NAC (N-Acetylcysteine)

Study: This RCT (Sarris et al., 2022,) enrolled patients with obsessive-compulsive disorder (OCD) to assess NAC (up to 3,000 mg/day) as an adjunct to standard treatment over 20 weeks. Primary outcomes were Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. Secondary outcomes included anxiety, depression, and quality of life

Findings: NAC showed no significant improvement in Y-BOCS scores compared to placebo (p>0.05). Subgroup analyses suggested modest benefits in treatment-resistant OCD, but results were not statistically significant. No serious adverse events were reported; mild gastrointestinal upset occurred in 10%. The study suggests limited efficacy for NAC in OCD, contrasting earlier smaller trials, highlighting the need for larger studies targeting specific OCD subtypes.

Study: This RCT (Srivastava et al., 2024,, CTRI/2019/05/019305) at AIIMS, India, enrolled 50 patients with acute ischemic stroke (within 4.5 hours of onset), randomized to IV NAC (150 mg/kg) + recombinant tissue plasminogen activator (rtPA) or rtPA alone. Primary outcomes were intracerebral hemorrhage, symptomatic intracerebral hemorrhage, extracranial bleeding, and adverse reactions. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS) at 24 hours, recanalization, and 3-month modified Rankin Scale (mRS).

Findings: NAC reduced infarct volume (140.27 vs. 226.07 mm³, p=0.0135) and NIHSS at 24 hours (p=0.03), indicating early neurological improvement. No significant differences were found in adverse events (p=0.99), intracranial hemorrhage (p=0.21), or 3-month mortality (p=0.99). The study suggests NAC is safe as an adjunct to rtPA and may improve early outcomes, but small sample size limits conclusions. Larger trials are needed.

RCT (Wang et al., 2022) in 1,006 patients undergoing haploidentical hematopoietic stem cell transplantation (HSCT). Examined NAC as prophylactic treatment to improve endothelial cell function and accelerate blood cell recovery post-transplant.

1,006 patients undergoing haploidentical HSCT. Multicenter RCT.

Study: This RCT (Zhang et al., 2022,) evaluated NAC (1,200 mg/day) in 120 patients with stable chronic obstructive pulmonary disease (COPD) over 24 weeks. Outcomes included forced expiratory volume in 1 second (FEV1), exacerbation frequency, and quality of life (St. George’s Respiratory Questionnaire, SGRQ)

Findings: NAC maintained FEV1 (p<0.05) while placebo patients declined. Exacerbation frequency decreased (1.2 vs. 2.1 per year, p<0.01), and SGRQ scores improved (p<0.05). Mild gastrointestinal side effects occurred in 8%. The study aligns with the PANTHEON trial (1,200 mg/day,), which reduced exacerbations in moderate COPD, but contrasts with trials using 600 mg/day showing no benefit (e.g.,)

Study: This ongoing double-blind, placebo-controlled RCT (Shungu et al., 2020,, NCT04542161) at Cornell University is testing NAC (900 mg and 3,600 mg/day) in ME/CFS patients with low cortical glutathione (GSH). The primary outcome is change in GSH levels via proton magnetic resonance spectroscopy. Secondary outcomes include fatigue (CDC CFS Symptom Inventory) and cognitive function. A 2016 pilot study (n=small) found 1,800 mg/day NAC increased GSH and reduced symptoms

Findings: Preliminary 2016 data showed significant GSH increase and symptom reduction (p<0.05). The current trial (recruiting, completion expected 2025) aims to confirm these effects in a larger cohort. No adverse events were reported in the pilot. The study suggests NAC may address oxidative stress in ME/CFS, but results are pending.