What is the rationale for using N-acetylcysteine (NAC) in the treatment of non-acetaminophen-related liver failure (NALF)?

A 2009 RCT study (1) involving adults with NALF (including many due to drug toxicity, HBV, and autoimmune causes) found longer transplant-free survival (not overall survival) in the treatment group, especially in those with lower grade encephalopathy, or liver failure caused by drugs or HBV.  How NAC might work in this setting (e.g. effect on microcirculation/02 delivery through interference with cytokines) is not clear but a cool article (2) recently reported lower serum levels of interleukin-17 among treated patients.  Fascinating!  

1.Bass S, Zook N. Intravenous acetylcysteine for indications other than acetaminophen overdose. Am J Health-Syst Pharm 2013;70:1496-1501.

2.Stravitz RT, Sanyal AJ, Reisch J, et al. Effects of N-acetylcysteine on cytokines in non-acetaminophen acute liver failure: potential mechanism of improvement in transplant-free survival. Liver Int. 2013;33:1324-1331.

What is the rationale for using N-acetylcysteine (NAC) in the treatment of non-acetaminophen-related liver failure (NALF)?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s