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N-acetylcysteine for COVID-19
24 studies from 257 scientists
26,243 patients in 12 countries
Statistically significant lower risk for mortality, hospitalization, and cases.
11 studies from 11 independent teams in 8 countries show statistically significant improvements.
COVID-19 N-acetylcysteine studies. Feb 2024. c19early.org
0 0.5 1 1.5+ All studies 25% With exclusions 24% Mortality 31% Hospitalization 11% Recovery 41% Cases 26% RCTs 29% RCT mortality 34% Prophylaxis 26% Early 21% Late 27% FavorsN-acetylcysteine Favorscontrol
Recent:
Frasson
Ferreira.
N-acetylcysteine has been officially adopted in 3 countries. Submit updates/corrections.
Feb 20
Covid Analysis N-acetylcysteine for COVID-19: real-time meta analysis of 24 studies
Statistically significant lower risk is seen for mortality, hospitalization, and cases. 11 studies from 11 independent teams in 8 countries show statistically significant improvements. Meta analysis using the most serious outcome reported..
Feb 1
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-..
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 and severity 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
10% lower mortality (p=0.67). 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.
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.
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
26% 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.
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