As the world continues to grapple with managing and containing the spread of COVID-19, medical advances are essential for keeping people safe. One potential advancement is through the use of NAC (N-acetylcysteine). While studies reveal that this medication may offer certain benefits in treating and preventing COVID-19, there can also be associated risks when using NAC.
To understand these factors at play, it is important to examine how this type of treatment could impact those infected with COVID-19, including efficacy ratings, recommended dosages, and possible side effects.
But before we dive too deep into the world of NAC for COVID, let’s explore what exactly this supplement is and how it works, plus its potential risks, known efficacy levels, and recommended dosages for adults and children alike. Now, let’s begin.
What is NAC?
NAC is a supplement composed of N-acetylcysteine, an amino acid that can help increase glutathione production in the body. Glutathione helps to protect cells from oxidative damage caused by free radicals and viruses.
Studies have found that NAC supplements may reduce inflammation and oxidative stress in people with viral infections. As a precursor of reduced glutathione, NAC is well recognized for its mucolytic impact, but it also exhibits direct and indirect antioxidant activity.
In addition to its antioxidant benefits, NAC has been shown to have antiviral properties and the ability to suppress the body’s immunological and inflammatory responses.
NAC COVID Protocol
Those who have not yet caught COVID may benefit from taking 600 milligrams of oral NAC (bid) to modify their immune system and prevent infection. If you start taking oral NAC at a dose of 1200 milligrams twice a day as soon as the first signs of a viral infection arise, such as a fever or a dry cough, you can reduce the symptoms and speed up your recovery. 
Patients who suffer from allergies or asthma should take an antihistamine before or during NAC inhalation. As a result, an inhalable formula of NAC can be administered with a nebulizer for somewhat severe patients without airway blockages. Hence, many people with COVID might recover at home with the support of self-treatment with oral or inhaled NAC.
However, allergy and asthma patients should take an antihistamine before or during NAC inhalation to reduce the risk of experiencing adverse effects.
If a patient develops clinically diagnosed pneumonia or dyspnea, in addition to standard treatment (including Remdesivir), they should receive intermittent or continuous IV NAC. This might avert the need for intensive care unit stays and invasive ventilation due to the development of acute respiratory distress syndrome.
Patient outcomes are not altered by whether NAC is infused intermittently or continuously.
NAC for COVID: Risks
While NAC can benefit those with respiratory infections, it is important to understand that there can be associated risks when taking NAC supplements or medications.
NAC has been known to cause adverse side effects in some people, such as stomach upset, heartburn, and nausea. It is also known to cause vomiting in some cases. NAC can also interact with certain medications, including lithium, antacids, and nitroglycerin.
It may also interact with certain medications, so it is important to consult a doctor before taking NAC for COVID-19 treatment or prevention.
NAC for COVID Prevention
While NAC for COVID has not been established as a proven medical treatment, some studies have found that NAC may help reduce the severity of symptoms associated with COVID-19. For instance, in one study, patients diagnosed with COVID-19 pneumonia who were given oral NAC at a dose of 1200 mg per day had a lower chance of requiring mechanical ventilation and death.  These results, however, must be confirmed by well-planned prospective clinical studies.
NAC for COVID: Efficacy
Studies have found that NAC can help reduce the severity and mortality rate of COVID-19 in those severely infected. N-acetylcysteine has shown promise as an additional treatment for COVID-19, and further research is required to determine its full efficacy. It may even reduce symptoms of mild cases when taken early on. 
However, until further research is conducted, NAC cannot be considered a proven medical treatment for COVID-19.
NAC for COVID: Dosage
The recommended NAC dosage for adults and children depends on the individual’s age, weight, health status, and severity of their illness. Adult NAC dosages range from 600mg to 2.4 grams per day (in divided doses). NAC should be taken twice daily as long as symptoms persist. NAC should not take longer than ten days without consulting a doctor.
In the case of children, NAC doses are lower and should not exceed 600mg per day in divided dosages.
While more research is needed, the present findings suggest that at a minimum of 1200 mg per day, NAC may be helpful for symptomatic people with COVID-19. Patients with severe illness and respiratory impairment may benefit from 100 mg/kg of intravenous NAC over at least three days.
The initial dosage can be raised to 150 mg/kg after 24 hours in acute respiratory distress syndrome cases. 
NAC dosing can be adjusted based on the individual’s weight and health status, with appropriate guidance from a healthcare professional.
Does NAC Help with COVID Pneumonia?
Although NAC supplements have not been proven to be a medical treatment for COVID-19, some studies suggest that NAC may help reduce the severity of symptoms associated with COVID-19 pneumonia.
NAC is thought to help reduce inflammation and improve oxygenation in those with severe respiratory illness. NAC has also shown promise in reducing cytokine storms, which can lead to severe respiratory distress in those with COVID-19. However, it should be used under the supervision of a doctor when treating COVID-19 pneumonia to determine the appropriate dose and duration of treatment.
NAC supplementation may also be beneficial in reducing the severity of acute respiratory distress syndrome (ARDS) and pneumonia associated with COVID-19. NAC has been found to reduce inflammation, oxidative stress, and mortality rates in clinical trials involving severe cases of COVID-19.
Bottom Line: NAC for COVID and Its Risks, Efficacy, and Dosages
Overall, NAC is potentially beneficial in preventing and treating COVID-19, particularly in severe cases. NAC may reduce symptoms of mild cases when taken early on, but NAC should not be used as a substitute for medical advice or proper prevention measures.
However, it may interact with certain medications. NAC dosing should be adjusted according to the individual’s weight and health status under appropriate guidance from a healthcare professional. Hence, it is important to consult a doctor before taking NAC to treat or prevent COVID-19.
Disclaimer: This article is only a guide. It does not substitute the advice given by your own healthcare professional. Before making any health-related decision, consult your healthcare professional.
Editorial References And Fact-Checking
- Shi Z, Puyo CA. N-Acetylcysteine to Combat COVID-19: An Evidence Review. Ther Clin Risk Manag. 2020 Nov 2;16:1047-1055. doi: 10.2147/TCRM.S273700. PMID: 33177829; PMCID: PMC7649937.
- Assimakopoulos SF, Aretha D, Komninos D, Dimitropoulou D, Lagadinou M, Leonidou L, Oikonomou I, Mouzaki A, Marangos M. N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study. Infect Dis (Lond). 2021 Nov;53(11):847-854. doi: 10.1080/23744235.2021.1945675. Epub 2021 Jun 29. PMID: 34182881.
- Wong KK, Lee SWH, Kua KP. N-Acetylcysteine as Adjuvant Therapy for COVID-19 – A Perspective on the Current State of the Evidence. J Inflamm Res. 2021 Jul 6;14:2993-3013. doi: 10.2147/JIR.S306849. PMID: 34262324; PMCID: PMC8274825.
- José LuisIzquierdo-Alonso, et. al. N-acetylcysteine for prevention and treatment of COVID-19: Current state of evidence and future directions. Journal of Infection and Public Health. Volume 15, Issue 12, December 2022, Pages 1477-1483. https://doi.org/10.1016/j.jiph.2022.11.009.