sterile N-Acetylcysteine / Generic mfg. - LARVOL DELTA

The management and clinical outcome of paracetamol poisoning in South African adults: A single-centre retrospective review. (PubMed, S Afr Med J) - "A high case fatality rate was observed in the studied population. Early identification of at-risk individuals and prompt initiation of NAC can reduce poor outcomes. Larger multicentre studies are needed to identify independent predictors of paracetamol-induced hepatoxicity and mortality in Africa."

Clinical data • Journal • Retrospective data • Acute Kidney Injury • Addiction (Opioid and Alcohol) • Hepatology • Human Immunodeficiency Virus • Infectious Disease • Liver Failure • Nephrology • Renal Disease

Mercury poisoning in a patient with thrombotic events: A case report. (PubMed, Radiol Case Rep) - "Chelation therapy with the available agent in our setting was initiated, along with intravenous N-acetylcysteine. Selenium was not administered due to its unavailability. Mercury intoxication poses a diagnostic challenge due to its nonspecific clinical manifestations, which may be attributed to more prevalent pathologies in the region."

Journal • Alzheimer's Disease • Cardiovascular • Cognitive Disorders • Hematological Disorders • Nephrology • Renal Disease

Evaluation of the Efficacy of Fomepizole in the Treatment of Acetaminophen Overdose (clinicaltrials.gov) - P2 | N=29 | Terminated | Sponsor: Richard Dart, MD, PhD | Recruiting ➔ Terminated; Futility

Trial termination • Hepatology • Liver Failure

Beyond the dose: unmasking 'therapeutic' paracetamol toxicity in a chronic alcohol user with severe acidosis-a case report. (PubMed, AME Case Rep) - "Intravenous N-acetylcysteine (NAC) was started, but the patient deteriorated rapidly and succumbed on day 2. The findings underscore the call for more nuanced guidelines and further research to determine appropriate dose thresholds and monitoring strategies for alcohol-dependent individuals. By harmonising these divergent clinical stances, patient safety can be enhanced through tailored, vigilant practice."

Journal • Addiction (Opioid and Alcohol) • Cardiovascular • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Liver Failure • Metabolic Disorders • Pain • Pulmonary Disease • Transplantation

The Perfect Storm: Aspirin-Induced Liver Injury in Epstein-Barr Virus Mononucleosis Complicated by Cold Agglutinin Hemolytic Anemia (ACG 2025) - "Due to initial diagnostic uncertainty and significant transaminase elevation, she was empirically treated with intravenous N-acetylcysteine. Repeat laboratory testing showed resolved anemia and near normal liver function tests. This complex case highlights a unique presentation of severe liver injury suspected to be triggered by aspirin in the setting of acute EBV infection complicated by cold agglutinin hemolysis. While Reye syndrome is a well-recognized clinical entity involving liver injury in children given aspirin for viral illness, this case suggests that young adults may also experience idiosyncratic liver toxicity in this setting, particularly in the immunologically active milieu of acute EBV infection.Figure: Table 1: Relevant laboratory values at specific timepoints following day of aspirin intake"

Anemia • Autoimmune Hemolytic Anemia • Epstein-Barr Virus Infections • Hematological Disorders • Hepatology • Infectious Disease • Inflammation • Liver Failure • HP

When 'Healthy' Turns Harmful: Mushroom Coffee-Induced Acute Hepatitis (ACG 2025) - "MRCP demonstrated hepatic steatosis without masses or biliary obstruction.Given a high suspicion for toxin-induced liver injury, intravenous N-acetylcysteine for 72 hours and supportive care were initiated. This case highlights the potential risk of acute liver injury associated with Reishi mushroom ingestion and underscores the importance of considering supplement use in the evaluation of unexplained hepatitis. Discontinuation of the supplement led to clinical and biochemical recovery."

Clinical • ADHD (Impulsive Aggression) • Anorexia • Attention Deficit Hyperactivity Disorder • Bipolar Disorder • CNS Disorders • Diabetes • Gastroenterology • Gastrointestinal Disorder • Hepatology • Infectious Disease • Inflammation • Liver Failure • Metabolic Disorders • Psychiatry • Substance Abuse

Leptospirosis in Disguise: A Case of Cholestatic Jaundice and Multiorgan Involvement Without Classic Risk Factors (ACG 2025) - "Given a rising bilirubin and elevated INR, acute liver failure was considered, and the patient was started on intravenous N-acetylcysteine (NAC) while undergoing serial INR monitoring every 6–12 hours. Empiric doxycycline was initiated early and resulted in marked clinical improvement. This case underscores the importance of considering leptospirosis in the differential diagnosis of unexplained multiorgan dysfunction, even in the absence of classic epidemiologic risk factors. Prompt recognition and empiric treatment can be lifesaving in patients presenting with severe manifestations of this rare infection."

