Synopsis

Source of validity: Scientific
Rating (out of 5): 3

N-acetyl-cysteine (NAC) is primarily justified for use in certain types of hepatitis based on scientific evidence, particularly in cases of acute liver injury due to acetaminophen (paracetamol) toxicity and, to a lesser extent, in non-acetaminophen acute liver failure. NAC acts as a precursor to glutathione, a critical antioxidant in the liver, and helps to replenish depleted glutathione stores during oxidative stress. Its most well-established clinical use is as the standard antidote for acetaminophen overdose, where it can prevent progression to fulminant hepatitis and liver failure if administered promptly.

Regarding other forms of hepatitis (viral, autoimmune, alcoholic), the evidence supporting NAC is less robust. Some small clinical trials and case reports suggest that NAC may have beneficial effects in acute liver failure not caused by acetaminophen, including hepatitis-related liver injury, by improving liver function and outcomes. For example, a randomized controlled trial published in the Gastroenterology journal (2009) showed NAC improved transplant-free survival in patients with early-stage non-acetaminophen acute liver failure, which can include fulminant viral hepatitis. However, the benefit appears most pronounced in early or mild cases. For chronic hepatitis (such as chronic hepatitis B or C), evidence is limited and inconsistent, with no established benefit.

In summary, NAC is scientifically validated for treating acetaminophen-induced hepatitis and has emerging but not definitive support for other acute liver failures, including severe hepatitis. It is not a standard or proven therapy for chronic hepatitis.

More about n-acetyl-cysteine (NAC)
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