N-Acetylcysteine (NAC) Supplements

Benefits, uses, side effects of NAC supplements

N-acetylcysteine (NAC) supplements are the synthetic form of the amino acid cysteine. Cysteine is a nonessential (or semi-essential) amino acid. This means your body produces some of what you need and you also get some from food.

Claims abound about the benefits of NAC supplements for certain health conditions, like respiratory diseases, heart disease, and mental health disorders. Some are backed by preliminary research while others aren't.

However, NAC has the unusual distinction of being approved by the Food and Drug Administration (FDA) for some uses.

This article explores the claims about NAC benefits and what the research shows. It also covers side effects, precautions, what to look for when buying it, and why some NAC supplements have been pulled off of store shelves.

Supplement Facts

  • Active Ingredient: Cysteine
  • Alternate Name(s): Acetylcysteine, L-cysteine
  • Legal Status: FDA-approved drug
  • Recommended Dose: Taken orally 600-1,200 mg/day is most common
  • Safety Considerations: Taken orally, likely safe. May interact with other medications. Given intravenously, should be medically supervised. Mild side effects reported.

Health Benefits of N-Acetylcysteine

Little or no evidence supports most purported NAC benefits. Research to date has been preliminary. Some of those findings are promising, though, and warrant further research.

Some research suggests NAC supplements can increase the amount of glutathione in your body. Glutathione is a powerful antioxidant. To create it, NAC bonds with two other amino acids—glutamine and glycine.

Glutathione plays essential roles in the body, including:

Integrative medicine practitioners suggest the glutathione increase might help prevent and manage some health conditions. These include:

You should not use NAC supplements for the sole treatment or prevention of any of the above conditions. Before using a supplement, talk to your healthcare provider. They can determine whether it's safe for you based on your medical history and what else you're taking.

N-Acetylcysteine powder, tablets, and capsules

Verywell / Anastasia Tretiak

Acetaminophen (Tylenol) Poisoning

The FDA doesn't often approve supplements for medicinal use, but NAC has the agency's stamp of approval for treating Tylenol (acetaminophen) poisoning. Acetaminophen is safe at low doses, but overdose can cause liver toxicity and failure, which can be fatal.

In overdose cases, healthcare providers can use intravenous (IV) infusions of NAC to prevent liver damage and other symptoms. (IV means it's delivered directly into a vein via a needle.) The NAC is usually given in three infusions over the course of 21 hours.

Get Emergency Treatment

Tylenol poisoning is a medical emergency. Don't try to treat it yourself. Call 911 immediately if you or someone you know may have overdosed on acetaminophen.

Lung Disease

Some studies have looked into the NAC benefits in people with lung diseases such as:

A 2015 meta-analysis published in European Respiratory Review evaluated 13 studies involving 4,155 people with COPD. It concluded that 1,200 milligrams (mg) of NAC per day reduced the incidence and severity of flares compared to a placebo.

The FDA has approved inhaled NAC as an add-on treatment for helping break up mucus in lung conditions.

COVID-19 and Other Viral Illnesses

Due to the antioxidant and anti-inflammatory characteristics of NAC, it has been used in clinical practice for people hospitalized with COVID-19.

A 2021 study published in Infectious Diseases looked at the effects of NAC supplementation. Researchers said taking 600 mg NAC orally (by mouth) twice daily for 14 days led to:

  • Reduced disease progression
  • Reduced need for intubation (a breathing tube)
  • Fewer deaths

But the study authors concluded that larger, well-designed trials need to be run to determine how safe and effective this treatment is. Two clinical trials quickly got underway.

Some evidence also supports using NAC to help treat:

Heart Disease

Proponents of NAC say it may help lower the risk of heart disease by reducing oxidative stress on the heart. Oxidative stress occurs when an imbalance of free radicals (unstable molecules) damages the body's cells and tissues.

In research, daily use of NAC reduced hypertension (high blood pressure), which is a significant contributor to atherosclerosis (plaque build-up in the arteries).

A 2015 study in the American Journal of Clinical Nutrition says people taking NAC supplements for four weeks had a significant drop in systolic (top number) and diastolic (bottom number) blood pressure. These drops occurred regardless of their weight, cholesterol levels, or whether they smoked.

The same study also suggested NAC may reduce your blood's homocysteine levels. High levels of homocysteine can increase your risk of heart disease. However, the long-term effects of NAC on blood pressure are unknown.

