N-Acetyl Cysteine

NAC/Drug Interactions:

  • AcetaminophenAcetaminophen: NAC has been shown to decrease the mortality rate, partly prevent liver damage, and partly restore enzyme activities in a paracetamol-induced hepatotoxicity animal model (287). In human research, side effects and mortality rate following high-dose acetaminophen were reduced with NAC use (288; 289). Based on a review, in comparison with methionine, NAC was found to be more effective at preventing liver damage in patients after paracetamol overdose (290). In human research, high serum acetaminophen concentrations were associated with fewer anaphylactoid reactions to NAC (291). Contrary to these benefits, late NAC (after five hours) treatment in animals, reduced survival after an LD50 dose of acetaminophen (292).
  • AcetylcholineAcetylcholine: In humans, NAC potentiated acetylcholine-induced coronary vasodilation (293).
  • AllopurinolAllopurinol: In a review, a combination of vitamins C, D, K, B-complex, and natural E; allopurinol; coQ10; alpha-lipoic acid; and NAC has been examined for protection against vascular diseases and neoplasms (294).
  • AntibioticsAntibiotics: Use of NAC may inactivate antibiotics (anecdotal). However, in human pilot studies, NAC did not have an effect on antibiotic absorption (295).
  • Anticoagulants/antiplateletsAnticoagulants/antiplatelets: In a clinical study, hemorrhage occurred in three patients taking NAC (10mg/min. intravenously), heparin (per study protocol), and ASA (150). In a randomized controlled trial in surgical patients, intravenous NAC resulted in a decrease in prothrombin time, prolonged coagulation time, decreased platelet aggregation, and increased blood loss (146; 147).
  • Antidiabetic agentsAntidiabetic agents: In HIV patients, use of antioxidants including NAC increased blood glucose levels (160). Intravenous NAC may result in a false positive hyperglycemic response, as evidenced in a case report (161).
  • AntihypertensivesAntihypertensives: In humans, effects of antihypertensive medications may be negated, as increases in systolic and diastolic blood pressures (N=11) were significantly greater in the NAC group compared to placebo (148). In animals, NAC potentiated the antihypertensive response to captopril and enalaprilat (296).
  • Anti-inflammatory agentsAnti-inflammatory agents: In vitro, NAC inhibited markers of inflammation, such as phospholipid metabolism, proinflammatory cytokine release, and protease activity (103). When given orally in human research, NAC resulted in reduction of neutrophil activity and respiratory burst, but not chemotaxis (297; 298).
  • AntiviralsAntivirals: In vitro, at concentrations up to 5mM of NAC, HIV growth in unstimulated peripheral blood mononuclear cells and in SCID mice was potentiated (299). However, in vitro, NAC has also been reported to suppress HIV in persistently infected cells (300).
  • BleomycinBleomycin: In vitro, clinically relevant concentrations of N-acetyl cysteine were not able to protect tumor cells against clonogenic killing by X-rays and by bleomycin (301).
  • Cardiovascular agentsCardiovascular agents: In humans, NAC had beneficial effects on MDA levels following reperfusion of the femoral artery (302). In vitro, NAC inhibited LDL oxidation (303). In animal research, NAC slowed the progression of atherosclerotic lesions and reversed the increase in plaque collagen (304). Based on animal research, NAC may be protective against structural and functional injury to the rat lung after liver ischemia reperfusion (78).
  • CefuroximeCefuroxime: In children with atopic allergic rhinitis, asthma, and sinusitis, a combination of cefuroxime 50-80mg/kg and NAC 15-25mg/kg daily for 10 days was effective in 95.8% of the children, and 37.5% of them were able to reduce their treatment for asthma (305). In children with lower respiratory tract infections, a combination of cefuroxime and N-acetyl cysteine resulted in clinical improvement in 100 of 103 patients (306). In patients suffering from acute exacerbations of chronic bronchial disease, the combination of cefuroxime and NAC improved coughing over NAC alone (307).
  • CharcoalCharcoal: In humans, charcoal use resulted in reduced NAC absorption or did not have an effect on absorption (162; 163; 164; 165; 166). Up to 96% of NAC may be absorbed by charcoal (309). In vitro, charcoal absorbed NAC (310). However, in some studies, coadministration of activated charcoal and NAC has been reported to decrease hepatic injury in patients with acetaminophen overdose (182).
