The bioavailability of oral NAC in humans is between 4 and 9.1% in one study and between 6 and 10% in another thus, studies using less than 1200 mg per day may show no significant benefit. N-acetylcysteine (NAC) potential mechanisms of action. Since then, NAC use has been expanded to acetaminophen overdose and chronic obstructive lung disease and its role is ever expanding clinically. Clinically it has been used in cystic fibrosis since 1969. Its chemical structure and nomenclature are depicted in Figure 1. N-acetylcysteine (NAC) is a sulfhydryl-containing compound, with mucolytic properties, originally patented in 1960, and its use in medicine was first reported in 1967. Supplementation may contribute to reducing morbidity and mortality in some chronic conditions as outlined in the article. The use of N-acetylcysteine should be considered in a number of conditions as our population ages and levels of glutathione drop. There are also a number of other conditions that may show benefit however, the evidence is not as robust. 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’s disease, ulcerative colitis, schizophrenia, bipolar illness, and obsessive compulsive disorder it can also be useful as a chelator for heavy metals and nanoparticles. N-acetylcysteine may be useful as an adjuvant in treating various medical conditions, especially chronic diseases. A table summarizing the potential mechanisms of action for N-acetylcysteine in these conditions is presented. This study uses a traditional integrated review format, and clinically relevant information is assessed using the American Family Physician Evidence-Based Medicine Toolkit. PubMed, several books, and conference proceedings were searched for articles on NAC and health conditions listed above reviewing supportive evidence. 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. To review the clinical usefulness of N-acetylcysteine (NAC) as treatment or adjunctive therapy in a number of medical conditions.
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