This study was too small to draw firm conclusions but provided promising evidence that may encourage further study.

Male Infertility

Research has looked at whether NAC may further improve fertility in biological males with varicoceles, enlarged veins in the scrotum and testicles. Varicoceles is a leading cause of male infertility.

According to a 2016 study, people who underwent surgery to treat varicoceles had higher conception rates if they took NAC before and after surgery. Again, though, this was a small, preliminary study.

Polycystic Ovary Syndrome

NAC may help alleviate symptoms of polycystic ovary syndrome (PCOS), according to a 2015 systematic review.

The review evaluated eight studies with a total of 910 people with PCOS. Investigators found NAC improved ovulation and pregnancy rates compared to a placebo. However, the improvement was not as great as it was with metformin (a prescription drug used to treat PCOS).

Researchers also reported NAC did not improve other common symptoms of PCOS, such as menstrual irregularities or weight gain.

Mental Health Disorders

NAC may play a role in treating mental health conditions related to inflammation and dysregulation of the neurotransmitter (brain chemical) glutamate.

Preliminary results have mostly been inconclusive, but some research suggests NAC supplements may be an effective add-on treatment for:

NAC supplements shouldn't be used alone for treating any mental health disorders. You should look at it as an additional treatment, and only after clearing it with your healthcare provider.

Neurological Diseases

NAC may have a use as an add-on treatment for some neurological conditions, including:

This is also believed to be due to its antioxidant and anti-inflammatory properties.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an umbrella term for Crohn's disease (CD) and ulcerative colitis (UC). Oxidative stress is believed to be involved in these conditions, so antioxidant treatments have gotten a fair amount of attention.

In studies, NAC supplements helped prevent relapses in people who were tapering off of the drug prednisone, both with CD and UC.

Sleep Apnea

Sleep apnea causes you to stop breathing for short periods while you sleep. It's considered a cause of inflammation and a risk factor for high blood pressure, stroke, and heart disease.

Some small studies have suggested that NAC supplements may help improve nighttime breathing and reduce snoring in people with sleep apnea.

Cysteine Deficiency

Since cysteine is made in the body and found in high-protein foods, deficiency is rare.

However, if you're a vegetarian or vegan, you may be at risk of cysteine deficiency, especially if you don't eat a lot of cysteine-rich plants.

Side Effects

As with all supplements, side effects are possible when taking NAC. They're more common at high doses and different for different forms of the supplement.

Possible side effects from oral NAC supplements include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Itching
  • Skin redness

NAC supplements smell like rotten eggs, which may contribute to nausea and vomiting. Using forms that mask the taste, such as flavored tablets that dissolve in water, can help with that.

Inhaled NAC may cause:

  • Runny nose
  • Drowsiness
  • Tightness in the chest
  • Numbness of the mouth

If you have asthma, your healthcare provider should monitor you for reactions to inhaled NAC.

Allergies to NAC are uncommon but can occur. The risk is highest during NAC infusions. In rare cases, an infusion may cause anaphylaxis, a life-threatening allergic reaction.

Precautions

Although NAC is generally safe when used as directed, it's not safe for everyone or at all times of life.

  • Pregnancy or breastfeeding: Don't take without approval from your healthcare provider.
  • Children: A safe and effective oral dose of NAC hasn't been established. Don't give it to children unless directed to by a healthcare provider.
  • People with bleeding disorders: NAC can slow blood clotting. Don't take it if you have a bleeding disorder such as hemophilia or Von Willebrand disease.
  • People with kidney disease: Conflicting research means guidelines for NAC in kidney disease aren't established. Talk to your healthcare provider first before using NAC.
  • People with asthma: Use caution with NAC unless done under medical supervision. NAC may cause bronchospasm when inhaled or taken orally.

Since NAC may affect blood tests and slow blood clotting, you may need to stop taking it 12 hours before a blood draw and for two weeks before elective surgeries.

Dosage of NAC

Most NAC supplements are sold in 500 mg dosages, although some are as high as 1,200 mg. Product suggested doses range from one to four doses per day for a total of 500 mg to 3,000 mg daily.

However, since the FDA does not regulate supplements, NAC doesn't have universal guidelines for its use. Use caution and work with a qualified healthcare provider when considering this (and any) supplement.

What Happens If I Take Too Much?

Oral NAC hasn't been tied to any cases of toxicity (overdose). However, taking too much NAC may make side effects more likely.

