N-acetylcysteine for non-acetaminophen induced acute liver failure: A review

• Published in: Saudi journal of gastroenterology Vol. 28; no. 2; pp. 85 - 91
• Main Authors: Jiang, Shirley, Hussaini, Trana, Yoshida, Eric
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.03.2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Acetaminophen; Acetaminophen - adverse effects; Acetylcysteine; Acetylcysteine - pharmacology; Acetylcysteine - therapeutic use; acute liver failure; Analgesics; Animals; Antioxidants - pharmacology; Antioxidants - therapeutic use; Case studies; Chemical and Drug Induced Liver Injury - drug therapy; clinical pharmacology; Complications and side effects; Drug overdose; Humans; liver; Liver failure; Liver Failure, Acute - chemically induced; Liver Failure, Acute - drug therapy; Mice; Prospective Studies; Review; Timor-Leste; Acetylcysteine; clinical pharmacology; acute liver failure; liver
• ISSN: 1319-3767; 1998-4049
• DOI: 10.4103/sjg.sjg_406_21

The use of N-acetylcysteine (NAC) for non-acetaminophen-induced acute liver failure (NAI-ALF) has been increasing despite controversy in its efficacy. National guidelines are in disagreement for NAC use as standard of care; however, many healthcare centers continue to adopt the use of NAC outside of acetaminophen poisoning. While NAC may have multiple mechanisms of action in treatment of ALF, this has not translated to clinical benefit. Murine models have reported antioxidant and anti-inflammatory properties, as well as improvement in liver-specific microcirculation. Multiple case studies and series have reported positive outcomes of NAC treatment for ALF of various etiologies. While prospective studies suggested the benefit of NAC treatment, these studies have methodological and statistical shortcomings that affect the validity of the results. In this review, we aimed to summarize the existing literature on the efficacy of NAC for NAI-ALF including mechanism of action, case studies and series demonstrating outcomes, and prospective studies that have led to its current widespread use, along with the reported rate of adverse events.