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N-acetylcysteine can be the key to tackling substance use disorders

Published online by Cambridge University Press:  13 August 2021

M. Alves*
Affiliation:
Psychiatry Department, Hospital Center of Setúbal, Setúbal, Portugal
L. Paulino Ferreira
Affiliation:
Psychiatry Department, Hospital Center of Setúbal, Setúbal, Portugal
D. Durães
Affiliation:
Psychiatry Department, Hospital Center of Setúbal, Setúbal, Portugal
A. Gamito
Affiliation:
Psychiatry Department, Hospital Center of Setúbal, Setúbal, Portugal
*
*Corresponding author.

Abstract

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Introduction

N-acetylcysteine (NAC) is a precursor of cysteine and glutathione, widely known as an antidote to paracetamol overdose. Its role as precursor of an antioxidant and modulating agent of glutamatergic, dopaminergic, neurotropic and inflammatory pathways, raised interest in its application in psychiatric disorders. NAC emerges as a promising therapeutic agent in substance use disorders (SUD) and provides a treatment option in a field with limited and suboptimal therapies.

Objectives

To describe the use of NAC in SUD (tobacco, cocaine, cannabis, methamphetamine and alcohol), its potential mechanisms and clinical application.

Methods

The literature was searched using the Pubmed database with the following keywords “N-acetylcysteine”, “Substance use disorders” and “Psychiatry”. Retrieved papers (2011-2018) were selected according to their relevance.

Results

SUD results in disruption of glutamate system, in nucleus accumbens, a critical brain area in the rewarding system. NAC reestablishes glutamate homeostasis restoring function of the cysteine-glutamate exchange in glial cells and reversing the downregulated GLT-1 receptor. Concerning its properties, evidence suggests that NAC is able to decrease drive, craving or compulsion to consume, making it particular useful in relapse prevention after achieving abstinence.

Conclusions

NAC has revealed itself as a promising therapeutic agent in SUD and its safety profile and favourable tolerability, as well as being an over-the-counter medication, adds to its interest. Data is still preliminary for the use of NAC in psychiatry disorders, due to the relatively small number of trials and their heterogeneous methodology. Larger studies are needed to confirm efficacy, optimal doses, long-term tolerability and side effects.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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