NAC. Quit CWE? Liver help.

[dude]

Swim heard of NAC, which is supposed to help the liver pass APAP. Swim started taking one a day. Any swims know anything about this? Here's a quote.

When you take a normal amount of APAP, a toxic metabolite called NAPQI is produced. Normally, your liver's supply of glutathione is able to bind to the NAPQI and prevent it from doing any harm. But when too much APAP is present, you do not have enough glutathione to bind to all the NAPQI and it's free to damage liver cells.
So why not just take glutathione? It's not very well-absorbed orally and a lot of it is wasted before it can do any good. NAC is much more well-absorbed and it can bind to NAPQI all by itself, it increases the effectiveness of your liver's own glutathione, and it speeds up the creation of new glutathione.
As far as how much APAP is safe- we just don't know. But every time a guideline comes out, it's lower than the preceeding one. I've heard 6, 4, and 2.6 grams. For people who drink or had a prior history of alcoholism, this is a very big deal. Same goes for Hep-C and other liver conditions. And taking APAP in significant amounts daily is also a big deal- that figure is always lower than how much is allowed in one day (the one day guideline does not assume daily use). I can't answer what a safe amount is for an individual person, so please no one PM me about that because I just don't know (and no one does). What I can tell you is that if you feel you are pushing it, you should start taking NAC with each dose.
You will be doing your liver a big favor.

[Forthesevenlakes]

Please provide the source for this quote...as it is, it sounds an awful lot like an advertisement, which is strictly verboten by the rules of d-f.

APAP is certainly harmful, hence the need for CWE. SWIM certainly doesn't want anyone thinking they can be lazy, and just take this product expecting to avoid the damage from acetaminorphen.

[dude]

It came from a forum on XXXXXX. It's not an advertisement. Swim did a little research on it and it appears to be given to people in emergency rooms when they have OD'd on APAP. Swim certainly doesn't recommend being lazy on CWE, but simply asked if any swim's know anything of this. It certainly seems to be a good thing for people taking in APAP. I wasn't sure if I could attach the link or not. Swim swears he saw other swims get their hands slapped for this. Plus swim still has a red sqr by his name from months ago. Swims like Jatelka who attack so easily, make some swims who can contribute too reluctant to join in. Anyway, Swim though that this NAC was something worth putting out there for people to look in to.

[Forthesevenlakes]

You showed some good judgment not attaching the link, linking to other forums and corporate sites are not allowed. Thanks for providing the source to me, I had to edit it out though since it was to a site that was advertising their own services. I apologize if I came off as accusing you of trying to advertise for someone else, I more meant that it sounded like a quote from someone advertising their own service or product.

I am, however, intrigued about the prospect of the NAC. If you or any other SWIMs can find some research papers, informational links, wikipedia entries, etc. on NAC (what does this stand for, by the way?) it would be interesting to post it here. If a lab rat someone knows happens to take too much APAP, it could save a life if a doctor or EMT knew about this, because normally APAP overdose will lead to death. SWIM is a bit confused about the operations of the NAC...does it treat acute APAP poisoning, or just help to reverse the liver damage constant APAP intake causes over time?

[Jatelka]

NAC is N-acetylcysteine. It is used to "mop-up" the damaging metabolites of paracetamol (APAP) in acute overdoses, preventing the liver damage from taking place.

From the bnf (British National Formulary)

"Administration of activated charcoal should be considered if paracetamol in excess of 150 mg/kg or 12 g whichever is the smaller, is thought to have been ingested within the previous hour.

Acetylcysteine protects the liver if infused within 24 hours of ingesting paracetamol. It is most effective if given within 8 hours of ingestion after which effectiveness declines sharply; if more than 24 hours have elapsed advice should be sought from a poisons information centre or from a liver unit on the management of serious liver damage. In remote areas methionine (2.5 g) by mouth is an alternative if acetylcysteine cannot be given promptly. Once the patient reaches hospital the need to continue treatment with the antidote will be assessed from the plasma-paracetamol concentration (related to the time from ingestion).

