Glutathione plays a key role in the detoxification of acetaminophen, nicotine from cigaret e smoke,
organophosphates (i.e. insecticides) and epoxides (carcinogens).1 Under circumstances of acute or chronic
exposure to the drug acetaminophen (Tylenol), liver glutathione is used up in the detoxification process, resulting in
a glutathione deficiency state. In turn, this reduces the antioxidant capacity of the liver, allowing free radical
intermediates to accumulate from Phase I detoxification enzyme activity. These reactive free radical species are
left unchecked to damage liver cells and can lead to acute liver failure and death.
Early treatment with N-Acetylcysteine (given intravenously) is the medical antidote for acetaminophen induced liver
toxicity because it is known to reconstitute liver glutathione levels.
In chronic acetaminophen toxicity states a hepatitis-like clinical picture develops involving liver scarring, at doses as
low as 3 gms of acetaminophen per day.10
Dosage Ranges
1. HIV and AIDS: 1,000-3000 mg per day
2. Acetaminophen Poisoning (Acute Overdose): Doses of 10-15 gms of acetaminophen require treatment with N-
Acetylcysteine at 140mg/kg followed by 70 mg/kg q 4h for 3 days, or 300 mg/kg infused over 20 hours, with half the
dose given in the first 15 minutes. Therapy must begin within 10-12 hours of poisoning; delay beyond 16 to 20
hours renders the treatment inef ective, and life threatening consequences may ensue. This circumstance requires
appropriate medical attention and monitoring.10
3. Liver Support: N-Acetylcysteine helps the liver defend itself against various toxins (acetaminophen, carbon
tetrachloride, also methylmercury and arsenic-induced oxidative stress). Patients with unusually high chronic
exposures may benefit from 1,000-2,000 mg NAC per day, in these cases.1,11,12
Adverse Side Effects, Toxicity and Contraindications
N-Acetylcysteine is non-toxic, even when given at high doses (i.e. treatment of acute acetaminophen poisoning).10
Some gastrointestinal effects may occur at high oral doses.
While supplementing the diet with high doses of NAC may be beneficial in cases of extreme oxidative stress (i.e. AIDS,
carbon tetrachloride or acetaminophen exposure), it may lead to increased free radical formation in otherwise healthy
individuals. In these individuals, it may act as a pro-oxidant rather than as an antioxidant. Thus, it is not
recommended for general prevention and anti-aging practices at this time.13
Drug-Nutrient Interactions
N-Acetylcysteine may reduce the ef ectiveness certain drugs such as acetaminophen, some chemotherapy drugs and
may produce adverse reactions with metoclopramide, nitroglycerine and nitroglyn.14
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Meschino Health Comprehensive Guide to Accessory Nutrients and Essential Oils
Accessory Nutrients and Essential Oils
N To raise liver glutathione levels, N-Acetylcysteine is best taken in conjunction with vitamin
. E (400 I.U. – 800 I.U.) selenium (100 – 200 mcg),1 and Vitamin C (500 - 3,000 mg).
B
N-Acetylcysteine supplementation may increase the urinary loss of zinc. Therefore,
supplemental zinc and copper should be added when supplementing with NAC for
extended periods.15
1. Murray M, Pizzoino J. Encyclopedia of Natural Medicine. 2nd edition. Rocklin, CA: Prima Publishing; 1998. p. 104-25;199-210.
2. Staal FJ, Ela SW, Roederer M, Anderson MT, Herzenberg LA, Herzenberg LA. Glutathiore deficiency and human immunodeficiency
virus infection. Lancet 1992;339:909-12.
3. Favier A, Sappey C, Leclerc P, Faure P, Micoud M. Antioxidant status and lipid peroxidation in patients infected with HIV. Chem Biol
Interact 1994;91:165-80.
4. Marmor M, Alcabes P, Titus S, Frenkel K, Krasinski K, Penn A, et al. Low serum thiol levels predict shorter times-to-death among HIV-
infected injecting drug users. AIDS 1997;11:1389-93.
5. Roberts RL, Aroda VR, Ank BJ. N-acetylcysteine enhances antibody-dependent cel ular cytotoxicity in neutrophils and mononuclear cells
from healthy adults and human immunodeficiency virus-infected patients. J Infect Dis 1995;172(6):1492-502.
6. Breitkreutz R, Pittack N, Thomas Nebe C, Schuster D, Brust J, Beichert M, et al. Improvement of immune functions in HIV infection by
sulfur supplementation: two randomized trials. J Mol Med 2000;78(1):55-62.
7. Roederer M, Staal FJ, Raju PA, Ela SW, Herzenberg LA. Cytokine-stimulated human immunodeficiency virus replication is inhibited by
N-acetyl-L-cysteine. Proc Natl Acad Sci 1990;87:4884-8.
8. Robinson MK, Hong RW, Wilmore DW. Glutathione deficiency and HIV infection. Lancet 1992;339:1603–4.
9. De Rossa SC, Zaretsky MD, Dubs JG, et al. N-acetylcysteine replenishes glutathione in HIV infection. Eur J Clin Invest 2000;30,10:915-
Comment [c39]: Could not find other authors.