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Key Contraindications (Both) Active malignancy or recent cancer history, pregnancy, breastfeeding, uncontrolled diabetes, severe pituitary disease

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NAC has been used clinically for decades as an FDA-approved drug for acetaminophen overdose (where it replenishes hepatic glutathione) and as a mucolytic agent [18]

An RCT of 174 patients with severe alcoholic hepatitis found that the combination of prednisolone + NAC (IV for 5 days, then oral for 2 weeks) significantly reduced 1-month mortality compared to prednisolone alone (8% vs 24%, p=0.006), though the difference was not significant at 6 months (Nguyen-Khac et al., N Engl J Med, 2011) [36]

Zinc depletion with prolonged supplementation 2