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N-acetylcysteine for COVID-19
26 studies with >20,000 patients
Serious outcome risk
N-acetylcysteine
Control
Significantly lower risk for mortality, hospitalization, progression, recovery, and cases.
13 studies from 13 independent teams in 10 countries show significant benefit.
COVID-19 N-acetylcysteine studies · October 2026
N-acetylcysteine was adopted in 3 countries. Recent:
Jin
Stranieri.
Covid Analysis N-acetylcysteine reduces COVID-19 risk: real-time meta-analysis of 26 studies (Version 4)
Significantly lower risk is seen for mortality, hospitalization, progression, recovery, and cases. 13 studies from 13 independent teams in 10 countries show significant benefit. Meta-analysis using the most serious outcome reported shows..
Jun 27
 Jin et al., Journal of International Medical Research, doi:10.1177/03000605261463447 Therapeutic effect of N-acetylcysteine in severe or critical coronavirus disease 2019 pneumonia: A retrospective cohort study
59% lower mortality (p=0.17), 12% improvement (p=0.76), and 71% lower progression (p=0.01). PSM retrospective 176 hospitalized patients with severe or critical COVID-19 pneumonia showing a possible reduction in the composite endpoint of mortality or disease progression during hospitalization with oral N-acetylcysteine (NAC, 0.2g..
Feb 28
 Stranieri et al., Antioxidants, doi:10.3390/antiox15030307 Decreased Plasma Concentration of Hydrogen Sulfide in Hospitalized COVID-19 Patients: A Novel Determinant of Mortality?
Retrospective 80 hospitalized COVID-19 patients (40 survivors, 40 non-survivors) and 40 non-COVID-19 controls showing that lower plasma hydrogen sulfide (H2S) levels at admission were significantly associated with in-hospital mortality. I..
Dec 2
2025
 Nghĩa et al., Tạp chí Y học Cộng đồng, doi:10.52163/yhc.v66iCD22.3875 Study on the effectiveness of molnupiravir regimen combined with n-acetyl cysteine and recourse of respiratory function in patients with mild-moderate COVID-19
19% improved recovery (p<0.0001). Retrospective 140 mild to moderate COVID-19 outpatients showing shorter treatment duration and improved symptom resolution with the addition of N-acetylcysteine and respiratory rehabilitation versus molnupiravir alone. The combination gro..
Jul 29
2025
 Kow et al., Inflammopharmacology, doi:10.1007/s10787-025-01876-x Effect of N-Acetylcysteine on mortality in COVID-19 patients: A systematic review and meta-analysis of randomized controlled trials
51% lower mortality (p=0.03). Meta analysis of 10 RCTs with 1,424 patients, showing significantly lower mortality with N-acetylcysteine.
Jul 22
2025
 Gong et al., BMC Pulmonary Medicine, doi:10.1186/s12890-025-03824-5 Efficacy and safety of combined nebulization of unfractionated heparin, acetylcysteine, budesonide and ipratropium bromide in hospitalised patients with COVID-19 pneumonia: a randomized controlled clinical trial
RCT 74 hospitalized COVID-19 pneumonia patients showing improved lung lesion absorption and oxygenation with combined nebulization of unfractionated heparin, acetylcysteine, budesonide, and ipratropium bromide. The treatment group demonst..
Apr 7
2025
 Reis et al., Scientific Reports, doi:10.1038/s41598-025-92242-y Antiviral effect of Bromelain combined with acetylcysteine against SARS-CoV-2 Omicron variant
In vitro and ex vivo study showing that BromAc (bromelain and N-acetylcysteine) exhibits antiviral activity against SARS-CoV-2 Omicron variant. Authors demonstrate that BromAc at 250 μg/mL significantly reduces infectious viral particles ..
Jan 16
2025
 Sanduzzi Zamparelli et al., Life, doi:10.3390/life15010113 Immune-Boosting and Antiviral Effects of Antioxidants in COVID-19 Pneumonia: A Therapeutic Perspective
Review of immune-boosting and antiviral effects of antioxidants in COVID-19 pneumonia. Authors provide an overview of the literature on the use of antioxidants, including vitamins, trace elements, ozone, glutathione, L-carnitine, melatoni..
Nov 8
2024
 Xie et al., Cellular & Molecular Biology Letters, doi:10.1186/s11658-024-00659-6 The role of reactive oxygen species in severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection-induced cell death
Review of the effects of reactive oxygen species (ROS) on cell death pathways in SARS-CoV-2 infection. SARS-CoV-2 induces oxidative stress and ROS generation which can lead to several types of regulated cell death including NETosis, ferro..
