Systematic review of N-acetylcysteine in the treatment of addictions

Abstract

Objective: To conduct the first systematic literature review of clinical trials of N-acetylcysteine (NAC) for the treatment of substance abuse disorders and addictive behaviors. Methods: A search of the MEDLINE, Embase and PsycINFO databases was conducted. The inclusion criteria for the review were clinical trials that used NAC in the treatment of a disorder related to substance use and/or addictive behaviors, limited to texts in English, Spanish, or French. The selected studies were evaluated with respect to type of trial, sample size, diagnostic input, intervention, length of follow-up, outcome variables, and results. Results: Nine studies analyzing a total of 165 patients met the eligibility criteria and were included in qualitative analysis. These studies evaluated the role of NAC in cocaine dependence (three studies), cannabis dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled. Conclusions:The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and cannabis dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction.

In Vitro Cysteine Reactivates Organophosphate Insecticide Dichlorvos-Inhibited Human Cholinesterases

“…19 It is a prodrug which is enzymatically metabolised (i.e. deacetylated) by the liver into its active metabolite cysteine and serves as a cysteine donor.…”

“…2 One of the detoxification mechanisms of NAC in acetaminophen poisoning is its direct reaction with N-acetyl-p-benzoquinone imine, the toxic metabolite of acetaminophen. 19 Thus, NAC may still act as an antidote in OP poisoning due to its direct reaction and neutralisation properties. On this basis, Figure 4 depicts another proposed mechanism for the reactivation of OP-inhibited ChEs by 2-PAM and cysteine wherein the reactions of 2-PAM and cysteine with OP-inhibited ChEs also proceed via an associative stepwise addition-elimination process.…”

Prevention of γ-Radiation-Induced DNA Damage in Human Lymphocytes Using a Serine-Magnesium Sulfate Mixture

“…[27][28][29] Other medical uses for NAC include the treatment of radiocontrastinduced nephropathy, cyclophosphamide-induced haemorrhagic cystitis and a number of psychiatric disorders; it also has significant antiviral activity against influenza type A viruses. 30 Moreover, NAC has been shown to replenish glutathione stores in cells and has free radical scavenging properties. 30 It is a prodrug which is enzymatically metabolised (i.e.…”

“…30 Moreover, NAC has been shown to replenish glutathione stores in cells and has free radical scavenging properties. 30 It is a prodrug which is enzymatically metabolised (i.e. deacetylated) to its active metabolite cysteine by the liver and serves as a cysteine donor.…”

“…The thiol group is reactive toward xenobiotics and seems to be responsible for the beneficial effects of cysteine in poisoning cases. 11,30 Both NAC and cysteine are known radioprotective agents whose radioprotective properties are attributable to the antioxidant and free radical scavenging characteristics of the thiol group. 10,11 The pKa values-the values at which half of the functional group are ionised-of the thiol group have been shown to play an important role in the radioprotective properties of these agents, in that the more the thiol is ionised, the greater the radioprotection.…”