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N-acetilcisteína (NAC)

¿Qué es?

La N-acetilcisteína (NAC) proviene del aminoácido L-cisteína. Los aminoácidos son componentes básicos de las proteínas. NAC tiene muchos usos y es un medicamento aprobado por la FDA.

La N-acetilcisteína es un antioxidante que podría desempeñar un papel en la prevención del cáncer. Como medicamento, los proveedores de atención médica lo usan para tratar la intoxicación por acetaminofén (Tylenol). Actúa uniendo las formas venenosas de acetaminofén que se forman en el hígado.

Las personas comúnmente usan N-acetilcisteína para la tos y otras condiciones pulmonares. También se usa para la gripe, el ojo seco y muchas otras condiciones, pero no existe una buena evidencia científica que respalde muchos de estos usos. Tampoco hay buena evidencia que respalde el uso de N-acetilcisteína para COVID-19.

Aunque muchos productos de suplementos dietéticos contienen N-acetilcisteína, la FDA de EE. UU ha declarado que es ilegal que los suplementos dietéticos contengan N-acetilcisteína, ya que técnicamente es un medicamento aprobado. Pero a partir de agosto de 2022, la FDA está considerando cambiar esta postura. Puede permitir la N-acetilcisteína en los suplementos dietéticos siempre que no surjan problemas de seguridad. Está pendiente una decisión final. Los productos de N-acetilcisteína recetados están disponibles bajo la guía de un proveedor de atención médica.

¿Qué tan efectivo es?

Natural Medicines Comprehensive Database (La Base Exhaustiva de Datos de Medicamentos Naturales) clasifica la eficacia, basada en evidencia científica, de acuerdo a la siguiente escala: Eficaz, Probablemente Eficaz, Posiblemente Eficaz, Posiblemente Ineficaz, Probablemente Ineficaz, Ineficaz, e Insuficiente Evidencia para Hacer una Determinación.

La clasificación de la eficacia para este producto es la siguiente:

Eficaz para...

  • Envenenamiento por acetaminofén (Tylenol). La ingesta de N-acetilcisteína recetada por vía oral o intravenosa reduce la tasa de mortalidad y previene el daño permanente causado por la intoxicación por acetaminofén. Los productos recetados deben ser administrados por un proveedor de atención médica.
  • Colapso pulmonar total o parcial (atelectasia). La inhalación de una forma recetada de N-acetilcisteína ayuda a tratar los pulmones colapsados causados por la obstrucción del moco. Los productos recetados deben ser administrados por un proveedor de atención médica.
  • Pruebas de pulmón. La inhalación de una forma recetada de N-acetilcisteína es útil para preparar a las personas para las pruebas pulmonares de diagnóstico. Los productos recetados deben ser administrados por un proveedor de atención médica.
  • Atención de personas con un tubo colocado en la tráquea (cuidado de la traqueotomía). La inhalación de una forma recetada de N-acetilcisteína ayuda a prevenir la formación de costras en personas con un tubo en la tráquea. Los productos recetados deben ser administrados por un proveedor de atención médica.

Posiblemente eficaz para...