  • Chemotherapeutic agentsChemotherapeutic agents: In human and animal research, NAC prevented some, but not all, side effects of chemotherapeutic agents (311; 312; 313; 314; 315; 316; 317), and NAC had synergistic effects in animal research (318). In vitro, clinically relevant concentrations of N-acetyl cysteine were not able to protect tumor cells against clonogenic killing by X-rays and by bleomycin (301). In human research, antioxidant supplementation, including NAC did not appear to alter the efficacy of chemotherapy (319). In vitro, NAC enhanced the chemotherapeutic effect on prostate cancer cells (320).
  • ChloroquineChloroquine: According to a review, NAC may antagonize effects of chloroquine (321).
  • CimetidineCimetidine: In animals, cimetidine enhanced the hepatoprotective action of NAC in acetaminophen toxicity (308).
  • Contrast agentsContrast agents: In humans, NAC may or may not play a role in the prevention of contrast-induced nephropathy (322; 323; 324; 325).
  • CyclophosphamideCyclophosphamide: In an animal study, Harrison et al. found that NAC at doses of 325mg/kg daily and 650mg/kg daily did not interfere with the antitumor effects of cyclophosphamide (326).
  • Cystic fibrosis agentsCystic fibrosis agents: In children with cystic fibrosis, the mucosa of the gastrointestinal tract produces an active transepithelial electric potential, which decreased with NAC treatment (327).
  • DoxorubicinDoxorubicin: In vitro, NAC enhanced the chemotherapeutic effect (320), inhibited cytotoxicity (328; 329), and inhibited doxorubicin-induced lipid peroxidation (330).
  • Exercise performance enhancement agentsExercise performance enhancement agents: Based on human research, NAC may increase exercise performance by reducing respiratory muscle fatigue (331). In human research, NAC improved potassium regulation, which played a role in reduced fatigue (235).
  • FenoldopamFenoldopam: In human research, a combination of fenoldopam and NAC has been investigated for effects on renal deterioration in patients with chronic renal insufficiency undergoing cardiac surgery, with potential for additive effects over either agent alone (212).
  • GentamicinGentamicin: In an animal study, NAC prevented gentamicin-induced tubular necrosis (332), and in human research, NAC prevented ototoxicity associated with gentamicin (333).
  • Hepatoprotective agentsHepatoprotective agents: In humans, intraoperative NAC administration during liver transplantation increased plasma IL-4 and IL-10 (334). Based on animal research, NAC may be protective against structural and functional injury to the rat lung after liver ischemia reperfusion (78).
  • Immunomodulatory agentsImmunomodulatory agents: In humans, NAC may increase the number of CD4+ cells in patients with suboptimal glutathione levels (335). Based on in vitro research, in cells isolated from healthy adults and HIV patients, NAC (1 and 5mM) enhanced the antibody-dependent cellular cytotoxicity of neutrophils and mononuclear cells and partially reversed the antineoplastic drug 1,3 bis(2-chloroethyl)-1-nitrosourea (BCNU)-induced inhibition of neutrophils (63).
  • InterferonInterferon: In humans with chronic hepatitis C infection, a combination of interferon and NAC for six months did not have an additive effect on virological responses over interferon alone (336).
  • Interleukin-2Interleukin-2: In humans, a combination of NAC and interleukin-2 improved quality of life and clinical outcome in cancer patients who had responded to previous chemotherapy (337).
  • IfosfamideIfosfamide: NAC did not prevent renal toxicity associated with ifosfamide in human research (338; 339) but may have inhibited hematuria (340; 341).
  • MesalamineMesalamine: In human research, NAC had a small additive clinical effect over mesalamine alone in ulcerative colitis patients (219).
  • Meso-2,3-dimercaptosuccinic acid (DMSA)Meso-2,3-dimercaptosuccinic acid (DMSA): In an animal study, NAC and DMSA were capable of achieving better reversibility in arsenic-induced oxidative stress than DMSA or NAC alone (342).
  • Mucoactive agentsMucoactive agents: Based on human research, NAC may decrease the viscosity of sputum (343). In human bronchial explants, NAC (1-5%) reduced ciliary beat frequency (344). NAC decreased mucous viscosity (343; 221; 220) and thickness (137; 143; 46; 222; 132) in in vitro and in human studies. Mucoactive agents, such as NAC, have been reviewed (345; 346; 347; 348).
  • Neurologic agentsNeurologic agents: According to a review, NAC may offer neuronal protection by preserving mitochondria and protecting motor neurons (349).
