) 21:50, 4 July 2023 (UTC)

Text is somewhat disorganized.

Text is somewhat disorganized. For example, psychiatric use should really be in subsections under medical use. Acwilson9 (talk) 01:30, 10 April 2024 (UTC)

Any more recent research on use to alleviate compulsion disorders?

Is there any more recent research, than that already cited, regarding use for treating various compulsive disorders? (My internist/GP just today suggested using it to alleviate compulsive picking of fingernails and townals, stating that a number of his patients report finding it helpful.) Acwilson9 (talk) 01:34, 10 April 2024 (UTC)