N-acetylcysteine and coronavirus disease 2019: May it work as a beneficial preventive and adjuvant therapy? A comprehensive review study

Abstract

Background: Coronaviruses are major pathogens of respiratory system causing different disorders, including the common cold, Middle East respiratory syndrome, and severe acute respiratory syndrome. Today's global pandemic coronavirus disease 2019 (COVID-19) has high mortality rate, with an approximate of 20% in some studies, and is 30–60 times more fatal than the common annual influenza, However, there is still no gold standard treatment for it. N-acetylcysteine (NAC) is a well-known multi-potential drug with hypothetically probable acceptable effect on COVID-related consequences, which we completely focused in this comprehensive review. Materials and Methods: PubMed, Scopus, Science Direct, and Google Scholar have been searched. Study eligibility criteria: efficacy of NAC in various subclasses of pathogenic events which may occur during COVID-19 infection. Efficacy of NAC for managing inflammatory or any symptoms similar to symptoms of COVID-19 was reviewed and symptom improvements were assessed. Results: Randomized clinical trials introduced NAC as an antioxidant glutathione analog and detoxifying agent promoted for different medical conditions and pulmonary disorders to alleviate influenza and reduce mortality by 50% in influenza-infected animals. The beneficial effects of NAC on viral disorders, including Epstein–Barr virus, HIV and hepatitis, and well-known vital organ damages were also exist and reported. Conclusion: We classified the probable effects of NAC as oxidative-regulatory and apoptotic-regulatory roles, antiviral activities, anti-inflammatory roles, preventive and therapeutic roles in lung disorders and better oxygenation functions, supportive roles in intensive care unit admitted patients and in sepsis, positive role in other comorbidities and nonpulmonary end-organ damages or failures and even in primary COVID-associated cutaneous manifestations. Based on different beneficial effects of NAC, it could be administered as a potential adjuvant therapy for COVID-19 considering patient status, contraindications, and possible drug-related adverse events.

N-Acetylcysteine and Other Sulfur-Donors as a Preventative and Adjunct Therapy for COVID-19

“…Although Etanercept has been proposed for use in COVID-19 to reduce the mortality of toxic epidermal necrolysis (TEN) [ 212 ], Atef et al proposed the use of 600 mg IV NAC every 8 h in surgical patients and ICU patients with TEN [ 213 ].…”

A systematic review and clinical atlas on mucocutaneous presentations of the current monkeypox outbreak: With a comprehensive approach to all dermatologic and nondermatologic aspects of the new and previous monkeypox outbreaks

“…The main causes of concern are the virus' sources, pathways of transmission, 2,5 characteristics of skin eruptions and constitutional symptoms, treatments, ways to prevent infection or possible vaccination. These concerns coalesce with the general remaining anxiety after the global COVID‐19 pandemic, 15–19 where concerns about the long term sequelae of a COVID infection, 20–22 its treatment, 23,24 effect of other medication on COVID, 25 in addition to its vaccination and side effects 26 are still prominently present among medical professionals and general population. Experts around the world are trying to use the lessons learned during the COVID pandemic to be more prepared for this new Monkeypox outbreak 27–29 …”

Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses

“…Tocilizumab and dexamethasone are the drugs indicated in severe COVID-19 hospitalized patients, who are at risk for severe secondary infection. However, the efficacy and safety of these drugs in advanced HIV patients have not been studied [ 116 ].…”