Clinical • Acute Kidney Injury • Atrial Fibrillation • Cardiovascular • Cholestasis • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Musculoskeletal Pain • Myositis • Nephrology • Renal Disease

Host Immunomodulatory Interventions in Severe Influenza. (PubMed, J Infect Dis) - "The World Health Organization conditionally advises against the use of systemic corticosteroids, macrolides, plasma therapy, mechanistic target of rapamycin inhibitors, and nonsteroidal anti-inflammatory drugs for such patients...An open-label randomized controlled trial (RCT) found that a triple combination of oseltamivir, clarithromycin, and naproxen improved outcomes in severe influenza...In contrast, adding macrolides or nitazoxanide has not consistently improved clinical outcomes. Promising evidence exists for anti-C5a antibodies in COVID-19, while case reports hint that intravenous N-acetylcysteine may benefit severe influenza pneumonia...Mycophenolic acid, pamidronate, and peroxisome proliferator-activated receptor gamma agonists are low priorities due to toxicity concerns...Treatment of severe influenza requires a multidisciplinary approach that integrates antiviral and immunomodulatory strategies. Clarifying these roles may enhance patient outcomes."

Journal • Infectious Disease • Influenza • Novel Coronavirus Disease • Pneumonia • Respiratory Diseases • mTOR

NAC vs Placebo on Opioid Use for Hysterectomy (clinicaltrials.gov) - P3 | N=240 | Recruiting | Sponsor: Medical University of South Carolina | Trial completion date: Oct 2025 ➔ Dec 2026 | Trial primary completion date: Sep 2025 ➔ Nov 2026

Trial completion date • Trial primary completion date • Gynecology

Acute Hepatitis in a Patient Treated With Ribociclib for Metastatic Breast Carcinoma. (PubMed, J Med Cases) - "We describe a case of a postmenopausal woman with newly diagnosed stage IV HR+/HER2-negative invasive lobular carcinoma who developed acute hepatocellular injury 8 weeks after initiating ribociclib and anastrozole...Ribociclib was discontinued and intravenous N-acetylcysteine (NAC) initiated, leading to gradual normalization of liver enzymes...In patients with significant hepatotoxicity, discontinuation of ribociclib and non-rechallenge may be prudent. Furthermore, consideration of NAC in management is important in cases demonstrating persistent transaminitis despite ribociclib discontinuation."

Journal • Breast Cancer • Fatigue • Fibrosis • Hepatology • HER2 Breast Cancer • HER2 Negative Breast Cancer • HER2 Positive Breast Cancer • Hormone Receptor Breast Cancer • Hormone Receptor Positive Breast Cancer • Immunology • Liver Failure • Oncology • Solid Tumor • HER-2

MSNAC: Physiological Effects of N-Acetyl Cysteine in Patients With Multiple Sclerosis (clinicaltrials.gov) - P=N/A | N=55 | Enrolling by invitation | Sponsor: Thomas Jefferson University | Trial completion date: Jan 2025 ➔ Jul 2027 | Trial primary completion date: Jan 2025 ➔ Jul 2027

Trial completion date • Trial primary completion date • CNS Disorders • Multiple Sclerosis

NAC-S: N-ACETYLCYSTEINE FOR THROMBOLYSIS IN ACUTE STROKE (clinicaltrials.gov) - P2 | N=12 | Terminated | Sponsor: University Hospital, Caen | N=19 ➔ 12 | Not yet recruiting ➔ Terminated; lack of patients

Enrollment change • Trial termination • Cardiovascular • Ischemic stroke

PET-MRI in Chronic Traumatic Brain Injury (CTBI) (clinicaltrials.gov) - P=N/A | N=150 | Enrolling by invitation | Sponsor: Thomas Jefferson University | Trial completion date: Feb 2025 ➔ Jul 2027 | Trial primary completion date: Feb 2025 ➔ Jul 2027

Trial completion date • Trial primary completion date • CNS Disorders • Vascular Neurology

FdopaPD2: FDOPA PET and Nutritional Support in Parkinson's Disease (clinicaltrials.gov) - P2 | N=50 | Active, not recruiting | Sponsor: Thomas Jefferson University | Trial completion date: May 2025 ➔ Jan 2027

Trial completion date • CNS Disorders • Movement Disorders • Parkinson's Disease

Cartap Poisoning with Paroxysmal Supraventricular Tachycardia: A Case Report. (PubMed, JNMA J Nepal Med Assoc) - "Treatment included amiodarone for supraventricular tachycardia and intravenous N-acetylcysteine, magnesium sulfate, and midazolam for general tonic clonic seizure. Cartap, toxic through ingestion and skin contact, can cause symptoms such as vomiting, convulsions, and cardiac issues like supraventricular tachycardia. Supportive care is crucial, and awareness of its risks is necessary."

Journal • Cardiovascular • CNS Disorders • Epilepsy • Pain • Pulmonary Disease • Ventricular Tachycardia

A phase 2 trial of short-term intravenous N-acetylcysteine in biliary atresia after Kasai portoenterostomy. (PubMed, Hepatol Commun) - P2 | "This study demonstrates how the two-stage "minimax" trial design can be used to efficiently evaluate potential therapies for BA. Although the primary endpoint was not met, NAC therapy was generally well-tolerated. NAC therapy may prove efficacious in future trials with (i) a less stringent primary endpoint and/or (ii) a longer course of treatment (NCT03499249)."