Accidental overdoses of IV NAC have caused deaths.

Interactions

NAC may intensify or interfere with the action of some medications, including:

  • Angina medications: NAC may intensify the effects of nitrates for angina (heart pain from reduced blood flow). This may cause severe headaches.
  • Blood thinners: NAC may further contribute to bleeding. You shouldn't take NAC without medical supervision.
  • Antihypertensive medication: NAC may further lower blood pressure and lead to dangerous lows (hypotension).
  • Activated charcoal: NAC supplementation may interfere with its intended action.

How to Store NAC

NAC supplements should be stored at room temperature in a cool, dry room. Discard any supplements that have expired, are discolored, or show signs of deterioration.

It is important to note that NAC may have an odor similar to sulfur, which is normal.

How to Buy

NAC is available over-the-counter (OTC) in several formulations, including:

  • Tablets
  • Capsules
  • Softgels
  • Effervescent tablets
  • Powders

Dietary supplements aren't regulated in the United States. When possible, choose a supplement that has been tested by a trusted third party, such as U.S. Pharmacopeia (USP), ConsumerLabs, or NSF. That doesn't guarantee safety and effectiveness but it does mean the contents match the label and are free from contamination.

Are NAC Supplements Being Banned?

Because the FDA has approved NAC for some medical uses, it's considered a drug in the United States. In July 2020, the FDA issued a reminder for manufacturers that an approved drug can't be sold as a dietary supplement, putting the legality of NAC supplements in question.

Since the FDA's full safety review on NAC supplements is ongoing, the agency issued a statement in August 2022 declaring that it would turn a blind-eye to the sale of NAC-containing dietary supplements until further notice. In other words, NAC-containing dietary supplements are permitted for the time being, so long as the product does not make false claims about its medical benefits.

N-acetylcysteine tablets
Verywell / Anastasia Tretiak

Summary

NAC is an FDA-approved drug as an intravenous treatment for acetaminophen poisoning and an inhaled treatment for breaking up mucus in some lung conditions.

NAC supplements have some preliminary evidence supporting their use for managing symptoms of viral illnesses, including COVID-19, heart disease, male infertility, PCOS, mental health and neurological disorders, inflammatory bowel disease, and sleep apnea.

Side effects and drug interactions are possible with NAC supplements. Always check with your healthcare provider before starting any medicinal product.

NAC is currently sold as a dietary supplement in many forms, but the FDA may put an end to that because it's legally classified as a drug.

27 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Šalamon Š, Kramar B, Marolt TP, Poljšak B, Milisav I. Medical and dietary uses of N-acetylcysteine. Antioxidants (Basel). 2019;8(5):111. doi:10.3390/antiox8050111

  2. Lizzo G, Migliavacca E, Lamers D, et al. A randomized controlled clinical trial in healthy older adults to determine efficacy of glycine and n-acetylcysteine supplementation on glutathione redox status and oxidative damage. Front Aging. 2022;3:852569. doi:10.3389/fragi.2022.852569

  3. Gaucher C, Boudier A, Bonetti J, Clarot I, Leroy P, Parent M. Glutathione: antioxidant properties dedicated to nanotechnologies. Antioxidants (Basel). 2018;7(5):62. doi:10.3390/antiox7050062

  4. Turgut T, Ilhan N, Deveci F, Akpolat N, Erden EŞ, Muz MH. Glutathione and nitrite levels in induced sputum at COPD patients and healthy smokersJ Thorac Dis. 2014;6(6):765-771. doi:10.3978/j.issn.2072-1439.2014.04.24

  5. Adeoye O, Olawumi J, Opeyemi A, Christiania O. Review on the role of glutathione on oxidative stress and infertilityJBRA Assist Reprod. 2018;22(1):61-66. doi:10.5935/1518-0557.20180003

  6. DailyMed. Acetadote—acetylcysteine injection, solution [drug label].

  7. National Library of Medicine: LiverTox. Acetaminophen.

  8. Schwalfenberg GK. N-acetylcysteine: a review of clinical usefulness (an old drug with new tricks)J Nutr Metab. 2021;2021:9949453. doi:10.1155/2021/9949453

  9. Cazzola M, Calzetta L, Page C, et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015;24(137):451-461. doi:10.1183/16000617.00002215