  • Dolor de pecho (angina). La ingesta de N-acetilcisteína por vía oral o intravenosa parece mejorar el dolor de pecho cuando se usa con el medicamento nitroglicerina. La ingesta de N-acetilcisteína por vía intravenosa también parece ayudar a prevenir la tolerancia a la nitroglicerina, pero podría aumentar el riesgo de dolores de cabeza y presión arterial baja. Los productos intravenosos solo pueden ser administrados por un proveedor de atención médica.
  • Autismo. La ingesta de N-acetilcisteína podría mejorar la irritabilidad en niños y adolescentes con autismo. Pero no parece ayudar a otros síntomas del autismo.
  • Hinchazón (inflamación) de las principales vías respiratorias del pulmón (bronquitis). La ingesta de N-acetilcisteína parece reducir la dificultad para respirar y la tos debido a esta afección. Además, la ingesta de N-acetilcisteína durante 3-36 meses parece prevenir los brotes.
  • Una enfermedad pulmonar que dificulta la respiración (enfermedad pulmonar obstructiva crónica o EPOC). La ingesta de N-acetilcisteína durante al menos 6 meses parece disminuir los brotes en aproximadamente un 40% en personas con EPOC de moderada a grave. Parece funcionar mejor en personas que aún no están tomando corticosteroides. En las personas con EPOC que necesitan ser hospitalizadas, la ingesta de N-acetilcisteína además del tratamiento regular ayuda a la recuperación.
  • Daño renal causado por colorantes de contraste (nefropatía inducida por contraste). La ingesta de N-acetilcisteína, con o sin otros medicamentos, podría ayudar a prevenir problemas renales causados por los tintes que se usan durante algunos exámenes de rayos X. Pero solo parece ayudar en personas que ya tienen una función renal deficiente.
  • Niveles altos de homocisteína en sangre (hiperhomocisteinemia). La ingesta de N-acetilcisteína parece reducir los niveles de homocisteína, un posible factor de riesgo de enfermedad cardíaca.
  • Niveles altos de colesterol u otras grasas (lípidos) en la sangre (hiperlipidemia). La ingesta de N-acetilcisteína parece reducir los niveles de una grasa en sangre llamada lipoproteína (a) en personas con niveles altos de esta grasa en sangre.
  • Toxicidad en personas que toman el fármaco contra el cáncer ifosfamida (Ifex). La ingesta de N-acetilcisteína parece ayudar a prevenir los efectos secundarios del fármaco contra el cáncer ifosfamida. Pero un medicamento llamado mesna parece funcionar mejor que la N-acetilcisteína.
  • Gripe (influenza). La ingesta de N-acetilcisteína parece reducir los síntomas de la gripe.
  • Insuficiencia renal. La ingesta de N-acetilcisteína parece ayudar a prevenir problemas como ataques cardíacos y accidentes cerebrovasculares en personas con insuficiencia renal.
  • Ataque cardíaco. La administración de N-acetilcisteína por vía intravenosa junto con el fármaco nitroglicerina parece ayudar a mantener la función cardíaca y reducir el daño cardíaco en personas que sufren un ataque cardíaco. A veces, el fármaco estreptoquinasa también se usa junto con N-acetilcisteína y nitroglicerina. Los productos intravenosos solo pueden ser administrados por un proveedor de atención médica.

Posiblemente ineficaz para...

  • Enfermedad de Lou Gehrig (esclerosis lateral amiotrófica o ELA). La ingesta de N-acetilcisteína por vía intravenosa no parece mejorar los síntomas de la ELA. Los productos intravenosos solo pueden ser administrados por un proveedor de atención médica.
  • Daño cardíaco causado por ciertos medicamentos contra el cáncer (cardiotoxicidad por antraciclina). La ingesta de N-acetilcisteína no parece prevenir ni tratar el daño cardíaco causado por la doxorrubicina.
  • Una enfermedad pulmonar que afecta a los recién nacidos (displasia broncopulmonar). La administración de N-acetilcisteína a través de un orificio en la tráquea no parece prevenir los problemas respiratorios en los bebés prematuros. Esto solo puede ser administrado por un proveedor de atención médica.
  • Trastorno por consumo de cannabis. La ingesta de N-acetilcisteína no parece mejorar la depresión ni ayudar a reducir el consumo de cannabis en adolescentes y adultos con trastorno por consumo de cannabis.
  • Fibrosis quística. La ingesta de N-acetilcisteína o la inhalación no parece mejorar la función pulmonar en personas con fibrosis quística.
  • Un trastorno hereditario marcado por la sensibilidad a la luz (protoporfiria eritropoyética o EPP). La ingesta de N-acetilcisteína no parece reducir la sensibilidad a la luz en personas con EPP.
  • Una infección del tracto digestivo que puede provocar úlceras (Helicobacter pylori o H. pylori). La ingesta de N-acetilcisteína junto con los tratamientos habituales para la infección por H. pylori no ayuda a eliminar la infección mejor que el tratamiento habitual.
  • Hinchazón (inflamación) del hígado (hepatitis). La ingesta de N-acetilcisteína no parece ayudar a tratar la hepatitis viral. Tampoco parece mejorar la respuesta a la terapia con interferón en personas con hepatitis C. Pero podría ayudar a prevenir recaídas en personas con hepatitis C.
  • VIH / SIDA. La ingesta de N-acetilcisteína no parece mejorar la función inmunológica ni reducir la cantidad de virus en el cuerpo en la mayoría de las personas con VIH.
  • Presión arterial baja. La ingesta de N-acetilcisteína no parece reducir el riesgo de insuficiencia renal en personas con presión arterial baja a largo plazo.
  • Incapacidad para quedar embarazada dentro de un año de intentar concebir (infertilidad). La ingesta de N-acetilcisteína no parece mejorar la tasa de embarazo o la tasa de aborto espontáneo en mujeres con problemas de fertilidad.
  • Trasplante de hígado. La administración de N-acetilcisteína por vía intravenosa durante la cirugía de donante de hígado no parece prevenir el rechazo del trasplante en los receptores de trasplante de hígado. Los productos intravenosos solo pueden ser administrados por un proveedor de atención médica.
  • Hinchazón (inflamación) del páncreas (pancreatitis). La ingesta de N-acetilcisteína no previene la pancreatitis en personas que se someten a un procedimiento determinado que puede causar inflamación del páncreas. Además, la ingesta de N-acetilcisteína por vía intravenosa junto con selenio y vitamina C no parece mejorar la función del páncreas en personas con pancreatitis grave. Los productos intravenosos solo pueden ser administrados por un proveedor de atención médica.
  • Recuperación después de la cirugía. La ingesta de N-acetilcisteína por vía oral o intravenosa no parece reducir el riesgo de ataque cardíaco, accidente cerebrovascular, lesión renal o muerte después de una cirugía cardíaca. Los productos intravenosos solo pueden ser administrados por un proveedor de atención médica.

