Synopsis

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

N-acetylcysteine (NAC) is scientifically validated as a supportive treatment for certain forms of hepatitis, particularly acute liver failure associated with acetaminophen (paracetamol) overdose and, to a lesser extent, non-acetaminophen acute liver injury, which can include viral hepatitis. NAC acts as a precursor to glutathione, a critical antioxidant in the liver, and helps replenish glutathione stores depleted during liver injury, thereby reducing oxidative stress and hepatocellular damage.

Strong evidence supports the use of NAC in acetaminophen-induced hepatitis, with numerous randomized controlled trials and guidelines endorsing its use as standard of care. In cases of non-acetaminophen acute liver failure, including viral hepatitis, the evidence is less robust but growing. Several clinical trials and meta-analyses (e.g., Lee et al., 2009; Hu et al., 2015) suggest that NAC administration can improve transplant-free survival and reduce complications in acute liver failure not caused by acetaminophen, though results are mixed and benefits are most pronounced in early stages of hepatic encephalopathy.

For chronic hepatitis (e.g., chronic hepatitis B or C), evidence is limited; some small studies have explored NAC’s antioxidant and anti-inflammatory effects, but there is insufficient data to recommend it as a primary therapy. Overall, NAC is a scientifically supported adjunct in specific acute hepatitis contexts, particularly for acetaminophen toxicity, with moderate evidence for broader hepatitis-induced liver injury.

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