Issue 9 - Compounding news - NAC
N-Acetyl cysteine has been used for a wide range of conditions - from prevention of the flu to treatment of bipolar disorder and recurrent pregnancy loss. It is converted in the body to L-cysteine and then to glutathione, our primary and most abundant endogenous antioxidant. Glutathione is responsible for neutralising reactive oxidative species, which are a natural product of metabolism but in excess cause damage to cell structures.
NAC for influenza - an Italian multi-centre, randomised, double blind, clinical trial evaluated the effect of NAC in 262 patients (600mg twice daily for 6 months). The results showed a significant reduction in the frequency, severity and duration of episodes of the flu. Interestingly, although the same number of patients in each group were infected with the virus, only 25% of infected patients in the NAC arm showed any symptoms, compared to 79% of infected patients in the placebo group.
NAC for bipolar disorder - Alterations in oxidative metabolism, resulting in increased oxidative stress, have been shown in patients with bipolar disorder. Investigators in a double blind randomised placebo controlled trial gave 75 patients with bipolar disorder NAC (1g twice daily for 6 months). The results showed large decreases in symptoms compared to placebo, with improvements in severity of symptoms and daily functioning.
NAC for Parkinsons Disease - Antioxidants have been thought to reduce the degeneration in the dopaminergic neurons, and NAC is currently being trialled in PD where there is deterioration in these cells in the midbrain. A wide range of both genetic and environmental factors have been proposed as contributing to the initiation and progression of PD, but the most important important is considered to be ageing and its associated oxidative damage. Studies have shown that depletion of glutathione is a contributing factor in PD, which is the rationale for the use of NAC. It is expected to increase brain levels of glutathione, reduce oxidative damage and protect against dopaminergic cell death.
NAC for PCOS and recurrent pregnancy loss - Oxidative stress and PCOS are considered to be contributory factors in recurrent pregnancy loss and NAC has been used as an antioxidant and also to improve the action of insulin. In PCOS it has been shown to reduce insulin levels and increase sensitivity. In women suffering with recurrent pregnancy loss it has been trialled in combination with folic acid resulting in increase in the "take home baby rate".
NAC is well know to have a strong, unpleasant taste and odour, so we often compound it into capsules. The doses used may be quite high and we can put about 600mg in one capsule, so the patient may need to take up to 4 capsules per day. This may be a better option for the patient than taking it in powder form.
As always please call or email me if you would like more information about NAC or to discuss any compounding questions that you have.