Probablemente ineficaz para...

  • Cáncer de cabeza y cuello. La ingesta de N-acetilcisteína no previene nuevos tumores ni mejora la supervivencia en personas con cáncer de cabeza y cuello.
  • Cáncer de pulmón. La ingesta de N-acetilcisteína no previene nuevos tumores ni mejora la supervivencia en personas con cáncer de pulmón.
  • Fallo multiorgánico. La administración de N-acetilcisteína por vía intravenosa podría aumentar el riesgo de muerte en personas con insuficiencia orgánica múltiple. Los productos intravenosos solo pueden ser administrados por un proveedor de atención médica.
Existe interés en usar N-acetilcisteína para otros propósitos, pero no hay suficiente información confiable para decir si podría ser útil.

¿Es seguro?

Cuando se toma por vía oral: La N-acetilcisteína probablemente sea segura para la mayoría de los adultos. La N-acetilcisteína es un medicamento recetado aprobado por la FDA. Puede causar efectos secundarios como sequedad de boca, náuseas, vómitos y diarrea. Tiene un olor desagradable que algunas personas encuentran difícil de tolerar.

Cuando se inhala: La N-acetilcisteína probablemente sea segura para la mayoría de los adultos, cuando se usa como medicamento recetado. Puede causar hinchazón en la boca, secreción nasal, somnolencia, sensación de humedad y opresión en el pecho.

Advertencias y precauciones especiales:

Embarazo: La N-acetilcisteína es posiblemente segura cuando se toma por vía oral o se inhala durante el embarazo. La N-acetilcisteína atraviesa la placenta, pero no hay evidencia de que dañe al feto. Pero la N-acetilcisteína solo debe usarse cuando sea médicamente necesario.

Lactancia: No hay suficiente información confiable para saber si la N-acetilcisteína es segura de usar durante la lactancia. Manténgase en el lado seguro y evite su uso.

Niños: Es probable que la N-acetilcisteína sea segura cuando se toma por vía oral en dosis de 900-2700 mg al día durante un máximo de 12 semanas.

Alergia: No use N-acetilcisteína si es alérgico a la acetilcisteína.

Asma: La N-acetilcisteína puede causar broncoespasmo en personas con asma si se inhala o se ingiere por vía oral. Si toma N-acetilcisteína y tiene asma, su proveedor de atención médica debe controlarlo.

