{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:45:53Z","timestamp":1792691153664,"version":"4.5.0"},"reference-count":150,"publisher":"Wiley","license":[{"start":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T00:00:00Z","timestamp":1623196800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Nutrition and Metabolism"],"published-print":{"date-parts":[[2021,6,9]]},"abstract":"<jats:p>Objective. To review the clinical usefulness of N-acetylcysteine (NAC) as treatment or adjunctive therapy in a number of medical conditions. Use in Tylenol overdose, cystic fibrosis, and chronic obstructive lung disease has been well documented, but there is emerging evidence many other conditions would benefit from this safe, simple, and inexpensive intervention. Quality of Evidence. PubMed, several books, and conference proceedings were searched for articles on NAC and health conditions listed above reviewing supportive evidence. This study uses a traditional integrated review format, and clinically relevant information is assessed using the American Family Physician Evidence-Based Medicine Toolkit. A table summarizing the potential mechanisms of action for N-acetylcysteine in these conditions is presented. Main Message. N-acetylcysteine may be useful as an adjuvant in treating various medical conditions, especially chronic diseases. These conditions include polycystic ovary disease, male infertility, sleep apnea, acquired immune deficiency syndrome, influenza, parkinsonism, multiple sclerosis, peripheral neuropathy, stroke outcomes, diabetic neuropathy, Crohn\u2019s disease, ulcerative colitis, schizophrenia, bipolar illness, and obsessive compulsive disorder; it can also be useful as a chelator for heavy metals and nanoparticles. There are also a number of other conditions that may show benefit; however, the evidence is not as robust. Conclusion. The use of N-acetylcysteine should be considered in a number of conditions as our population ages and levels of glutathione drop. Supplementation may contribute to reducing morbidity and mortality in some chronic conditions as outlined in the article.<\/jats:p>","DOI":"10.1155\/2021\/9949453","type":"journal-article","created":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T16:38:41Z","timestamp":1623343121000},"page":"1-13","source":"Crossref","is-referenced-by-count":157,"title":["N-Acetylcysteine: A Review of Clinical Usefulness (an Old Drug with New Tricks)"],"prefix":"10.1155","volume":"2021","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7874-2336","authenticated-orcid":true,"given":"Gerry K.","family":"Schwalfenberg","sequence":"first","affiliation":[{"name":"Department of Family Medicine, University of Alberta, No. 301, 9509-156 Street, Edmonton T5P 4J5, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-3476(67)80019-2"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.44.235.404"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1278316"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1021\/jf040266f"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1186\/1550-2783-2-2-38"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1021\/acs.chemrev.7b00123"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1093\/carcin\/22.7.999"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1042\/bj20130282"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.3109\/00365513.2012.734859"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1021\/acs.chemrestox.9b00152"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1111\/j.2042-7158.1990.tb05357.x"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1590\/s1516-44462011000400003"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0147858"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-10-5311-5_10"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1503\/jpn.100057"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.15586\/jcbmr.2016.13"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1007\/s004030000187"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.3390\/jcm6010001"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2251"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1007\/bf01061422"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1007\/BF00606662"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199120020-00004"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2005.1770"},{"key":"24","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2015.04.015"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2019.104332"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2016.12.004"},{"key":"27","doi-asserted-by":"publisher","DOI":"10.2147\/tcrm.s273700"},{"key":"28","article-title":"N-acetyl-cysteine