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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Mortality 92% Inhaled Improvement Relative Risk ICU admission 36% Inhaled Hospitalization time 1% Inhaled N-acetylcysteine  Panahi et al.  LATE TREATMENT  RCT Is late treatment with N-acetylcysteine beneficial for COVID-19? RCT 250 patients in Iran (May - August 2021) Lower mortality with N-acetylcysteine (p<0.000001) Panahi et al., J. Medical Virology, Dec 2022 Favors N-acetylcysteine Favors control

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

Panahi et al., Journal of Medical Virology, doi:10.1002/jmv.28393, IRCT20080901001165N55
Dec 2022  
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14th treatment shown to reduce risk in February 2021
*, now known with p = 0.000034 from 24 studies, recognized in 3 countries.
Lower risk for mortality, hospitalization, and cases.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
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 length of stay or ICU admission. The NAC group was older on average, while the control group had significantly lower SpO2 at baseline. 400 μg/day NAC inhaler spray for 7 days.
Targeted administration to the respiratory tract provides treatment directly to the typical source of initial SARS-CoV-2 infection and replication, and allows for rapid onset of action, higher local drug concentration, and reduced systemic side effects (early treatment may be more beneficial).
This study is excluded in the after exclusion results of meta analysis: large difference in mortality vs. ICU results, significant baseline differences.
risk of death, 91.8% lower, RR 0.08, p < 0.001, treatment 4 of 125 (3.2%), control 49 of 125 (39.2%), NNT 2.8, Inhaled.
risk of ICU admission, 35.7% lower, RR 0.64, p = 0.38, treatment 9 of 125 (7.2%), control 14 of 125 (11.2%), NNT 25, Inhaled.
hospitalization time, 0.8% lower, relative time 0.99, p = 0.81, treatment 125, control 125, Inhaled.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Panahi et al., 19 Dec 2022, Randomized Controlled Trial, Iran, peer-reviewed, 7 authors, study period May 2021 - August 2021, trial IRCT20080901001165N55. Contact:,
This PaperN-acetylcys..All
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
Yunes Panahi, Mostafa Ghanei, Morteza Rahimi, Abbas Samim, Amir Vahedian‐azimi, Stephen L Atkin, Amirhossein Sahebkar
Journal of Medical Virology, doi:10.1002/jmv.28393
The aim of this study was to evaluate the effect and safety of N-acetylcysteine (NAC) inhalation spray in the treatment of patients with coronavirus disease 2019 (COVID-19). This randomized controlled clinical trial study was conducted on patients with COVID-19. Eligible patients (n = 250) were randomly allocated into the intervention group (routine treatment + NAC inhaler spray one puff per 12 h, for 7 days) or the control group who received routine treatment alone. Clinical features, hemodynamic, hematological, biochemical parameters and patient outcomes were assessed and compared before and after treatment. The mortality rate was significantly higher in the control group than in the intervention group (39.2% vs. 3.2%, p < 0.001). Significant differences were found between the two groups (intervention and control, respectively) for white blood cell count (6.2 vs. 7.8, p < 0.001), hemoglobin (12.3 vs. 13.3, p = 0.002), C-reactive protein (CRP: 6 vs. 11.5, p < 0.0001) and aspartate aminotransferase (AST: 32 vs. 25.5, p < 0.0001). No differences were seen for hospital length of stay (11.98 ± 3.61 vs. 11.81 ± 3.52, p = 0.814) or the requirement for intensive care unit (ICU) admission (7.2% vs. 11.2%, p = 0.274). NAC was beneficial in reducing the mortality rate in patients with COVID-19 and inflammatory parameters, and a reduction in the development of severe respiratory failure; however, it did not affect the length of hospital stay or the need for ICU admission. Data on the effectiveness of NAC for Severe Acute Respiratory Syndrome Coronavirus-2 is limited and further research is required.
administration of NAC, and no information was available on its inhalation. Until now, inhalation administration of NAC has generally been associated with mucolytic activity, in contrast to oral administration of NAC, which is mainly associated with antioxidant activity. This molecule, as well as other thiol derivatives, acts primarily on the lower respiratory tract to loosen mucus, as the main target of the drug is mucin. However, some studies have shown that inhaled NAC is also effective on oxidative stress and that patients with higher oxidative stress may be good responders to inhaled NAC therapy, as the glutathione replenished by inhaled NAC can reverse the oxidant-antioxidant imbalance. 37, 42 In accord with the current study, a multi-center, prospective cohort study by Assimakopoulos et al. 43 in 2021 was conducted on hospitalized patients with moderate or severe COVID-19: patients who received standard of care were compared with patients who additionally received oral NAC (600 mg) for 14 days. The results showed that oral NAC administration (1200 mg/day) in patients with COVID-19 pneumonia reduces the risk for mechanical ventilation (MV) and 14-day and 28-day mortality. In addition, NAC improved the PO 2 /FiO 2 ratio over time and decreased WBC, CRP, D-dimer and lactic acid dehydrogenase (LDH) levels. A randomized study by Gaynitdinova et al. 44 invasive MV use between the intervention and control groups. 46 In addition, a double-blind, placebo-controlled,..
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Late treatment
is less effective
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