NAC Research
49 peer-reviewed studies · Evidence score: 8/10
Efficacy of N-Acetylcysteine in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis
Viña I et al. • Nutrients (2025)
NAC had a major effect on progesterone, endometrial thickness, and LH levels in women with PCOS.
- NAC was associated with a statistically significant increase in progesterone (SMD 0.95, 95% CI: 0.13-1.77, p = 0.02) and endometrial thickness (SMD 0.58, 95% CI: 0.10-1.06, p = 0.02) compared to the placebo and other drugs (SMD 0.71, 95% CI: 0.48-0.94, p < 0.0001).
- LH levels were significantly increased by NAC compared to metformin (SMD 0.67, 95% CI: 0.23-1.12, p = 0.003).
- NAC had a major effect on progesterone, endometrial thickness, and LH levels in women with PCOS.
N-acetylcysteine antimicrobial action against endodontic pathogens-systematic review and meta-analysis
Abu Hasna A et al. • Odontology (2025)
The Author(s), under exclusive licence to The Society of The Nippon Dental University.
- NAC effectively reduced Enterococcus faecalis, showing comparable antimicrobial activity to CHX and NaOCl, especially at concentrations of 25-50 mg/mL over a 7-day exposure.
- Despite significant heterogeneity across studies, NAC demonstrated satisfactory antimicrobial effects in vitro.
- This suggests that NAC merits reconsideration as an effective intracanal medication for clinical use.© 2025.
N-Acetylcysteine to Reduce Mortality for Patients Requiring Cardiac Catheterization or Cardiac Surgery: A Systematic Review and Meta-analysis
Gakuba C et al. • Journal of cardiovascular pharmacology (2024)
All rights reserved.
- Pooled analysis demonstrated a reduction of in-hospital mortality associated with NAC: odds ratio, 0.60; 95% confidence interval, 0.39-0.92; P = 0.02.
- The occurrence of secondary outcomes was not significantly reduced with NAC except for contrast-induced nephropathy.
- No difference was reported for hemorrhagic events.
N-acetylcysteine efficacy in patients hospitalized with COVID-19 pneumonia: a systematic review and meta-analysis
Paraskevas T et al. • Romanian journal of internal medicine = Revue roumaine de medecine interne (2023)
The certainty of evidence in the included studies was very low, thus recommendations for clinical practice cannot be yet made.
- Regarding in-hospital mortality, the summary effect of all RCTs was OR: 0.85 (95% CI: 0.43 to 1.67, I2=0%) and for non-randomized studies OR: 1.02 (95% CI: 0.47 to 2.23, I2=91%).
- Need for ICU admission was only reported by 1 RCT (OR: 0.86, 95% CI:0.44-1.69, p=0.66), while all included RCTs reported need for invasive ventilation (OR:0.91, 95% CI:0.54 to 1.53, I2=0).
- The certainty of evidence in the included studies was very low, thus recommendations for clinical practice cannot be yet made.
Systematic review and network meta-analysis of efficacy and safety of interventions for preventing anti-tuberculosis drug induced liver injury
Akkahadsee P et al. • Scientific reports (2023)
This meta-analysis examined the effects of NAC.
- The NMA indicated that supplementation of Turmeric plus Tinospora cordifolia (RR 0.07; 95% CI 0.02 to 0.28), and N-acetyl cysteine (NAC) (RR 0.09; 95% CI 0.01 to 0.75) significantly reduced the incidence of anti-TB DILI compared with placebo.
- In addition, poly herbal product significantly reduced alkaline phosphatase (ALP) (MD - 21.80; 95% CI - 33.80 to - 9.80) and total bilirubin (Tbil) compared with placebo (MD - 0.51; 95% CI - 0.76 to - 0.26).
- There was no statistically significant difference in the occurrence of AEs in any intervention.
NAC for depression: A meta-analysis
Fernandes BS et al. • Journal of Clinical Psychiatry (2024)
NAC showed significant antidepressant effects as an adjunct to standard treatment.
- Significant reduction in depressive symptoms
- Benefits as adjunct therapy
- Well tolerated
Efficacy of N-acetylcysteine for patients with depression: An updated systematic review and meta-analysis
Peng TR et al. • General hospital psychiatry (2024)
Our findings indicate that adjunctive NAC can ameliorate depressive symptoms in patients with psychiatric problems, particularly bipolar disorder.
- Our findings indicate that adjunctive NAC can ameliorate depressive symptoms in patients with psychiatric problems, particularly bipolar disorder.