Aug 11
2024
 Van Tin et al., Cells, doi:10.3390/cells13161331 Spike Protein of SARS-CoV-2 Activates Cardiac Fibrogenesis through NLRP3 Inflammasomes and NF-κB Signaling
In vitro study showing that the SARS-CoV-2 spike protein can activate cardiac fibroblasts through ACE2-dependent mechanisms, leading to cardiac fibrosis via the NLRP3 inflammasome and NF-κB signaling pathways. The results suggest that COV..
Jul 1
2024
 Chaopreecha et al., Phytomedicine, doi:10.1016/j.phymed.2024.156279 (date from preprint) Andrographolide attenuates SARS-CoV-2 infection via an up-regulation of glutamate-cysteine ligase catalytic subunit (GCLC)
In vitro study showing andrographolide attenuates infection of SARS-CoV-2 wildtype and omicron variants in human lung epithelial cells and monkey kidney cells. Proteomic analysis revealed andrographolide induces expression of the glutathi..
Jun 1
2024
 Abdelmonem et al., QJM: An International Journal of Medicine, doi:10.1093/qjmed/hcae070.076 Safety and Efficacy of N-Acetylcysteine as an Adjuvant Therapy in Critically Ill COVID-19 Patients
Retrospective 80 ICU patients reporting no statistically significant differences with NAC treatment, however the actual results are not provided. The study is described as a retrospective observational study however authors also state tha..
Apr 16
2024
 Agamah et al., ScienceOpen, doi:10.58647/DRUGARXIV.PR000010.v1 Network-based multi-omics-disease-drug associations reveal drug repurposing candidates for COVID-19 disease phases
In silico study identifying potential drugs beneficial for COVID-19 by integrating transcriptomics, proteomics, metabolomics, lipidomics, and drug data. Authors explore interactions between drugs, molecular features, and disease severity...
Apr 6
2024
 Hashemian et al., Journal of Comprehensive Pediatrics, doi:10.5812/jcp-139612 Efficacy of N‑Acetylcysteine in Children with Moderate COVID-19: A Placebo-Controlled Randomized Clinical Trial
44% shorter hospitalization (p=0.008). RCT 58 hospitalized children with moderate COVID-19 showing shorter hospitalization and improved oxygen saturation with N-acetylcysteine treatment. However, baseline oxygen values are inconsistent with the reported inclusion criteria - th..
Feb 1
2024
 Frasson et al., Journal of Molecular Cell Biology. doi:10.1093/jmcb/mjae004 Identification of druggable host dependency factors shared by multiple SARS-CoV-2 variants of concern
In vitro study showing that inhibition of host cell factors rather than viral elements may prevent emergence of SARS-CoV-2 variants resistant to current drugs. Authors identified host genes/proteins commonly required for infection by majo..
Dec 13
2023
 Ferreira et al., Frontiers in Immunology, doi:10.3389/fimmu.2023.1308477 Taming the SARS-CoV-2-mediated proinflammatory response with BromAc®
In vitro study of peripheral blood cells from 9 healthy donors showing reduced proinflammatory cytokines, growth factors, and regulatory cytokines; decreased neutrophils and monocytes; and increased HLA-DR expression on monocytes with Bro..
Nov 20
2023
 Atefi et al., Immunity, Inflammation and Disease, doi:10.1002/iid3.1083 Evaluation of the efficacy and safety of oral N‐acetylcysteine in patients with COVID‐19 receiving the routine antiviral and hydroxychloroquine protocol: A randomized controlled clinical trial
67% lower mortality (p=0.61). RCT 60 hospitalized COVID-19 patients evaluating the efficacy and safety of adding oral N-acetylcysteine (NAC) at 600mg three times daily to standard antiviral treatment regimens. The NAC group showed significantly greater reduction in C-..
Oct 4
2023
 Abbasi et al., International Journal of Medical Laboratory, doi:10.18502/ijml.v10i3.13746 The Effects of Vitamin D3 and N-Acetylcysteine Administration in Patients with COVID-19 Hospitalization in the Iranian Population
RCT 100 hospitalized patients reporting shorter hospitalization with vitamin D + N-acetylcysteine. However, day 28 SaO2 is not consistent with the reported recovery values. For three arms the day 28 values are worse than the baseline valu..