as adjuvant therapy in female infertility: a systematic review and meta-analysis","author":"N. Devi","year":"2020","journal-title":"Journal of Basic and Clinical Physiology and Pharmacology"},{"issue":"3","key":"29","first-page":"548","article-title":"Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature","volume":"69","author":"M. H. Ebell","year":"2004","journal-title":"American Family Physician"},{"key":"30","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0511304103"},{"key":"31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2014.08.008"},{"key":"32","doi-asserted-by":"publisher","DOI":"10.1080\/08035259950170574"},{"key":"33","article-title":"The effect of long term use of inhaled N-acetylcysteine on cystic fibrosis lung disease","author":"J. McNamara","year":"2017","journal-title":"C67. Suppurative Lung Diseases In Children"},{"key":"34","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-24.5.390"},{"key":"35","first-page":"132","article-title":"Lung cell oxidant injury: decrease in oxidant mediated cytotoxicity by N-acetylcysteine","volume":"139","author":"L. M. Simon","year":"1985","journal-title":"European Journal of Respiratory Diseases. Supplement"},{"key":"36","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.00002215"},{"key":"37","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3003.2000.16b12.x"},{"key":"38","doi-asserted-by":"publisher","DOI":"10.1186\/s40248-016-0039-2"},{"key":"39","doi-asserted-by":"publisher","DOI":"10.02\/ijaai.103109"},{"key":"40","first-page":"184","article-title":"Preventive effect of N-acetylcysteine in a mouse model of steroid resistant acute exacerbation of asthma","volume":"12","author":"P. Eftekhari","year":"2013","journal-title":"EXCLI Journal"},{"key":"41","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21145"},{"key":"42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2008.12.170"},{"key":"43","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2016.06.015"},{"key":"44","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-019-1042-x"},{"key":"45","doi-asserted-by":"publisher","DOI":"10.2014\/JCPSP.408411"},{"key":"46","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1113354"},{"issue":"1","key":"47","first-page":"802","article-title":"Efficacy and safety of N-acetylcysteine therapy for idiopathic pulmonary fibrosis: an updated systematic review and meta-analysis","volume":"18","author":"F. Fen","year":"2019","journal-title":"Experimental and Therapeutic Medicine"},{"key":"48","doi-asserted-by":"publisher","DOI":"10.1056\/nejm198812153192401"},{"key":"49","doi-asserted-by":"publisher","DOI":"10.1056\/nejm197703032960914"},{"key":"50","doi-asserted-by":"publisher","DOI":"10.1093\/gastro\/gov062"},{"key":"51","doi-asserted-by":"publisher","DOI":"10.1016\/s0750-7658(99)80127-0"},{"issue":"2","key":"52","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s13181-010-0071-0","article-title":"Acute chloroform ingestion successfully treated with intravenously administered N-acetylcysteine","volume":"6","author":"D. M. Dell\u2019Aglio","year":"2010","journal-title":"Journal of Medical Toxicology"},{"key":"53","doi-asserted-by":"publisher","DOI":"10.1016\/j.tox.2012.07.007"},{"key":"54","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199106273242604"},{"key":"55","doi-asserted-by":"publisher","DOI":"10.4103\/1319-3767.207711"},{"key":"56","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-009-9151-0"},{"key":"57","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2015.01.003"},{"key":"58","doi-asserted-by":"publisher","DOI":"10.1186\/1476-5926-11-4"},{"key":"59","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.00499"},{"key":"60","volume-title":"Effect of N-Acetylcysteine on Remission Maintenance in Patients with Ulcerative Colitis: A Randomized Controlled Clinical Trial","author":"S. Kourosh Masnadi","year":"2021"},{"key":"61","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2015.10.006"},{"key":"62","doi-asserted-by":"publisher","DOI":"10.1016\/j.cellsig.2005.03.013"},{"key":"63","doi-asserted-by":"publisher","DOI":"10.1002\/art.34502"},{"key":"64","doi-asserted-by":"publisher","DOI":"10.3390\/antiox9121283"},{"issue":"9","key":"65","first-page":"3744","article-title":"N-Acetyl-L-Cysteine inhibits the development of glucose intolerance and hepatic steatosis in diabetes-prone mice","volume":"8","author":"A. Falach-Malik","year":"2016","journal-title":"American Journal of Translational