  • NitratesNitrates: Based on a review, severe life-threatening hypotension or death may occur if nitrates are used in combination with NAC (350).
  • Nitroglycerin (NTG)Nitroglycerin (NTG): In humans, NAC has been associated with potentiating NTG-induced headaches and coronary dilation (148; 167). NAC has also been implicated in inhibiting NTG tolerance in both humans and animals and in in vitro studies (351; 352; 234; 353; 354; 355; 233; 356; 357). However, other studies found NTG tolerance to be unaffected by NAC (358; 359; 360). NAC reversed tolerance to oral nitrates in a human dorsal hand vein model (361). In vitro, NAC potentiated nitroglycerin-induced platelet inhibition (362; 363).
  • NitroprussideNitroprusside: In humans, NAC potentiated sodium nitroprusside-induced coronary vasodilation (293).
  • Osteoporosis agentsOsteoporosis agents: According to a review, NAC may reduce the bone absorption marker N-telopeptide (N-Tx) (364).
  • PhenazopyridinePhenazopyridine: In a case report, a combination of NAC, intravenous carnitine, and alkalinization of the urine resulted in normal kidney function following a suicide attempt using phenazopyridine (130).
  • RadiotherapyRadiotherapy: In humans, a combination of radiotherapy (1.25Gy twice daily at six-hour intervals up to a total dose of 60 Gy per 48 fractions over 32 days) plus NAC (intravenous 100mg/kg 30 minutes before radiotherapy followed by 30mg/kg over seven hours, and 60mg inhaled 30 minutes before and after each radiotherapy session) did not have an effect over radiotherapy alone (365).
  • Thyroid hormoneThyroid hormone: According to a review, NAC may reduce thyroid toxicity by increasing antioxidant status (366).
  • TigecyclineTigecycline: In humans, a catheter-lock solution consisting of NAC, tigecycline, and heparin was successful for catheter salvage in patients with hemodialysis catheter-associated bacteremia (367).
  • Trimethoprim-sulfamethoxazoleTrimethoprim-sulfamethoxazole: In individuals with HIV, 3g of 20% liquid solution of NAC (15mL) twice daily one hour before trimethoprim-sulfamethoxazole (TMP-SMX) or 800mg of NAC daily did not result in differences in discontinuation rates of TMP-SMX therapy or the number of adverse reactions (368; 257).
  • Tuaminoheptane sulphateTuaminoheptane sulphate: In healthy humans, the combination of tuaminoheptane sulphate with N-acetyl cysteine offered rapid decongestant properties (91).
  • ZidovudineZidovudine: In vitro, NAC reduced zidovudine-induced hematopoietic toxicity (369).

    • NAC/Herb/Supplement Interactions:

  • Alpha-lipoic acidAlpha-lipoic acid: Based on in vitro research, the combination of lipoic and NAC resulted in decreases in oxidative stress and apoptotic markers in fibroblasts from Alzheimer's disease patients (370).
  • Amanita smithianaAmanita smithiana: NAC was used as part of a treatment option for mushroom poisoning in a case report (371).
  • Anticoagulants/antiplateletsAnticoagulants/antiplatelets: In a clinical study, hemorrhage occurred in three patients taking NAC (10mg/min. intravenously), heparin (per study protocol), and ASA (150). In a randomized controlled trial in surgical patients, intravenous NAC resulted in a decrease in prothrombin time, prolonged coagulation time, decreased platelet aggregation, and increased blood loss (146; 147).
  • Anti-inflammatory herbsAnti-inflammatory herbs: Based on in vitro research, NAC inhibited markers of inflammation, such as phospholipid metabolism, proinflammatory cytokine release, and protease activity (103). When given orally in human research, NAC resulted in reduction of neutrophil activity and respiratory burst, but not chemotaxis (297; 298).
  • AntioxidantsAntioxidants: In in vitro research, NAC reduced the radical intensity of sodium L-ascorbate, sodium 5,6-benxylidene-L-ascorabate, gallic acid, and caffeic acid (372). In human research, treatment with a combination of antioxidants, such as alpha-lipoic acid, coenzyme Q10, manganese, vitamin C, selenium, and alpha-tocopherol with NAC, did not protect against exercise-induced DNA damage (373). In HIV patients with lipoatrophy or sustained hyperlactatemia, a combination of antioxidants, including vitamin C, vitamin E, and NAC, resulted in increased insulin resistance (160). Theoretical interactions exist with other antioxidants, including but not limited to cysteine, beta-carotene, and other phytochemicals.