Sep 20
2023
 Yuan et al., Signal Transduction and Targeted Therapy, doi:10.1038/s41392-023-01580-8 The role of cell death in SARS-CoV-2 infection
Review of cell death pathways in SARS-CoV-2 infection. Authors note that N-acetylcysteine (NAC) is a precursor to glutathione that may inhibit ferroptosis. Ferroptosis is a regulated cell death triggered by oxidative stress that has been ..
Jul 21
2023
 Galindo-Andúgar et al., Revista Clínica Española, doi:10.1016/j.rceng.2023.07.006 Impact of N-Acetylcysteine in the mortality of patients hospitalized with COVID-19: a retrospective cohort study
43% lower mortality (p=0.05). Retrospective 378 hospitalized patients in Spain, showing lower mortality with N-acetylcysteine treatment.
Jun 30
2023
 Alam et al., Journal of Advanced Veterinary and Animal Research, doi:10.5455/javar.2023.j665 N-acetylcysteine reduces severity and mortality in COVID-19 patients: A systematic review and meta-analysis
35% lower mortality (p<0.0001). Systematic review and meta analysis showing lower mortality with N-acetylcysteine treatment.
Jun 1
2023
 Sherkawy et al., Archives of Pharmaceutical Sciences Ain Shams University, doi:10.21608/aps.2023.212265.1122 Impact of N-Acetylcysteine on Modulating Inflammation in Patients Hospitalized with Moderate COVID-19 Infections: A Prospective Randomized Trial
15% lower need for oxygen therapy (p=0.6) and 12% shorter hospitalization (p=0.45). RCT 60 hospitalized patients showing that oral N-acetylcysteine (NAC) at 1800mg daily significantly decreased plasma TNF-α levels and increased glutathione peroxidase levels. The NAC group had a shorter duration of oxygen support, while t..
Jun 1
2023
 Afaghi et al., Caspian J Intern Med, doi:10.22088/cjim.14.3.553 N-acetylcysteine as adjuvant therapy for hospitalized Covid-19 patients: A single-center prospective cohort study
29% lower mortality (p=0.42), 41% lower ventilation (p=0.16), 20% lower ICU admission (p=0.36), and 14% shorter hospitalization (p=0.002). Prospective study of 217 patients treated with NAC and 245 matched controls, showing improved recovery with treatment. 1500mg intravenous NAC daily.
May 19
2023
 Prabowo et al., Narra J, doi:10.52225/narra.v3i2.121 The role of N-acetylcysteine in decreasing neutrophil-lymphocyte ratio in COVID-19 patients: A double-blind, randomized controlled trial
RCT 40 moderate/severe COVID-19 patients in Indonesia, showing significantly lower NLR with N-acetylcysteine treatment.
May 8
2023
 Gamarra-Morales et al., Nutrients, doi:10.3390/nu15092235 Response to Intravenous N-Acetylcysteine Supplementation in Critically Ill Patients with COVID-19
16% lower mortality (p=0.49). RCT 140 ICU patients in Spain, 72 treated with N-acetylcysteine (NAC). NAC patients showed improved PaO2/FiO2, CRP, D-dimer, and LDH, and there were associations between glutathione and clinical outcomes and severity biomarkers in NAC-tre..
Apr 14
2023
 Soto et al., Pharmaceuticals, doi:10.3390/ph16040591 N-Acetyl Cysteine Restores the Diminished Activity of the Antioxidant Enzymatic System Caused by SARS-CoV-2 Infection: Preliminary Findings
Prospective analysis of 16 COVID-19 patients treated with NAC and 20 healthy controls, showing that NAC may help restore diminished activity of the antioxidant enzymatic system in patients with COVID-19.
Mar 15
2023
 Schloss et al., Inflammopharmacology, doi:10.1007/s10787-023-01183-3 Nutritional deficiencies that may predispose to long COVID
Review of 22 nutritional factors that have been linked to COVID-19 outcomes, the role of nutrients in COVID-19 infection, and the prevalence of multiple nutritional deficiencies in the population.
Feb 13
2023
 Karimi et al., Advances in Animal and Veterinary Sciences, doi:10.17582/journal.aavs/2023/11.3.404.409 The Potential of Melatonin and N-Acetylcysteine on Remdesivir Induced Liver Injury in Covid 19 Patients
RCT 70 hospitalized COVID-19 patients evaluating the effects of N-acetylcysteine (NAC) and melatonin on liver injury induced by remdesivir treatment. NAC 600mg twice daily and melatonin 6mg daily. All patients received remdesivir. Liver e..