Research"},{"key":"66","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/6428630"},{"key":"67","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2016.02.003"},{"key":"68","doi-asserted-by":"publisher","DOI":"10.1007\/s001250050440"},{"key":"69","doi-asserted-by":"publisher","DOI":"10.1007\/s11033-011-1148-9"},{"key":"70","doi-asserted-by":"publisher","DOI":"10.1016\/j.niox.2018.05.003"},{"key":"71","doi-asserted-by":"publisher","DOI":"10.2147\/jpr.s228255"},{"key":"72","doi-asserted-by":"publisher","DOI":"10.1016\/s0015-0282(02)03133-3"},{"key":"73","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/817849"},{"key":"74","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2015.09.076"},{"key":"75","doi-asserted-by":"publisher","DOI":"10.1016\/s1472-6483(10)60322-7"},{"key":"76","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2009.02.034"},{"key":"77","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2008.10.015"},{"issue":"7","key":"78","first-page":"Pi13","article-title":"The effect of N-acetylcysteine on blood pressure and markers of cardiovascular risk in non-diabetic patients with chronic kidney disease: a placebo-controlled, randomized, cross-over study","volume":"16","author":"M. Renke","year":"2010","journal-title":"Medical Science Monitor"},{"key":"79","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.114.101964"},{"key":"80","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2018.6103"},{"key":"81","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-15-65"},{"key":"82","doi-asserted-by":"publisher","DOI":"10.1172\/jci29444"},{"key":"83","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0131394"},{"key":"84","doi-asserted-by":"publisher","DOI":"10.1007\/s00204-019-02589-1"},{"key":"85","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/4805853"},{"key":"86","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-014-1657-1"},{"key":"87","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2017.10.001"},{"key":"88","doi-asserted-by":"publisher","DOI":"10.1016\/j.tiv.2010.10.020"},{"key":"89","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3007653"},{"key":"90","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2007.12.016"},{"key":"91","doi-asserted-by":"publisher","DOI":"10.1007\/s10495-008-0305-7"},{"key":"92","doi-asserted-by":"publisher","DOI":"10.1186\/s13046-018-1016-8"},{"key":"93","doi-asserted-by":"publisher","DOI":"10.15761\/jic.1000177"},{"issue":"3","key":"94","first-page":"153","article-title":"Anti-oxidant treatment in obstructive sleep apnoea syndrome","volume":"53","author":"K. Sadasivam","year":"2011","journal-title":"Indian Journal of Chest Diseases and Allied Sciences"},{"key":"95","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148519"},{"key":"96","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2008.07.014"},{"key":"97","doi-asserted-by":"publisher","DOI":"10.1007\/s002280050140"},{"key":"98","doi-asserted-by":"publisher","DOI":"10.1089\/aid.1992.8.209"},{"key":"99","doi-asserted-by":"publisher","DOI":"10.4103\/2229-3485.210450"},{"issue":"suppl 63","key":"100","first-page":"PA2958","article-title":"N-acetylcysteine and mortality in hospitalized pulmonary tuberculosis infection","volume":"54","author":"T. Jeeraaumponwat","year":"2019","journal-title":"European Respiratory Journal"},{"key":"101","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2009.08.025"},{"key":"102","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2011.05.014"},{"key":"103","doi-asserted-by":"publisher","DOI":"10.1096\/fj.202001807"},{"key":"104","doi-asserted-by":"publisher","DOI":"10.2217\/fmb-2020-0074"},{"key":"105","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000022577"},{"key":"106","doi-asserted-by":"publisher","DOI":"10.1097\/01.smj.0000182486.39913.da"},{"key":"107","doi-asserted-by":"publisher","DOI":"10.1097\/mcg.0b013e31822be4d6"},{"key":"108","doi-asserted-by":"publisher","DOI":"10.1007\/s12275-017-7089-9"},{"key":"109","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012357.pub2"},{"key":"110","doi-asserted-by":"publisher","DOI":"10.3390\/molecules23123305"},{"key":"111","doi-asserted-by":"publisher","DOI":"10.1006\/exnr.1996.0136"},{"key":"112","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1548"},{"key":"113","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7547382"},{"key":"114","doi-asserted-by":"publisher","DOI":"10.14283\/jpad.2017.22"},{"key":"115","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000575"},{"key":"116","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-020-05762-8"},{"key":"117","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.118.021755"},{"key":"118","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.s241497"},{"key":"119","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00088"},{"issue":"15 