  • AntiviralsAntivirals: In vitro, at concentrations up to 5mM of NAC, HIV growth in unstimulated peripheral blood mononuclear cells and in SCID mice was potentiated (299) However, in vitro, NAC has also been reported to suppress HIV in persistently infected cells (300).
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: In patients undergoing surgical intervention, NAC had beneficial effects on MDA levels following reperfusion of the femoral artery (302). In vitro, NAC inhibited LDL oxidation (303). In animal research, NAC slowed the progression of atherosclerotic lesions and reversed the increase in plaque collagen (304). Based on animal research, NAC may be protective against structural and functional injury to the rat lung after liver ischemia reperfusion (78).
  • Chemotherapeutic supplementsChemotherapeutic supplements: In vitro, NAC enhanced the chemotherapeutic effect on prostate cancer cells (320). In human and animal research, NAC prevented some, but not all, side effects of chemotherapeutic agents (311; 312; 313; 314; 315; 316; 317), and NAC had synergistic effects in animal research (318). In human research, antioxidant supplementation, including NAC, did not appear to alter the efficacy of chemotherapy (319).
  • CurcuminCurcumin: In human research, a combination of curcumin, NAC, bovine lactoferrin, and pantoprazole resulted in reduced dyspeptic and inflammatory symptoms in patients with Helicobacter pylori infection, without an effect on Helicobacter pylori eradication (374).
  • EGCGEGCG: In human research, the systemic availability of (-)epigallocatechin-3-gallate (EGCG), a green tea component, was increased in patients using a nutrient mixture containing NAC (375).
  • Exercise performance enhancement herbs and supplementsExercise performance enhancement herbs and supplements: Based on human research, NAC may increase exercise performance by reducing respiratory muscle fatigue (331). In human research, NAC-induced improved potassium regulation played a role in reduced fatigue (235).
  • Hepatoprotective herbs and supplementsHepatoprotective herbs and supplements: In human research, intraoperative NAC administration during liver transplantation increased plasma IL-4 and IL-10 (334). Based on animal research, NAC may be protective against structural and functional injury to the rat lung after liver ischemia reperfusion (78).
  • Hyperbaric oxygen therapyHyperbaric oxygen therapy: A combination of hyperbaric oxygen therapy for ulcers and NAC resulted in a decrease in oxidative stress associated with the oxygen therapy (376).
  • HypoglycemicsHypoglycemics: In HIV patients, use of antioxidants including NAC increased blood glucose levels (160). Intravenous NAC may result in a false positive hyperglycemic response, as evidenced in a case report (161).
  • HypotensivesHypotensives: In humans, effects of antihypertensive supplements may be negated, as increases in systolic and diastolic blood pressures (N=11) were significantly greater in the NAC group compared to placebo use in one clinical trial (148). In animals, NAC potentiated the antihypertensive response to captopril and enalaprilat (296).
  • Immunomodulatory herbs and supplementsImmunomodulatory herbs and supplements: Based on human research, NAC may increase the number of CD4+ cells in patients with suboptimal glutathione levels (335). In in vitro research, in cells isolated from healthy adults and HIV patients, NAC (1 and 5mM) enhanced the antibody-dependent cellular cytotoxicity of neutrophils and mononuclear cells and partially reversed the antineoplastic drug 1,3 bis(2-chloroethyl)-1-nitrosourea (BCNU)-induced inhibition of neutrophils (63).
  • L-arginineL-arginine: The combination of arginine and NAC reduced various risk factors for cardiovascular disease, such as blood pressure, cholesterol, C-reactive protein, and intima-media thickness, in human research (377).
  • MagnesiumMagnesium: Magnesium deficiency has been associated with treatment with NAC and other antioxidants (47).
  • Mucoactive agentsMucoactive agents: Based on human research, NAC may decrease the viscosity of sputum (343). In human bronchial explants, NAC (1-5%) reduced ciliary beat frequency (344). NAC decreased mucous viscosity (343; 221; 220) and thickness (137; 143; 46; 222; 132) in in vitro and in human studies. Mucoactive agents, such as NAC, have been reviewed (345; 346; 347; 348).
  • Osteoporosis herbs and supplementsOsteoporosis herbs and supplements: According to a review, NAC may reduce the bone absorption marker N-telopeptide (N-Tx) (364).
