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

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Synopsis

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

N-acetyl-cysteine (NAC) is an antioxidant and a precursor to glutathione, a key molecule in the body’s defense against oxidative stress. Its primary clinical use has been as an antidote for acetaminophen (paracetamol) overdose, which causes acute liver injury. There is some scientific interest and research into its potential benefits in chronic liver diseases, including cirrhosis, due to its ability to replenish glutathione stores and reduce oxidative stress and inflammation.

Several small clinical trials and animal studies have investigated NAC’s effects in chronic liver conditions, including cirrhosis. Some studies suggest that NAC may improve certain biochemical markers of liver function or oxidative stress in cirrhotic patients. However, the overall quality of evidence is low, with studies being small, short-term, and often lacking robust clinical endpoints such as survival or prevention of complications.

Major liver disease guidelines do not currently recommend routine use of NAC in the management of cirrhosis. Its use is sometimes considered in acute-on-chronic liver failure or in specific scenarios like non-acetaminophen acute liver failure, but evidence is limited and inconsistent. Thus, while there is a scientific rationale and some preliminary research, robust clinical validation is lacking. More large-scale, high-quality studies are needed to confirm any benefit of NAC in cirrhosis management.

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