Jan 3
2023
 Ghayour et al., Research Square, doi:10.21203/rs.3.rs-2309373/v2 Evaluation of the recovery rate and prevention of hospitalization among covid-19 outpatients: a randomized clinical trial comparing N-acetylcysteine with Bromhexine
93% lower mortality (p=0.01), 78% lower hospitalization (p<0.0001), and 16% faster recovery (p=0.02). RCT 225 outpatients in Iran showing lower mortality and hospitalization, and faster recovery with N-acetylcysteine and bromhexine. Baseline information per group is not provided, Figure 1 has the control group hospitalization status switc..
Dec 19
2022
 Panahi et al., Journal of Medical Virology, doi:10.1002/jmv.28393 Evaluation the efficacy and safety of N‐acetylcysteine inhalation spray in controlling the symptoms of patients with COVID‐19: An open‐label randomized controlled clinical trial
92% lower mortality (p<0.0001), 36% lower ICU admission (p=0.38), and 1% shorter hospitalization (p=0.81). RCT 250 hospitalized COVID-19 patients showing reduced mortality rate and inflammatory markers with N-acetylcysteine (NAC) 400μg inhaled spray twice daily for 7 days as adjunctive treatment. There was no significant difference in hospital..
Oct 25
2022
 Çavuş et al., Aksaray Üniversitesi Tıp Bilimleri Dergisi, 3:2 Kritik COVID-19 hastalarında kullanılan N-asetilsisteinin(NAC) klinik bulgulara, inflamatuar parametrelere böbrek fonksiyonlarına olan etkileri
13% higher mortality (p=0.47), 20% higher ventilation (p=0.25), 12% shorter ICU admission (p=0.58), and 13% shorter hospitalization (p=0.09). Retrospective 190 critical COVID-19 patients in Turkey, showing no significant differences with N-acetylcysteine treatment in unadjusted results with no baseline details. NAC 2400mg/day.
Oct 21
2022
 La Maestra et al., Cells, doi:10.3390/cells11203313 Inhibition of the Cell Uptake of Delta and Omicron SARS-CoV-2 Pseudoviruses by N-Acetylcysteine Irrespective of the Oxidoreductive Environment
ACE2-HEK293 in vitro study showing dose-dependent inhibition of the uptake of delta and omicron SARS-CoV-2 pseudoviruses with N-acetylcysteine.
Oct 8
2022
 Rahimi et al., Jundishapur Journal of Natural Pharmaceutical Products, doi:10.5812/jjnpp-129817 Efficacy of N-acetyl Cysteine in Severe COVID-19 Patients: A Randomized Controlled Phase III Clinical Trial
33% lower mortality (p=0.19) and 8% shorter hospitalization (p=0.63). RCT 40 ICU patients in Iran, showing lower mortality with NAC treatment, without statistical significance. Single dose intravenous NAC 300 mg/kg.
Jun 20
2022
 Mousapour et al., Gastroenterology and Hepatology from Bed to Bench, doi:10.22037/ghfbb.v15i3.2565 Efficacy and Safety of Acetylcysteine for the Prevention of Liver Injury in Covid-19 Intensive Care Unit Patients Under Treatment with Remdesivir: A Double-Blind, Placebo-Controlled Randomized Clinical Trial: Prevention of liver injury in severe Covid-19 pneumonia
2% lower mortality (p=1), 27% lower ventilation (p=0.57), 6% greater improvement (p=0.82), and 5% higher hospital discharge (p=0.8). RCT 83 severe COVID-19 pnuemonia patients in Iran, 42 treated with acetylcysteine, showing no significant difference in clinical outcomes. All patients received remdesivir, famotidine, and vitamin C. More patients were at baseline categor..
May 31
2022
 Fariña-González et al., Journal of Intensive Care Medicine, doi:10.1177/08850666221105423 Hourly Analysis of Mechanical Ventilation Parameters in Critically Ill Adult Covid-19 Patients: Association with Mortality
39% lower mortality (p=0.08). Retrospective 140 mechanically ventilated patients in Spain, showing lower mortality with acetylcysteine treatment in unadjusted results, not reaching statistical significance.
May 28
2022
 Delić et al., Microorganisms, doi:10.3390/microorganisms10061118 Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial
14% lower mortality (p=0.37). RCT mechanically ventilated patients in Croatia, 39 treated with N-acetylcysteine and 52 control patients, showing no significant difference in mortality with treatment. Treated patients showed a lower incidence of gram-positive or MRSA-c..