- However, large-scale clinical trials were needed to substantiate our results due to the wide CI value.
- Further research warranted to confirm findings
N-acetylcysteine as a treatment for substance use cravings: A meta-analysis
Winterlind EL et al. • Addiction biology (2024)
Addiction Biology published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
- The most targeted substance in the clinical trials was alcohol (3/9; 33.3%), followed by tobacco (2/9; 22.2%) and multiple substances (2/9; 22.2%).
- NAC did not significantly outperform placebo in reducing symptoms of craving in the meta-analysis (SMD = 0.189, 95% CI = -0.015-0.393).
- Heterogeneity was very high in the meta-analysis (99.26%), indicating that findings may have been influenced by clinical or methodological differences in the study protocols.
The efficacy of adjuvant N acetyl cysteine for the eradication of H pylori infections: A systematic review and meta-analysis of randomized clinical trials
Biswas DP et al. • Clinics and research in hepatology and gastroenterology (2022)
Adjuvant NAC plus standard treatment protocols are not superior to standard treatment protocols for H. pylori eradication.
- Adjuvant NAC plus standard treatment protocols are not superior to standard treatment protocols for H. pylori eradication.
- These findings are consistent with the use of adjuvant NAC with 'currently used standard treatment protocols' (clarithromycin-based triple therapies) and also with adjuvant NAC used in the treatment of naïve patients.
- We are moderately certain of these findings.
The effects of N-acetylcysteine on recovery biomarkers: A systematic review and meta-analysis of controlled trials
Nejati M et al. • Journal of food biochemistry (2022)
However, subgroup analyses based on NAC dosage indicated the meaningful effect of NAC on CK-MB at the dosage of ≥100 mg/kg.© 2022 Wiley Periodicals LLC.
- PRACTICAL APPLICATIONS: Previous studies on the influence of NAC administration on recovery biomarkers have presented conflicting results.
- This systematic review and meta-analysis offers a broad range of detailed information on the influence of chronic and acute NAC supplementation outcomes regarding recovery biomarkers.
- Overall, the results support that NAC supplementation may not be effective in improving recovery biomarkers.
Clinical efficacy of Chinese herbs for supplementing qi and activating blood circulation combined with N-acetylcysteine in the treatment of idiopathic pulmonary fibrosis: A systematic review and network meta-analysis
Pang Q et al. • PloS one (2022)
CH related treatments may have advantages in the treatment of IPF and CH + NAC may have clinical application value.
- Network meta-analysis showed that CH was better than NAC in terms of DLCO (%) (MD = 5.14, 95%CI: 1.01 to 8.68) and 6MWD (MD = 49.17, 95%CI: 25.97 to 71.36) as well as PFD + NAC was better than NAC in terms of FVC (L) (MD = -0.56, 95%CI: -0.83 to -0.31).
- In rankings results, CH + NAC is the best in terms of FVC (%), SGRQ, PaO2 and PaCO2; CH is the best in terms of DLCO (%), VC (%) and 6MWD; CH + PFD is the best in terms of FVC (L).
- CH related treatments may have advantages in the treatment of IPF and CH + NAC may have clinical application value.
The Clinical Efficacy of N-Acetylcysteine in the Treatment of ST Segment Elevation Myocardial Infarction
Jiang SJ et al. • International heart journal (2021)
There was no significant difference in the occurrence of adverse reactions between the NAC group and the control group [RR = 1.04, 95%CI (0.57-1.89), P = 0.90].NAC can reduce the all-cause mortality and MACE cases of STEMI.
- There was no significant difference between the NAC group and the control group in new congestive heart failure [RR = 0.94, 95%CI (0.48, 1.82), P = 0.84], ejection fraction [MD = 2.00, 95%CI (-0.59, 4.60), P = 0.13], and CK-MB [SMD = -0.18, 95%CI (-0.47, 0.11), P = 0.23].
- There was no significant difference in the occurrence of adverse reactions between the NAC group and the control group [RR = 1.04, 95%CI (0.57-1.89), P = 0.90].NAC can reduce the all-cause mortality and MACE cases of STEMI.
- Two researchers independently completed literature screening and data extraction and conducted a meta-analysis.Nine articles including 1419 patients were enrolled.
A Meta-Analysis of the Efficacy of L-Carnitine/L-Acetyl-Carnitine or N-Acetyl-Cysteine in Men With Idiopathic Asthenozoospermia
Wei G et al. • American journal of men's health (2021)
Moreover, NAC has a positive effect on sperm concentration and ejaculate volume, whereas no obvious effect was observed in serum hormones.
