08/03/2022
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~OFF-label USE OF ACETYLCYSTEINE...
=N-acetylcysteine (NAC) is the mainstay of therapy for acetaminophen toxicity. NAC has Federal and Drug Administration (FDA) approval for the treatment of potentially hepatotoxic doses of acetaminophen (APAP), and it is almost 100% effective if given within 8 hours post-ingestion.
*** NAC repletes glutathione reserves by providing cysteine, which is an essential precursor in glutathione production. NAC by itself also binds to the toxic metabolites and scavenges free radicals.
=Mucolytic Effect, NAC has been reported to reduce the viscosity of sputum in both cystic fibrosis and COPD, facilitating the removal of pulmonary secretions.
***The free sulfhydryl group confers NAC with the ability to reduce disulphide bonds, thus decreasing mucus viscosity and facilitating mucociliary clearance.
=acute hepatic failure(or Ischemic Hepatitis, IH)
***N-Acetylcysteine (NAC), a potent anti-oxidant, may prevent IH by improving tissue oxygen delivery and improving hepatic hypoxia.
=prevention of contrast-induced nephropathy.
***Since acetylcysteine is a vasodilator as well as an antioxidant, it may work in two distinct ways, by preventing reduction in renal blood flow (RBF) or contrast-induced oxidative damage.
=The NAC orally daily produced a greater improvement in s***m concentration, ej*****te volume, s***m motility and normal morphology for idiopathic infertile men, whereas no significant influence in serum hormones.
***NAC can also reduce the effect of ROS activity in s***matozoa, which was a factor of reducing s***m viscosity, Therefore, the decrease in viscosity may be the reason of the increase in semen volume.
=topical treatment of keratoconjunctivitis sicca.
***Owing to its potent antioxidant, anti-inflammatory and mucolytic properties, topical NAC has had extensive use in the treatment of ocular pathology.
=There is good evidence to show it is of benefits in acute exposures to cyclopeptide containing mushrooms and carbon tetrachloride.
***Antidote for amatoxin poisoning,
N-acetylcysteine (NAC) has been used for decades but its benefit is still unproven.
=There are animal and human tissue studies showing its use in decreasing cisplatin-induced nephrotoxicity, although clinical evidence is minimal.
=NAC may also have therapeutic application in chronic valproate hepatotoxicity and acute pennyroyal or clove oil ingestion-induced hepatotoxicity..
=NAC being used as an antineoplastic agent as well as for psychiatric conditions like schizophrenia, bipolar disorder, depression, gastrointestinal conditions like hepatorenal syndrome, Helicobacter pylori infections, necrotizing enterocolitis, critical care patients like lung injury, cardiac injury, multiorgan dysfunction, sepsis and hematological conditions like sickle cell disease(still in the experimental stage).
=There's a case reports of NAC helping with improving neurological status in patients comatose with carbon monoxide poisoning.
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