N-Acetylcysteine (NAC) — Cysteine derivative / antioxidant precursor / mucolytic
NAC is the rate-limiting precursor for glutathione (GSH) synthesis — the body's primary intracellular antioxidant. Provides cysteine for GSH via direct precursor replenishment. Also acts as a direct antioxidant (thiol group), reduces disulfide bonds in mucus (mucolytic), and modulates NF-κB, mTOR, and glutamatergic signaling. At high IV doses, prevents acetaminophen-induced hepatotoxicity by replenishing GSH stores. Oral evidence for: PCOS/fertility (improves ovulation and pregnancy rates), OCD augmentation, addiction craving reduction, COPD exacerbation prevention.
Overview
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Compound Class
Cysteine derivative / antioxidant precursor / mucolytic
Mechanism of Action
NAC is the rate-limiting precursor for glutathione (GSH) synthesis — the body's primary intracellular antioxidant. Provides cysteine for GSH via direct precursor replenishment. Also acts as a direct antioxidant (thiol group), reduces disulfide bonds in mucus (mucolytic), and modulates NF-κB, mTOR, and glutamatergic signaling. At high IV doses, prevents acetaminophen-induced hepatotoxicity by replenishing GSH stores. Oral evidence for: PCOS/fertility (improves ovulation and pregnancy rates), OCD augmentation, addiction craving reduction, COPD exacerbation prevention.
Regulatory Status
FDA-approved IV form (Acetadote) for acetaminophen overdose. Oral is OTC supplement. FDA removed some oral NAC products from supplement market (2021 ruling under review).
Evidence Level
High for IV acetaminophen toxicity (FDA-approved). Moderate for PCOS, COPD, and psychiatric augmentation. Multiple Cochrane reviews.