NAC INFO SHEET
NAC (N- acetylcysteine) is a derivative of the naturally
occurring amino acid cysteine. In the United States, NAC is
available by prescription as an aerosol drug (similar to
aerosolized pentamidine) to treat bronchitis. NAC is also used in
liquid form in very high doses to treat Tylenol overdoses. In
Europe, NAC is very commonly used for bronchitis, and is produced
in two oral forms.
The Theory Behind NAC
One reason PWAs take NAC is to try to pump up levels of
glutathione (GSH). GSH is a vital protein that cells need to
function. Many studies have documented low GSH in people with HIV.
Dr. Luc Montagnier's work with CD4 cells from PWAs suggests that
even cells without HIV can grow weak and die, but with added GSH
can regain their vigor. This is where NAC comes in. NAC is broken
down by the body into cysteine. Researchers have also noted that
low levels of cysteine in PWAs. The body uses cysteine to replace
glutathione. Taking NAC may be a way to add cysteine, so that your
body can replenish depleted GSH levels. It is still unclear whether
NAC is converted to GSH in PWAs.
More Theory Behind Taking NAC
Whether or not NAC is converted to GSH, it might help protect
the body from the effects of excess TNF-alpha (tumor necrosis
factor). TNF is a naturally occurring protein in your body. It's
often elevated in people with HIV and may be a part of HIV disease.
It can turn on latent HIV, and increase HIV reproduction. It can
cause a generalized inflammatory response that may be critical to
AIDS-related weight loss. Both GSH and NAC interfere with TNF in
the test tube.
NAC and GSH are also anti-oxidants -substances that mop up free
radicals, volatile particles produced naturally in the body,
especially when you have an infection. Too many free radicals can
cause inflammation and damage organs; and like TNF, may turn on and
speed the spread of HIV. How much these free radicals contribute to
HIV disease is unclear.
There are reports that taking NAC with dapsone reduces some of
that drug's toxicity without reducing its effectiveness. There are
ongoing studies in Canada to see whether NAC may decrease PWAs'
allergic reactions to Bactrim/Septra.
NAC Studies in PWAs
Studies of NAC seem to have raised more questions than they've
answered. An NIH study was disappointing: after 12 weeks of taking
up to 9600 mg a day, NAC had no effect on CD4 cell counts or p24 (a
sloppy marker of HIV activity). However, PWAs in the study had
regular GSH levels, so NAC shouldn't have done much for them
anyway. More research is needed to see what NAC can do for PWAs who
have low GSH levels.
This NIH study created a storm of controversy. The researchers
reported that NAC was very poorly absorbed - it did not get into
the blood, and that people in the study had no change in their
intracellular GSH levels. Other researchers protested that the NIH
didn't follow the proper procedures for measuring NAC or GSH
levels.
A later study in HIV positive people with low GSH reported
increased intracellular GSH 4 hours after taking a single dose of
NAC (figured as @1800 mg if you weigh 130 pounds). A small study at
Stanford also reported that 7 PWAs taking 1000-2000 mg for up to 12
weeks had an immediate increase in intracellular GSH. There's an
on-going study at Stanford using 8000 mg/day to sort this out.
2 new studies (summer '94)
15 people with HIV in Brazil took either 400 mg iv twice a day, or
600 mg capsules twice a day. The 8 people on iv NAC fared best,
moving from an average of 256 CD4 cells to 501. The 7 people taking
the oral dose went from 403 CD4s to 563, and 1449 CD8s to 2376.
Much more interesting was a one-year, three arm Mexican study of
300 people with HIV. The study compared AZT (500 mg) to AZT/ddC and
AZT/ddC/NAC (NAC-1500 mg/day). There were significant differences
in opportunistic infections and CD4 counts between the AZT-only
group and the other two groups. AZT only: 62% developed new OIs,
and their CD4's slipped from an average of 247 to 181 over the
course of the year. AZT/ddC: 32% got OIs and their CD4s rose
steadily from 175 to 294. AZT/ddC/NAC: 23% developed OIs and their
CD4 cells went from 148 to 356. The difference between taking
AZT/ddC or the NAC combo was not statistically significant, but
adding NAC seemed to show a trend toward greater response.
Dosing
No one knows what the best dose of NAC is. Most PWAs in America
take between 1200-1800 mg a day based upon test tube data, and the
advice of American researchers who have been studying NAC in HIV
disease for years. This may not be the best dose in the body. A
German researcher who has also been working with PWAs and NAC for
several years maintains that people should take 400-600 mg three
times a week, preferably two hours after exercise (the less is more
theory). Who's right? Only large clinical trials will tell.
Side Effects and Toxicity
NAC has been used safely at doses up to 11,000 mg a day, but
side effects can occur. A few clients from the Health Group have
also reported some stomach upset and diarrhea while on NAC. One
patient in the NIH study had an anaphylactoid reaction (a severe
bronchial spasm) in the highest IV dose group. Anemia,
thrombocytopenia, nausea and weight loss were also seen in this
study, but these effects were not necessarily caused by NAC.
No drug interactions were reported from the NIH study. However,
the Martindale Extra Pharmacopoeia reports that some antibiotics,
including amphotericin, ampicillin, erythromycin and tetracycline
may be incompatible or inactivated when mixed with NAC.
PWAs with a history of ulcers should perhaps avoid NAC, since it
can reduce mucous that they need to protect their stomachs.
NAC is a chelating agent, and may purge minerals from your body.
Nutritionists recommend keeping track of minerals and taking some
supplements if necessary.
What We Carry
The Health Group imports pharmaceutical grade NAC from
Switzerland and Germany. In the US, several companies make NAC and
sell it through health food stores. Is there a difference between
imported NAC and health food store NAC? We don't know. Health food
store NAC can be cheaper. Health food products are manufactured
with no FDA monitoring to guarantee the quality. We paid an
independent laboratory to test one brand of health store NAC. It
was fine. But this tells us nothing about the product's shelf-life,
or even other jars of the same product.
Pharmaceutical grade NAC is guaranteed to have a standard amount
of NAC in each tablet. It is also packaged in air tight wrapping
(the capsules) or with a dessicant in the lid (effervescents) so
that the NAC will not degrade once it is exposed to air. The third
difference is that pharmaceutical grade NAC also contains a mild
buffer, so it's gentler on the digestive system.
We carry two kind of NAC: 800 mg effervescent tablets and 200 mg
capsules. The effervescent form is cheaper per mg.
Effervescent NAC comes as fizzy tablets which you dissolve in 8
oz. of water, like alka seltzer. The tablets are made by Elan SA in
Switzerland, where they are approved for bronchitis. This brand of
NAC comes in tubes of 10 x 800 mg tablets. Each tube costs $8.50.
This NAC contains Nutrasweet (aspartame). Capsules: Fluimucil
Kapseln are regular capsules — swallowed like any other pill.
The capsules are made by Inpharzam, a subsidiary of the Zambon
Group, in Germany. The capsules (200 mg each) come 15 to a box for
$14.00 per box and have no sweetener.
Info Sheets
PWA Health Group 150 West 26th Street, Suite 201 New York City, NY
10001 (212) 255-0520 Fax: (212) 255-2080
NAC: How it
can help your immune system
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