Good evidence exists to support the use of N-acetylcysteine as an adjunct treatment to reduce the total and negative symptoms of schizophrenia .
N-acetylcysteine also appears to be effective in reducing craving in substance use disorders , especially for the treatment of cocaine and cannabis use among young people , in addition to preventing relapse in already abstinent individuals .
Oral N-acetylcysteine is safe and well tolerated without any considerable adverse effects .
N-acetylcysteine , a sulphur-containing amino acid for the treatment of paracetamol overdose and chronic obstructive pulmonary disease , is a widely available off-the-shelf oral antioxidant supplement in many countries .
With the potential to modulate several neurological pathways , including glutamate dysregulation , oxidative stress , and inflammation that can be beneficial to the brain functions , N-acetylcysteine is being explored as an adjunctive therapy for many psychiatric conditions .
This narrative review synthesis es and presents the current evidence from systematic review s , meta-analyses , and latest clinical trials on N-acetylcysteine for addiction and substance abuse , schizophrenia , obsessive-compulsive and related disorders , and mood disorders .
N-acetylcysteine (NAC) in schizophrenia resistant to clozapine: a double blind randomised placebo controlled trial targeting negative symptoms
Background Clozapine is an effective treatment for a proportion of people with schizophrenia ( SZ ) who are resistant to the beneficial effects of other antipsychotic drugs . However , anything from 40–60 % of people on clozapine experience residual symptoms even on adequate doses of the medication , and thus could be considered ‘ clozapine resistant ’ . Agents that could work alongside clozapine to improve efficacy whilst not increasing the adverse effect burden are both desired and necessary to improve the lives of individuals with clozapine-resistant SZ .  N-Acetylcysteine ( NAC ) is one such possible agent . Previous research from our research group provided promising pilot data suggesting the efficacy of NAC in this patient population . The aim of the study reported here is to exp and this work by conducting a large scale clinical trial of NAC in the treatment of clozapine-resistant SZ . Methods This study is an investigator initiated , multi-site , r and omised , placebo-controlled trial . It aims to include 168 patients with clozapine-resistant SZ , divided into an intervention group ( NAC ) and a control group ( placebo )  . Participants in the intervention group will receive 2 g daily of NAC . The primary outcome measures will be the negative symptom scores of the Positive and Negative Syndrome Scale ( PANSS ) . Secondary outcome measures will include : changes in quality of life ( QoL ) as measured by the Lancashire Quality of Life Profile ( LQoLP ) and cognitive functioning as measured by the total score on the MATRICS . Additionally we will examine peripheral and cortical glutathione ( GSH ) concentrations as process outcomes . Discussion This large scale clinical trial will investigate the efficacy of NAC as an adjunctive medication to clozapine . This trial , if successful , will establish a cheap , safe and easy-to-use agent ( NAC ) as a ‘ go to ’ adjunct in patients that are only partly responsive to clozapine . Trial registration Australian and New Zeal and Clinical Trials Registration Number : Current R and omised Controlled Trial ACTRN12615001273572 . The date of registration 23 November 2015
Good evidence exists to support the use of N-acetylcysteine as an adjunct treatment to reduce the total and negative symptoms of schizophrenia .
N-acetylcysteine also appears to be effective in reducing craving in substance use disorders , especially for the treatment of cocaine and cannabis use among young people , in addition to preventing relapse in already abstinent individuals .
Oral N-acetylcysteine is safe and well tolerated without any considerable adverse effects .
N-acetylcysteine , a sulphur-containing amino acid for the treatment of paracetamol overdose and chronic obstructive pulmonary disease , is a widely available off-the-shelf oral antioxidant supplement in many countries .
With the potential to modulate several neurological pathways , including glutamate dysregulation , oxidative stress , and inflammation that can be beneficial to the brain functions , N-acetylcysteine is being explored as an adjunctive therapy for many psychiatric conditions .
This narrative review synthesis es and presents the current evidence from systematic review s , meta-analyses , and latest clinical trials on N-acetylcysteine for addiction and substance abuse , schizophrenia , obsessive-compulsive and related disorders , and mood disorders .