  • Vitamin CVitamin C: In humans with an acute arm muscle injury, a combination of vitamin C (12.5mg/kg of body weight) and NAC (10mg/kg of body weight) for seven days resulted in increased serum iron in the vitamin C and NAC group compared with placebo and may transiently increase tissue damage and oxidative stress (88). Vitamin C plus NAC did not have an additive effect over NAC alone in combination with saline for prevention of contrast agent-induced nephrotoxicity (378).
  • Vitamins (general)Vitamins (general): In a review, a combination of vitamin C, vitamin D, vitamin K, vitamin B-complex, natural E, allopurinol, coQ10, alpha-lipoic acid, and NAC has been studied for protection against vascular diseases and neoplasms (294).
  • ZincZinc: Concurrent ingestion of NAC and zinc favored gastrointestinal absorption of zinc (168). However, high doses of NAC (approximately 800mg) may induce zinc depletion by increasing the metal's urinary excretion (168).

    • NAC/Food Interactions:

  • MushroomsMushrooms: NAC was used as part of a treatment option for mushroom (Amanita smithiana) poisoning in a case report (371).

    • NAC/Lab Interactions:

  • Albumin-to-creatinine ratioAlbumin-to-creatinine ratio: Based on clinical research, NAC may improve the albumin-to-creatinine ratio (379).
  • Asymmetric dimethylarginine (ADMA)Asymmetric dimethylarginine (ADMA): In human research, during hemodialysis, NAC reduced ADMA levels over hemodialysis alone (380).
  • CD4 cellsCD4 cells: In healthy humans, NAC prevented a decrease in CD4+ T cell numbers (335). In human research, NAC increased the response and the percentage of cells expressing CD25 and CD95 (381).
  • ChlorideChloride: False positive serum test results may occur with NAC use, based on secondary sources.
  • Coagulation panelCoagulation panel:: In human research, NAC decreased prothrombin time and platelet aggregation, prolonged coagulation time, and increased blood loss (146; 147).
  • Creatine kinaseCreatine kinase: In vitro, NAC activated creatine kinase (382). In human research, NAC resulted in a decrease in creatine kinase-MB levels (383).
  • CreatinineCreatinine: Intravenous NAC may falsely lower serum creatinine, according to secondary sources. However, in human research, results did not demonstrate that NAC artifactually lowered creatinine measured using the Jaff? method (384). Significant decreases in serum creatinine occurred in a case series (385). In renal patients, NAC prevented an increase in creatinine (386; 246; 387) but did not have an effect in some studies (388).
  • Cystatin CCystatin C: In human research, NAC did not appear to effect cystatin C levels (387).
  • CysteineCysteine: Intravenous NAC may increase plasma cysteine levels, based on secondary sources.
  • CytokinesCytokines: In human research, NAC reduced inflammatory production of TNF-alpha (389; 390). Intraoperative NAC administration during liver transplantation increased plasma IL-4 and IL-10 (334). In vitro, Gon et al. found bronchial epithelial cell mediums containing 1mL of NAC to have an inhibited expression of IL-8 induced by bleomycin (concentration of NAC not provided) (391).
  • ElastaseElastase: In cystic fibrosis patients, NAC resulted in a decrease in sputum levels of elastase and in neutrophil production of elastase (190; 298).
  • ErythropoietinErythropoietin: In humans, oral NAC supplementation increased erythropoietin production (393).
  • E-selectinE-selectin: According to a review, NAC reduced levels of E-selectin in human research (392).
  • Glomerular filtration rateGlomerular filtration rate: Postoperative eGFR was not changed with NAC in cardiac patients (394).
  • GlucoseGlucose: In HIV patients, use of antioxidants including NAC increased blood glucose levels (160). Intravenous NAC may result in a false positive hyperglycemic response, as evidenced in a case report (161).
  • GlycocalyxGlycocalyx: In human research, NAC prevented the hyperglycemia-induced reduction of glycocalyx (a layer of proteoglycans covering the endothelium of the vessel wall) (395).
  • GoldGold: Intravenous NAC may increase urinary gold excretion, based on secondary sources.
  • GSH (glutathione)GSH (glutathione): Significant increases in GSH occurred with NAC supplementation in a clinical trial (150). In human and animal research, NAC increased levels of glutathione in plasma (1; 2; 3; 4; 5) and bronchoalveolar lavage fluid (1; 6). A lack of effect on glutathione has also been observed in human research (396). Bruno et al. found 2mM of NAC restores glutathione levels in primary cultures of mouse hepatocytes (397).
