Evidence supporting the use of: N-acetyl-cysteine (NAC)
For the health condition: Addictions (drugs)

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Synopsis

Source of validity: Scientific
Rating (out of 5): 2

N-acetyl-cysteine (NAC) is used as a supplement to support the treatment of various addictions, especially substance use disorders involving cocaine, cannabis, nicotine, and other drugs. This use is primarily justified by scientific investigation, not tradition or folk medicine. Preclinical studies and some human clinical trials suggest that NAC may help reduce cravings and prevent relapse, likely by modulating glutamate neurotransmission in the brain's reward circuitry, particularly the nucleus accumbens. NAC acts as a precursor to glutathione, an important antioxidant, and influences extracellular glutamate levels, which are often dysregulated in addiction. Clinical evidence is mixed: some small randomized controlled trials (RCTs) and meta-analyses have reported modest benefits in reducing cravings or drug use, particularly for cannabis and cocaine. However, other studies have shown minimal or no significant effects compared to placebo. The safety profile of NAC is favorable, which encourages ongoing research. Major guidelines do not currently recommend NAC as a first-line treatment for addiction, but it is sometimes used as an adjunct in clinical trials or off-label in practice. The overall quality of evidence is low to moderate, with significant heterogeneity between studies, small sample sizes, and short follow-up periods. More robust, large-scale RCTs are needed to clarify its efficacy and optimal use in addiction treatment.

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