Supplement","key":"120","first-page":"P5","article-title":"N-acetyl cysteine for fatigue in progressive multiple sclerosis: a pilot randomized double-blind placebo-controlled trial (P5.2-093)","volume":"92","author":"K. Krysko","year":"2019","journal-title":"Neurology"},{"key":"121","doi-asserted-by":"publisher","DOI":"10.1177\/1352458510384010"},{"key":"122","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/5174957"},{"key":"123","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpath.2011.01.036"},{"key":"124","doi-asserted-by":"publisher","DOI":"10.1097\/ijg.0b013e31819c46b1"},{"key":"125","doi-asserted-by":"publisher","DOI":"10.1038\/s41419-019-1365-z"},{"key":"126","first-page":"253","article-title":"A double-blind, cross-over, study of oral N-acetylcysteine in Sj\u00f6gren's syndrome","volume":"61","author":"M. T. Walters","year":"1986","journal-title":"Scandinavian Journal of Rheumatology"},{"issue":"1","key":"127","first-page":"10","article-title":"Getting a knack for NAC: N-Acetyl-Cysteine","volume":"8","author":"R. A. Sansone","year":"2011","journal-title":"Innovations in Clinical Neuroscience"},{"key":"128","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/2469486"},{"key":"129","doi-asserted-by":"publisher","DOI":"10.1097\/FBP.0b013e32833d41b2"},{"key":"130","doi-asserted-by":"publisher","DOI":"10.1038\/sj.npp.1301624"},{"key":"131","doi-asserted-by":"publisher","DOI":"10.1177\/0004867419893439"},{"key":"132","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.12370"},{"issue":"2","key":"133","first-page":"134","article-title":"Efficacy of N-acetylcysteine augmentation on obsessive compulsive disorder: a multicenter randomized double blind placebo controlled clinical trial","volume":"12","author":"A. Ghanizadeh","year":"2017","journal-title":"Iranian Journal of Psychiatry"},{"key":"134","doi-asserted-by":"publisher","DOI":"10.1097\/jcp.0000000000000431"},{"key":"135","doi-asserted-by":"publisher","DOI":"10.4088\/jcp.16m11101"},{"key":"136","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2008.04.022"},{"key":"137","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.60"},{"key":"138","doi-asserted-by":"publisher","DOI":"10.1017\/s1092852900023002"},{"key":"139","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000264976.86990.00"},{"key":"140","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2011.10.024"},{"issue":"6","key":"141","first-page":"30","article-title":"N-acetylcysteine: a potential treatment for substance use disorders","volume":"17","author":"R. L. Tomko","year":"2018","journal-title":"Current Opinion in Psychiatry"},{"key":"142","doi-asserted-by":"publisher","DOI":"10.1016\/j.etap.2014.01.024"},{"key":"143","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/8682737"},{"key":"144","doi-asserted-by":"publisher","DOI":"10.4103\/0976-9668.116986"},{"issue":"4","key":"145","first-page":"293","article-title":"N-acetylcysteine in the treatment of human arsenic poisoning","volume":"3","author":"D. S. Martin","year":"1990","journal-title":"Journal of the American Board of Family Medicine"},{"key":"146","doi-asserted-by":"publisher","DOI":"10.2147\/ijn.s204372"},{"issue":"5","key":"147","article-title":"Medical and dietary uses of N-Acetylcysteine","volume":"8","author":"\u0160. \u0160alamon","year":"2019","journal-title":"Antioxidants (Basel)"},{"key":"148","doi-asserted-by":"publisher","DOI":"10.1097\/01.mbc.0000195922.26950.89"},{"key":"149","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(97)00005-3"},{"key":"150","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2362.2000.00736.x"}],"container-title":["Journal of Nutrition and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/jnme\/2021\/9949453.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jnme\/2021\/9949453.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jnme\/2021\/9949453.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T16:39:04Z","timestamp":1623343144000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/jnme\/2021\/9949453\/"}},"subtitle":[],"editor":[{"given":"Tatiana","family":"Emanuelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,9]]},"references-count":150,"alternative-id":["9949453","9949453"],"URL":"https:\/\/doi.org\/10.1155\/2021\/9949453","relation":{},"ISSN":["2090-0732","2090-0724"],"issn-type":[{"value":"2090-0732","type":"electronic"},{"value":"2090-0724","type":"print"}],"subject":[],"published":{"date-parts":[[2021,6,9]]}}}