  • Heavy metalsHeavy metals: In an animal research on heavy metals, urinary chromium was higher in animals treated with NAC (398). In animal research, NAC treatment significantly reduced the mercuric chloride content in the kidney and liver (399). According to a review, use of NAC for mercury poisoning may be counterproductive (121).
  • HomocysteineHomocysteine: Significant decreases in homocysteine levels occurred with NAC supplementation in clinical trials (153; 197; 240).
  • Hydrogen peroxideHydrogen peroxide: In human research, nebulized NAC increased levels of exhaled hydrogen peroxide (400).
  • Inflammatory mediatorsInflammatory mediators: In vitro, NAC inhibited markers of inflammation, such as phospholipid metabolism, proinflammatory cytokine release, and protease activity (103).
  • InsulinInsulin: Significant increases in insulin levels occurred after NAC supplementation in a clinical trial (202).
  • KetonesKetones: Intravenous NAC may result in a false positive urinary ketone test, as evidenced in a case report (161). Adding one drop of glacial acetic acid to the Ketostix may show the false positive nature of the test.
  • LithiumLithium: High serum NAC may falsely decrease serum lithium levels, based on secondary sources.
  • Liver enzymesLiver enzymes: In human research, NAC resulted in a reduction in liver enzymes with acetaminophen overdose (182); however, in animals, high doses of NAC have been associated with alterations in liver enzymes that indicate hepatoxicity (254).
  • Lp(a)Lp(a): Based on human research, NAC may decrease serum Lp(a) (401).
  • MagnesiumMagnesium: Magnesium deficiency has been associated with treatment with NAC and other antioxidants (47).
  • Nitric oxide metabolismNitric oxide metabolism: In human research, NAC normalized parameters indicative of nitric oxide metabolism, such as nitrates, nitrites, peroxynitrite, NADPH diaphorase, and nitrate reductase (402).
  • N-telopeptideN-telopeptide: According to a review, NAC may reduce the bone absorption marker N-telopeptide (N-Tx) (364).
  • Oxygen free radicalsOxygen free radicals: After NAC treatment of humans, there was a decrease in the production of superoxide anions by stimulated neutrophils (64) and of other markers of oxidative stress (403; 18; 243). In humans undergoing knee surgery, low-dose NAC infusion resulted in significantly lower plasma, but not tissue, malondialdehyde (MDA; a marker of oxidative stress) levels upon reperfusion (404). NAC did not have an effect on MDA levels in chronic obstructive pulmonary disease (COPD) patients treated for 15 days (405). In vitro, hypochlorous acid production from neutrophils treated with NAC was reduced (406). In human research, NAC resulted in reduced luminol (suggesting a reduction in various oxygen radicals such as hydrogen peroxide) and lucigenin (specific for O2-) (383).
  • Prothrombin time (PTT)Prothrombin time (PTT): A small study in six male patients found that 10mg/kg per hour of NAC decreased the PTT in all subjects by approximately 30-40% (280). A rapid decline was noted in the first hour, with steady state being reached in 16 hours. When the infusion was stopped after 32 hours, a rapid increase in PTT occurred.
  • ThioredoxinThioredoxin: Theoretically, thioredoxin levels may be reduced with NAC use.
  • Tidal volumeTidal volume: In humans, antioxidants, including NAC, have been reported to alter tidal volume (407)
  • Total mucosal visibility (TMV) scoreTotal mucosal visibility (TMV) score: In human research, NAC lowered the TMV score (408).
  • Tumor necrosis factor-alpha (TNF-alpha)Tumor necrosis factor-alpha (TNF-alpha): In human research, NAC resulted in reduced coronary sinus TNF-alpha levels (383).
  • Urea nitrogenUrea nitrogen: Significant decreases occurred with NAC supplementation in a clinical trial (205).
  • Urinary sodiumUrinary sodium: Significant increases in urinary sodium occurred with NAC supplementation in a case series (385).
  • Vascular endothelial growth factor (VEGF)Vascular endothelial growth factor (VEGF): In vitro, NAC inhibited production of VEGF (409).
  • Ventilatory response to carbon dioxideVentilatory response to carbon dioxide: In humans, an increase in the sensitivity of the ventilatory response to carbon dioxide has been reported with the use of antioxidants, including NAC (407).