  10. MedlinePlus. Acetylcysteine oral inhalation.

  11. Assimakopoulos SF, Aretha D, Komninos D, et al. N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study. Infect Dis. 2021;53(11):847-854. doi:10.1080/23744235.2021.1945675

  12. Hildebrandt W, Sauer R, Bonaterra G, Dugi KA, Edler L, Kinscherf R. Oral N-acetylcysteine reduces plasma homocysteine concentrations regardless of lipid or smoking status. Am J Clin Nutr. 2015;102(5):1014-1024. doi:10.3945/ajcn.114.101964

  13. Barekat F, Tavalaee M, Deemeh MR, et al. A preliminary study: N-acetyl-L-cysteine improves semen quality following varicocelectomy. Int J Fertil Steril. 2016;10(1):120-126. doi:10.22074/ijfs.2016.4777

  14. Thakker D, Raval A, Patel I, et al. N-Acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials. Obstet Gynecol Int. 2015;2015:817849. doi:10.1155/2015/817849

  15. Ooi SL, Green R, Pak SC. N-acetylcysteine for the treatment of psychiatric disorders: a review of current evidence. Biomed Res Int. 2018;2018:2469486. doi:10.1155/2018/2469486

  16. Çakici N, van Beveren NJM, Judge-Hundal G, Koola MM, Sommer IEC. An update on the efficacy of anti-inflammatory agents for patients with schizophrenia: a meta-analysis. Psychol Med. 2019;49(14):2307-2319. doi:10.1017/S0033291719001995

  17. Masnadi Shirazi K, Sotoudeh S, Masnadi Shirazi A, Moaddab SY, Nourpanah Z, Nikniaz Z. Effect of N-acetylcysteine on remission maintenance in patients with ulcerative colitis: A randomized, double-blind controlled clinical trialClin Res Hepatol Gastroenterol. 2021;45(4):101532. doi:10.1016/j.clinre.2020.08.010

  18. Wu K, Su X, Li G, Zhang N. Antioxidant carbocysteine treatment in obstructive sleep apnea syndrome: a randomized clinical trialPLoS One. 2016;11(2):e0148519. doi:10.1371/journal.pone.0148519

  19. Tenório MCDS, Graciliano NG, Moura FA, Oliveira ACM, Goulart MOF. N-Acetylcysteine (NAC): impacts on human healthAntioxidants (Basel). 2021;10(6):967. doi:10.3390/antiox10060967

  20. Fowdar K, Chen H, He Z, et al. The effect of N-acetylcysteine on exacerbations of chronic obstructive pulmonary disease: A meta-analysis and systematic review. Heart Lung. 2017;46(2):120-128. doi:10.1016/j.hrtlng.2016.12.004

  21. Mount Sinai. Cysteine.

  22. Yarema M, Chopra P, Sivilotti ML, et al. Anaphylactoid reactions to intravenous N-acetylcysteine during treatment for acetaminophen poisoning. J Med Toxicol. 2018;14(2):120-127. doi:10.1007/s13181-018-0653-9

  23. Nikbakht M, Ahmadi F, Vaseghi G, et al. The role of n-acetylcysteine in platelet aggregation and reperfusion injury in recent years. Curr Clin Pharmacol. 2017;12(2):83-91. doi:10.2174/1574884712666170704145842

  24. Genzen JR, Hunsaker JJ, Nelson LS, Faine BA, Krasowski MD. N-acetylcysteine interference of Trinder-based assays. Clin Biochem. 2016;49(1-2):100-104. doi:10.1016/j.clinbiochem.2015.10.005

  25. Mahmoudi GA, Astaraki P, Mohtashami AZ, Ahadi M. N-acetylcysteine overdose after acetaminophen poisoning. Int Med Case Rep J. 2015;8:65-69. doi:10.2147/IMCRJ.S74563

  26. Food and Drug Administration. Warning letter: Vita Heaven, LLC dba Hangover Heaven.

  27. U.S. Food and Drug Administration. FDA releases final guidance on enforcement discretion for certain NAC products.

Bio headshot for Jennifer Lefton

By Jennifer Lefton, MS, RD/N, CNSC, FAND
Jennifer Lefton, MS, RD/N-AP, CNSC, FAND is a Registered Dietitian/Nutritionist and writer with over 20 years of experience in clinical nutrition. Her experience ranges from counseling cardiac rehabilitation clients to managing the nutrition needs of complex surgical patients.

Originally written by Cathy Wong