Jan 27
2022
 Izquierdo et al., Science Progress, doi:10.1177/00368504221074574 Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19
26% lower mortality (p=0.0007). Retrospective 19,208 COVID+ hospitalized patients in Spain, 2,071 treated with high dose NAC, showing lower mortality with treatment. In multivariable analysis, authors adjust for corticosteroids, but do not adjust for HCQ use which was a..
Jan 21
2022
 Goc et al., European Journal of Microbiology and Immunology, doi:10.1556/1886.2021.00022 Inhibitory effects of specific combination of natural compounds against SARS-CoV-2 and its Alpha, Beta, Gamma, Delta, Kappa, and Mu variants
In vitro study testing combinations of plant extracts and micronutrients with several variants of SARS-CoV-2. A combination of vitamin C, N-acetylcysteine, curcumin, quercetin, resveratrol, theaflavin, naringenin, baicalin, and broccoli e..
Dec 27
2021
 Ramadhan et al., Indonesian Journal of Tropical and Infectious Disease, 9:3 The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In COVID-19 Patients
135% higher mortality (p=0.68). Prospective study with 75 NAC patients and 16 control patients, showing no significant difference in mortality.
Dec 2
2021
 Faverio et al., ERJ Open Research, doi:10.1183/23120541.00542-2021 Impact of N-acetyl-l-cysteine on SARS-CoV-2 pneumonia and its sequelae: results from a large cohort study
19% higher mortality (p=0.33), 34% higher ICU admission (p=0.08), and 1% higher hospital discharge (p=0.94). Retrospective 1,083 consecutive hospitalized COVID patients in Italy, showing no significant differences with NAC treatment. The number of patients transferred to another facility exceeds the number of deaths, which may significantly affe..
Nov 10
2021
 Ignatova et al., Russian Medical Inquiry, doi:10.32364/2587-6821-2021-5-7-473-478 Therapeutic possibilities of using an expectorant mucolytic agent with antioxidant properties in COVID-19 infection
20% shorter hospitalization (p=0.05). Retrospective 111 patients with moderate COVID-19 pneumonia, 56 treated with NAC, showing shorter hospitalization time with treatment. NAC 1200mg daily intravenous, divided into two doses.
Jul 9
2021
 Avdeev et al., Journal of Infection, doi:10.1016/j.jinf.2021.07.003 N-acetylcysteine for the treatment of COVID-19 among hospitalized patients
69% lower mortality (p=0.34), 77% lower ventilation (p=0.18), 77% lower ICU admission (p=0.18), and 15% shorter hospitalization (p=0.01). Prospective study of 24 hospitalized COVID-19 patients in Russia treated with NAC, and 22 matched controls, showing significantly improved SpO2/FiO2, and significantly shorter hospitalization with treatment.
Jun 29
2021
 Assimakopoulos et al., Infectious Diseases, doi:10.1080/23744235.2021.1945675 N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study
97% lower mortality (p=0.006). Retrospective 42 hospitalized PCR+ COVID-19 pneumonia patients treated with NAC, and a matched control group of 40 patients, showing significantly lower severe respiratory failure and significantly lower mortality with treatment. NAC 600 ..
Jun 28
2021
 Altay et al., Advanced Science, doi:10.1002/advs.202101222 Combined Metabolic Activators Accelerates Recovery in Mild-to-Moderate COVID-19
80% lower hospitalization (p=0.25) and 83% improved recovery (p<0.0001). RCT 304 low-risk outpatients, 229 treated with N-acetylcysteine, l-carnitine tartrate, nicotinamide riboside chloride, and serine, showing significantly faster recovery with treatment. Plasma levels of proteins and metabolites associated ..
Jun 10
2021
 Taher et al., Pharmacological Reports, doi:10.1007/s43440-021-00296-2 A pilot study on intravenous N-Acetylcysteine treatment in patients with mild-to-moderate COVID19-associated acute respiratory distress syndrome
18% lower mortality (p=0.65), 14% lower ventilation (p=0.67), 20% shorter ICU admission (p=0.48), and 33% shorter hospitalization (p=0.31). RCT 92 hospitalized patients, 47 treated with NAC, showing non-significant improvements in outcomes. IRCT20120215009014N355. NAC 40mg/kg/day intravenous for 3 days.
May 26
2021
 Pourhoseingholi et al., Research Square, doi:10.21203/rs.3.rs-365321/v2 Case Characteristics, Clinical Data, And Outcomes of Hospitalized COVID-19 Patients In Qom Province, Iran: A Prospective Cohort Study
11% lower mortality (p=0.43). Prospective study of 2,468 hospitalized COVID-19 patients in Iran, showing no significant difference with NAC treatment. IR.MUQ.REC.1399.013.