Desorden sangrante: La N-acetilcisteína podría retardar la coagulación sanguínea. La N-acetilcisteína podría aumentar el riesgo de hematomas y hemorragias en personas con trastornos hemorrágicos.

Cirugía: La N-acetilcisteína podría retardar la coagulación sanguínea. Esto podría aumentar el riesgo de hemorragia durante y después de la cirugía. Deje de tomar N-acetilcisteína al menos 2 semanas antes de una cirugía programada.

¿Existen interacciones con medicamentos?

Serias
No tome esta combinación
Nitroglicerina
La nitroglicerina puede dilatar los vasos sanguíneos y aumentar el flujo sanguíneo. La ingesta de N-acetilcisteína parece aumentar los efectos de la nitroglicerina. Esto podría aumentar el riesgo de efectos secundarios como dolor de cabeza, mareos y aturdimiento.
Moderadas
Tenga cuidado con esta combinación
Carbón activado
A veces, el carbón activado se usa para prevenir el envenenamiento en personas que toman demasiado acetaminofén (Tylenol) u otros medicamentos. La ingesta de N-acetilcisteína al mismo tiempo que el carbón activado podría disminuir su eficacia para prevenir el envenenamiento.
Cloroquina (Aralen)
La cloroquina es un medicamento que se usa para tratar la malaria. La N-acetilcisteína podría reducir los efectos de la cloroquina contra la malaria.
Medicamentos para la presión arterial alta (medicamentos antihipertensivos)
La N-acetilcisteína podría reducir la presión arterial. La ingesta de N-acetilcisteína junto con medicamentos que reducen la presión arterial puede hacer que la presión arterial baje demasiado. Controle su presión arterial de cerca.
Medicamentos que retardan la coagulación de la sangre (medicamentos anticoagulantes / antiplaquetarios)
La N-acetilcisteína podría retardar la coagulación sanguínea. La ingesta de N-acetilcisteína junto con medicamentos que también retardan la coagulación de la sangre puede aumentar el riesgo de hematomas y hemorragias.

¿Existen interacciones con hierbas y suplementos?

Hierbas y suplementos que pueden reducir la presión arterial
La N-acetilcisteína podría reducir la presión arterial. Tomarlo con otros suplementos que tienen el mismo efecto puede hacer que la presión arterial baje demasiado. Ejemplos de suplementos con este efecto incluyen andrographis, péptidos de caseína, L-arginina, niacina y ortiga.
Hierbas y suplementos que pueden retardar la coagulación sanguínea
La N-acetilcisteína podría retardar la coagulación sanguínea y aumentar el riesgo de hemorragia. Tomarlo con otros suplementos con efectos similares podría aumentar el riesgo de hemorragia en algunas personas. Ejemplos de suplementos con este efecto incluyen ajo, jengibre, ginkgo, natokinasa y Panax ginseng.

¿Existen interacciones con alimentos?

No se conoce ninguna interacción con alimentos.

¿Como se usa normalmente?

La N-acetilcisteína es un medicamento recetado aprobado por la FDA. Se puede tomar de varias formas, incluso por vía oral, por vía intravenosa y por inhalación. Por lo general, se toma por vía oral en dosis de 600 a 1200 mg al día. Hable con un proveedor de atención médica para averiguar qué tipo de producto y dosis podrían ser los mejores para una afección específica.

La N-acetilcisteína también está disponible en muchos suplementos dietéticos. Pero según la FDA, el uso de N-acetilcisteína en suplementos es ilegal porque es un medicamento aprobado. Los productos complementarios no deben usarse en lugar de los productos recetados.

Otros nombres

Acetyl Cysteine, Acétyl Cystéine, Acetylcysteine, Acétylcystéine, NAC, N-Acetyl-B-Cysteine, N-Acétyl Cystéine, N-Acetyl-L-Cysteine, N-Acétyl-L-Cystéine, N-Acetylcysteine, N-Acétylcystéine.

Metodología

Para saber más sobre cómo este artículo fue escrito, refiérase a la metodología de la Base exhaustiva de datos de medicamentos naturales.

Referencias

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