Journal • P2 data • Hepatology • Transplantation

A Study of N-acetylcysteine in Patients With COVID-19 Infection (clinicaltrials.gov) - P2 | N=48 | Active, not recruiting | Sponsor: Memorial Sloan Kettering Cancer Center | Trial completion date: May 2025 ➔ May 2026 | Trial primary completion date: May 2025 ➔ May 2026

Trial completion date • Trial primary completion date • Infectious Disease • Novel Coronavirus Disease

An Unusual Case of Methemoglobinemia (ATS 2025) - "Toxicology was consulted, and per their recommendation, dapsone was discontinued and he was treated with intravenous (IV) N-acetylcysteine (NAC), ascorbic acid (IV 1g Q6H), and cimetidine (400 mg TID). Our case demonstrates two learning points: First, methemoglobinemia can cause hypoxia even at MetHb levels less than 10% and second, treatment with alternative agents to methylene blue should be considered if G6PD deficiency is suspected."

Clinical • Anemia • Celiac Disease • Dermatitis • Dermatology • Hematological Disorders • Immunology • Metabolic Disorders • Pulmonary Disease • Rare Diseases • HP

Practice Patterns for N-acetylcysteine Dosing for Acetaminophen Toxicity in the United States. (PubMed, Innov Pharm) - "Background: Although the FDA approved acetaminophen toxicity dosing regimen for intravenous n-acetylcysteine (NAC) is a three-bag regimen, alternate regimens have been published which are generally simpler, and decrease errors and adverse effects. The weight for dosing was commonly capped at 100 kg, but some institutions did not use a maximum. Alternative intravenous regimens have been implemented at some institutions with the impetus for change being safety and simplicity."

Journal

Incidence and predictors of linezolid-associated thrombocytopenia in critically Ill patients: nomogram development based on comprehensive screening of over 70 factors. (PubMed, Expert Rev Anti Infect Ther) - "Protective factors were surgery (OR 0.34, p < 0.01), IV N-acetylcysteine (OR 0.12, p < 0.01), oral N-acetylcysteine (OR 0.17, p < 0.01), higher baseline platelets (OR 0.79, p = 0.05), and acetaminophen (OR 0.42, p < 0.01)...Prolonged therapy, solid organ tumors, dialysis, high lactate, and vasopressor use increase risk; high platelet counts, N-acetylcysteine, and IV acetaminophen decrease risk. External validation and prospective trials are warranted."

Journal • Critical care • Hematological Disorders • Oncology • Solid Tumor • Thrombocytopenia

Evaluation of the Effect of N-acetylcysteine in the Prevention of Colistin Nephrotoxicity in Critically Ill Patients: A Randomized Controlled Trial. (PubMed, J Res Pharm Pract) - "It was found that the 28-day mortality rate (P = 0.540) and length of ICU stay (P = 0.699) were not significantly improved by coadministration of intravenous N-acetylcysteine with colistin. There was also no difference in the stages of the RIFLE criteria (P = 0.641), and most patients were in the normal stage (58.3%). Concomitant administration of intravenous NAC at a dose of 2 g daily does not prevent colistin-induced nephrotoxicity, 28-day mortality, and length of ICU stay in critically ill patients."

Clinical • Journal • Acute Kidney Injury • Critical care • Nephrology • Renal Disease • OGA

Acetaminophen in aSAH to Inhibit Lipid Peroxidation and Cerebral Vasospasm (clinicaltrials.gov) - P3 | N=44 | Terminated | Sponsor: Vanderbilt University Medical Center | N=120 ➔ 44

Enrollment change • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Subarachnoid Hemorrhage

DOUBLE JEOPARDY: CEREBRAL EDEMA IN A PREGNANT PATIENT WITH ACETAMINOPHEN OVERDOSE (SCCM 2025) - "She was admitted for management of ALF due to APAP toxicity and started on IV N-acetylcysteine (NAC) therapy. While our patient did not have severe ALF, pregnancy results in physiologic changes in cerebral vascular permeability as seen in disorders such as eclampsia. Cerebral edema may occur with milder degrees of APAP toxicity in pregnancy."

Clinical • Anesthesia • Cardiovascular • CNS Disorders • Hematological Disorders • Hepatology • Liver Failure • Pain • Thrombosis

IV N-ACETYLCYSTEINE FOR NON-ACETAMINOPHEN-INDUCED ACUTE LIVER FAILURE (SCCM 2025) - "It is difficult to conclude whether duration of IV NAC therapy can be guided with liver function tests or if IV NAC improves survival due to the high mortality rate in this study. Prospective trials are needed to determine the utility of IV NAC for NAI-ALF."

CNS Disorders • Hepatology • Liver Failure

A randomized, clinical trial of intravenous N-acetylcysteine as an antioxidant therapy in acute organophosphorus pesticide poisoning. (PubMed, Toxicol Res (Camb)) - "Mortality was lower in the NAC group (2 out of 28) than the standard treatment-only group (5 out of 28) but the difference was not statistically significant. This trial found that NAC improved antioxidant enzyme levels including serum CAT and GPX but did not affect clinically relevant outcomes."

Journal • Critical care • CAT