New Drug _NAC_ Shows Promise in Treatment of Covid-19

In life, we take many things for granted, two of those things being our health and our lungs. Then Covid hit and for some it didn’t change much but for others their health and lungs took the brunt of it and suddenly optimal health and lung health became a thing of the past. 

During this time, many treatments have been tried and tested to help Covid patients regain their health and one that is staying is NAC for Covid-19. 

In this article, we will unpack what NAC is, the benefits of it and how it is being used to treat Covid-19.

First, what is NAC?

NAC also known as N-Acetylcysteine is a supplemental form of cysteine, an amino acid required by our bodies. 

Although you may be hearing about NAC for the first time,  NAC has been around for years and was originally used in the case of acetaminophen overdose. Over time, NAC has been used in many other applications including lung health and to treat mental health disorders such as anxiety and depression (1). 

How does it work?

In the treatment of Covid, NAC has many uses with its main properties being mucolytic, antioxidant, immune modulation and anti viral. 

Mucolytic

NAC was originally used to treat acetaminophen overdoses and how it did this was in its mucolytic properties. NAC mucolytic properties allow it to dislodge thick mucus from the airways, in the case of overdose it helps rid the body of the toxins and in Covid it helps improve ventilation allowing for easier breathing. 

Antioxidant Properties

NAC is the precursor to Glutathione, a potent antioxidant in our bodies. 

During Covid, our antioxidant levels can become depleted, whilst free radicals caused by physiological stress as well as the virus can cause damage to our cells. 

Glutathione can help prevent and slow the  free radical damage that can occur as well as replenishing our antioxidant stores. 

Anti Inflammatory 

Another important property of NAC is its anti-inflammatory properties, Covid causes an increase in inflammation in our body during and even after. This increased inflammation can result in delayed healing, damage to our cells and can contribute to mental health symptoms such as depression and anxiety after Covid (2). 

NAC has been shown to reduce inflammatory markers thus helping our bodies to fight Covid, preventing further damage to our cells and can help with the aftermath. 

Anti Viral 

With viruses, they need specific pathways in order to replicate  and for the  Covid  virus, it’s the same, the pathway needed to replicate is the NF-kB Pathway. 

NAC has been demonstrated to inhibit this pathway, meaning it can potentially suppress the replication of Covid as well as additional influenza strains and respiratory viruses (1). 

What is the research saying?

Whilst all this may sound promising the most important question is, what is the evidence saying? Multiple studies have been done on the use of NAC in Covid and these studies are ongoing.

NAC has not only been used in mild Covid but also to treat severe Covid patients in ICU. In these mechanically ventilated patients NAC can help prevent comorbidities such as pneumonia, lymphopenia and can reduce mortality. 

In the case of severe Covid, lymphopenia is a common side effect, this is in simple terms the a reduction of lymphocytes, one of our immune cells caused by cell death.  Without these cells, our body has the reduced fighting ability against Covid. 

A high dose of NAC of 1200mg twice daily  has been shown to increase levels of Glutathione in these cells and inhibit cell death. This increases our cellular immunity and increases our fighting ability.  

A Covid induced ‘cytokine storm’ has been associated with mortality in covid-19 patients. Cytokines as well as neutrophils are part of our bodies immune response to illness. 

During Covid, our bodies produce free radicals, these free radicals cause injury to the cells and convert into potentially more damaging substances that have been shown to cause pulmonary edema during acute lung injury. 

This produces a snowball effect in our bodies and results in pulmonary edema and ARDs (Adult Respiratory Distress Syndrome). 

On top of causing damage to the cells, the free radicals can amplify inflammation by increasing the replication pathway. This effect has been shown to increase mortality. NAC’s antioxidant properties allow it to reduce this so-called ‘storm’ and can reduce mortality and improve clinical outcomes (1). 

Side effects of NAC

NAC is used as a conjunctive therapy to Covid, meaning it can be used safely with commonly used antibiotics without causing interactions. 

If a patient does experience side effects from NAC, these side effects are mild and include diarrhea, nausea, fatigue, vomiting and a skin rash (1) (3). 

Administration and Dosing

NAC can be potentially used as a prophylactic treatment for Covid with a dose of 600 mg to improve immunity. 

For individuals with symptoms of Covid such as a dry cough and/or fever, a dose of 1200mg twice daily can be used in the form of a capsule or tablet. NAC can be given in the form of a nebuliser for Covid patients who have severe respiratory symptoms and is shifted to IV NAC when the patient develops pneumonia or dyspnoe (1). 

Is NAC over the counter?

After all this you may be wanting to rush to the store to get your hands on this supplement but before you rush off, can we actually get it? 

This is an interesting question. Up until 2021, NAC was available over the counter as well as from prescription. However last year the FDA requested information relevant to the use of NAC as a dietary supplement to prove that it was used as a dietary supplement before being used as a drug (4). 

This request is ongoing and resulted in FDA sending warning letters to supplement companies and companies such as Amazon who subsequently removed their NAC supplements mid last year.  Although some supplement companies are still selling NAC, the future of NAC being available over the counter is questionable.  

Final Thoughts

Understandably there has been a lot of doom and gloom over the Covid pandemic but thankfully there are promising treatments and studies currently underway to help us fight this virus. 

NAC is one of these treatments and with the results it’s been giving, it is definitely showing promise in the fight against Covid.