N-acetylcysteine (NAC) Side Effects and Considerations

Special Considerations

• The American Academy of Emergency Medicine recommends that when used as an antidote for acetaminophen poisoning, NAC's side effects should not prevent completion of therapy, as the benefits far outweigh the risks 1, 2
• The American College of Chest Physicians notes that when used for COPD exacerbation prevention (typically 600 mg twice daily), NAC is well tolerated with minimal adverse effects 3, 4
• The European Society for Clinical Nutrition and Metabolism reports that when added to parenteral nutrition at doses of 20-50 mg/kg/day, NAC has been shown to decrease liver enzyme elevations with minimal side effects 5, 6
• In the largest study of NAC for COPD (1,006 patients), the incidence of adverse effects did not differ significantly between NAC and placebo groups, according to the American College of Chest Physicians 4