Acetylcysteine is a byproduct of cysteine and a precursor to glutathione. It is used as a mucolytic to thin mucus in the lungs and as an antidote to acetaminophen overdose. It can also have side effects and is not suitable for all patients.
Acetylcysteine, also known as N-acetylcysteine or NAC, is a byproduct of N-acetyl, which is derived from cysteine, an amino acid produced by the human body. It is also a precursor to the synthesis of glutathione, a powerful antioxidant. Medicinally, this substance is formulated into a solution of acetylcysteine containing a concentration of 10 or 20 percent, buffered by the addition of diluted disodium edentate and hydrochloric acid or sodium hydroxide to achieve a pH between 6.0 and 7.5. Acetylcysteine is prescribed as a mucolytic, which means it helps thin excess mucus in the lungs when it’s inhaled. However, this compound is also made into oral and intravenous medications for the purpose of counteracting an acetaminophen overdose.
The mechanism of action underlying the mucolytic properties of acetylcysteine appears to reside in the sulfhydryl group of its molecular formula. In fact, this group is believed to destroy disulfide chains typically found in mucus that otherwise trap cellular waste by binding to glycoproteins. The effect of this activity is a reduction in the viscosity of mucous secretions, making them less resistant to normal flow and discharge. Since mucosal viscosity is directly related to excessive accumulation of glycoproteins and deoxyribonucleic acid (DNA), acetylcysteine is particularly effective since neither material hinders its action.
As an inhalant, acetylcysteine is useful in treating a variety of respiratory ailments, such as bronchitis, pneumonia, tuberculosis, and emphysema. It is also sometimes given to assist breathing in surgical patients while they are under anesthesia, as well as after surgery for those who have had procedures involving the windpipe or windpipe. Also, the drug can be introduced to aid in the diagnosis of respiratory diseases.
As an antidote to paracetamol toxicity, acetylcysteine exerts a hepatoprotective effect by decreasing the impact of N-acetyl-p-benzoquinone imine (NAPQI) accumulation that can result from taking large doses of this pain reliever. Toxicity occurs because normal glutathione levels cannot handle the overload of NAPQI, which would otherwise bind and lead to the liver for elimination. Instead, NAPQI levels remain free and attack hepatocytes, specialized cells in the liver involved in the regulation of carbohydrates, cholesterol and proteins. As a result, the liver may stop working as it should. However, acetylcysteine not only promotes the binding action of glutathione, but also binds to NAPQI itself.
However, not all patients are candidates for acetylcysteine therapy. Indeed, some asthmatics are sensitive to the drug and experience further bronchoconstriction. In addition, large or long-term doses are known to reduce oxygen transport and increase blood pressure in the heart and lungs. This effect has been particularly noted in those taking dietary supplements for bodybuilding, which often contain acetylcysteine.
Other side effects of acetylcysteine include nausea, cramps, drowsiness and unexplained fever. Although there is no clear evidence that the use of this drug could impair fertility or cause birth defects in humans, caution should be exercised if the patient is or might become pregnant. Careful consideration should also be made for nursing mothers as it is not known whether this drug passes into breast milk.
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