May 23
2021
 Pellegrini et al., Gastroenterology, doi:10.1016/S0016-5085(21)02756-6 A Retrospective Analysis of Outcomes Amongst COVID-19 Infected Patients with Acute Hepatitis Receiving N-Acetylcysteine Therapy in a Safety Net Hospital
52% lower mortality (p=0.0001). Retrospective 864 hospitalized late stage COVID-19 patients in the USA, 138 receiving NAC treatment for acute hepatitis, showing lower mortality with treatment. Results are adjusted for confounders, however details are not provided.
Apr 20
2021
 Hashemi et al., Journal of Biomolecular Structure and Dynamics, doi:10.1080/07391102.2021.1910570 The in silico mechanism of hVKOR interaction with acetaminophen and its metabolite, as well as N-acetyl cysteine: caution on application in COVID-19 patients
In silico study suggesting increased risk of cerebral hemorrhage with acetaminophen use for COVID-19. Authors show acetaminophen metabolite N-acetyl-p-benzoquinone imine (NAPQI), and to a lesser extent N-acetylcysteine (NAC), bind to hum..
Mar 6
2021
 Akhter et al., Viruses, doi:10.3390/v13030425 The Combination of Bromelain and Acetylcysteine (BromAc) Synergistically Inactivates SARS-CoV-2
In vitro study showing dose dependent inactivation of SARS-CoV-2 with the combination of bromelain and acetylcysteine.
Feb 19
2021
 Gaynitdinova et al., Pulmonologiya, doi:10.18093/0869-0189-2021-31-1-21-29 N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia
15% shorter hospitalization (p=0.001) and 51% improved recovery (p=0.001). RCT 46 hospitalized patients with moderate COVID-19 pneumonia, 24 treated with N-acetylcysteine, showing significantly shorter hospitalization with treatment. NAC 1,200 - 1,500mg/day intravenously.
Nov 30
2020
 Shi et al., Therapeutics and Clinical Risk Management, doi:10.2147/TCRM.S273700 N-Acetylcysteine to Combat COVID-19: An Evidence Review
Review of N-acetylcysteine (NAC) as a potential treatment for COVID-19. Authors propose that NAC's antioxidant, anti-inflammatory, and immune-modulating properties could benefit COVID-19 patients by suppressing neutrophil activation, redu..
Sep 23
2020
 de Alencar et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1443 Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19)
3% higher mortality (p=0.94), 16% higher ventilation (p=0.64), 9% lower ICU admission (p=0.65), and 10% longer hospitalization (p=0.87). RCT 135 severe stage patients in Brazil, showing no significant differences. NAC 21g (~300mg/kg) for 20 hours. U1111-1250-356 [ensaiosclinicos.gov.br].
May 4
2020
 Huh et al., medRxiv, doi:10.1101/2020.05.04.20089904 Association of previous medications with the risk of COVID-19: a nationwide claims-based study from South Korea
28% fewer cases (p<0.0001). Retrospective database analysis of 65,149 in South Korea, showing significantly lower cases with existing N-acetylcysteine treatment. The journal version of this paper does not present the N-acetylcysteine results.
Aug 15
2017
 Martinez de Lizarrondo et al., Circulation, doi:10.1161/CIRCULATIONAHA.117.027290 Potent Thrombolytic Effect of N-Acetylcysteine on Arterial Thrombi
Experimental study in mice showing potent thrombolytic effects with N-acetylcysteine (NAC) in arterial thrombosis models. Authors hypothesize that NAC's thrombolytic mechanism involves destabilizing the VWF-dependent outer portion of thro..
Feb 1
2011
 Chen et al., Journal of Clinical Investigation, doi:10.1172/JCI41062 N-acetylcysteine reduces the size and activity of von Willebrand factor in human plasma and mice
Experimental study using purified human vWF, human plasma, and wild-type/ADAMTS13-deficient mice showing that N-acetylcysteine (NAC) reduces von Willebrand factor multimer size and activity.
Jul 1
1997
 De Flora et al., European Respiratory Journal, doi:10.1183/09031936.97.10071535 Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment
RCT 262 elderly and/or chronic disease patients in Italy showing significantly reduced frequency and severity of influenza-like episodes with 600mg N-acetylcysteine twice daily for 6 months. Seroconversion to influenza A/H1N1 was similar ..