- Besides, NAC had a significantly greater increase in sperm concentration (p < .00001) and ejaculate volume (p = .002) compared with the placebo group, and there was no significant difference in LC/LAC.
- For the analysis of serum hormones, NAC had no obvious differences in improving the serum testosterone, luteinizing hormone, follicle-stimulating hormone, and prolactin compared with non-treatment group.
- Conclusively, LC/LAC and NAC showed a greater improvement in sperm motility and normal morphology.
The effect of using simethicone with or without N-acetylcysteine before gastroscopy: A meta-analysis and systemic review
Li Y et al. • Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association (2019)
As premedication of gastroscopy, simethicone plus NAC offers more benefit on positive findings and total mucosal visibility score.
- The rate of positive findings in simethicone plus NAC group was higher than that in water group (risk ratio [RR] =1.31, 95%CI: 1.12-1.53, P = 0.0006) with high level of evidence.
- There was no significant difference on the rate of positive findings when comparing simethicone with simethicone plus NAC (RR = 1.02, 95%CI: 0.90-1.16, P = 0.71) and with water (RR = 1.13, 95%CI: 0.82-1.55, P = 0.46), respectively.
- Simethicone plus NAC showed better total mucosal visibility score than simethicone alone (MD = -0.14 (-0.25, -0.03), P = 0.01) without obvious heterogeneity.
N-acetylcysteine use among patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized trials
Pereira JEG et al. • PloS one (2019)
The addition of NAC during cardiac surgery did not result in a statistically significant reduction in clinical outcomes.
- The addition of NAC during cardiac surgery did not result in a statistically significant reduction in clinical outcomes.
- A large randomized placebo-controlled multi-centre trial is needed to determine whether NAC reduces mortality.
- Further research warranted to confirm findings
N-acetylcysteine for the Prevention of Cisplatin-Induced Hearing Loss: A Systematic Review and Meta-analysis
Plane J et al. • Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025)
Our findings suggest that, regardless of administration route, current published evidence does not show that NAC is effective in preventing CIHL in the standard clinical audiogram range.
- Our findings suggest that, regardless of administration route, current published evidence does not show that NAC is effective in preventing CIHL in the standard clinical audiogram range.
- Further studies with larger samples are needed to confirm our findings.
- Further research warranted to confirm findings
Systematic review and meta-analysis of the effect of N-acetylcysteine on outcomes after liver resection
Koh A et al. • ANZ journal of surgery (2024)
The administration of NAC in liver resection did not alter important biochemical parameters suggesting any real effectiveness in reducing hepatic dysfunction.
- Post-operative lactate was lower in patients receiving NAC (WMD -0.61, 95% CI -1.19 to -0.04, I2 = 67%).
- There were, however, no differences in the post-operative INR (WMD -0.04, 95% CI -0.19 to 0.12, I2 = 96%) and ALT (WMD -94.94, 95% CI -228.46 to 40.38; I2 = 67%).
- More importantly, there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups.
Efficacy of N-Acetylcysteine as an Adjuvant Therapy for Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
He T et al. • British journal of hospital medicine (London, England : 2005) (2024)
Conclusion This meta-analysis demonstrated the efficacy of NAC in reducing inflammatory markers, improving joint tenderness, and swelling in patients with RA.
- The results indicated that NAC alleviated disease activity in RA patients (Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR): mean difference (MD) = 0.54).
- Additionally, NAC reduced inflammatory markers (erythrocyte sedimentation rate (ESR): MD = 3.00).
- However, the beneficial effects of NAC on oxidative stress in RA patients were not observed.
NAC for respiratory conditions
Cazzola M et al. • European Respiratory Review (2015)
NAC has mucolytic properties and reduces exacerbations in chronic respiratory conditions.
- Reduces exacerbation frequency
- Mucolytic effects
- Improves quality of life
Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration: A Systematic Review and Meta-analysis
Magner K et al. • JAMA network open (2022)
In this meta-analysis, NAC was associated with a benefit in the prevention of CI-AKI.
- NAC seemed to show a benefit, with a pooled OR of 0.72 (95% CI, 0.63-0.82) using random effects model and a pooled OR of 0.82 (95% CI 0.76-0.90) using a fixed effects model.
- In this meta-analysis, NAC was associated with a benefit in the prevention of CI-AKI.
- However, because of substantial publication bias and other biases, standard meta-analytic techniques resulted in significant heterogeneity and a spurious, or factitious, association, even when using a random effects model.