Patients at risk of liver damage and therefore requiring treatment can be identified from a single measurement of the plasma-paracetamol concentration, related to the time from ingestion, provided this time interval is not less than 4 hours; earlier samples may be misleading. The concentration is plotted on a paracetamol treatment graph of a reference line (‘normal treatment line') joining plots of 200 mg/litre (1.32 mmol/litre) at 4 hours and 6.25 mg/litre (0.04 mmol/litre) at 24 hours. Those whose plasma-paracetamol concentration is above the normal treatment line are treated with acetylcysteine by intravenous infusion (or, if acetylcysteine is not available, with methionine by mouth, provided the overdose has been taken within 10–12 hours and the patient is not vomiting).

Patients on enzyme-inducing drugs (e.g. carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, alcohol, and St John’s wort) or who are malnourished (e.g. in anorexia, in alcoholism, or those who are HIV-positive) may develop toxicity at lower plasma-paracetamol concentration and should be treated if the concentration is above the high-risk treatment line (which joins plots that are at 50% of the plasma-paracetamol concentrations of the normal treatment line).

The prognostic accuracy of plasma-paracetamol concentration taken after 15 hours is uncertain but a concentration above the relevant treatment line should be regarded as carrying a serious risk of liver damage.
Plasma-paracetamol concentration may be difficult to interpret when paracetamol has been ingested over several hours. If there is doubt about timing or the need for treatment then the patient should be treated with an antidote."

In certain parts of the world (SWIJ believes Australia, but please correct her if she's wrong) paracetamol (APAP) tablets contain NAC as a preventative measure. There was some discussion a couple of years back as to whether this should happen in the UK. What happened instead was a restriction on the number of pills that could be bought OTC at any one time.

[merseyloyalist]

NAC is used by bodybuilders as they take large amounts of orals that can damage the liver daily,something else that works is the herb Milk Thistle(Silymarin) or also the ayurvedic Liv52 which has been used successfully by eastern bloc athletes for decades,currently swim takes 175mg of milk thistle 4 x daily with noticeable results ie,tiredness gone and appetite back with a vengence

[BANGINCOLOR]

Originally Posted by Forthesevenlakes

I am, however, intrigued about the prospect of the NAC. If you or any other SWIMs can find some research papers, informational links, wikipedia entries, etc. on NAC (what does this stand for, by the way?) it would be interesting to post it here. If a lab rat someone knows happens to take too much APAP, it could save a life if a doctor or EMT knew about this, because normally APAP overdose will lead to death. SWIM is a bit confused about the operations of the NAC...does it treat acute APAP poisoning, or just help to reverse the liver damage constant APAP intake causes over time?

Over 2,000 posts here at the forums and you NEVER heard of NAC??? Just seems kinda weird considering how effective it is and what it does.

[Forthesevenlakes]

Originally Posted by BANGINCOLOR

Over 2,000 posts here at the forums and you NEVER heard of NAC??? Just seems kinda weird considering how effective it is and what it does.

SWIM almost never takes opioids containing APAP, so its not really much of an issue for him. And hey, there's always something new to learn, that's one of the reasons SWIM loves this place.

[BANGINCOLOR]

Originally Posted by Forthesevenlakes

SWIM almost never takes opioids containing APAP, so its not really much of an issue for him. And hey, there's always something new to learn, that's one of the reasons SWIM loves this place.

SWIM always like to learn too and now that I think about it, all his meds are free of apap.

Back when SWIM started taking pain meds, had to start with the crapolas. Very little narc, very high apap but then SWIM finally graduated (and cause his situation got worse) to the quality pain meds.

[dude]

Yeah Bang, Swim wondered the same thing. So much info on CWE, but never heard of NAC. I love to learn also. Swim hopes to "graduate" to quality meds one day. But for now it's 10/325's. Any advice swim will take.

[mbu37]

According to the label on my bottle of NAC it is recommended that people take 3 times the amount of vitamin C (it does not specify the form of vitamin C) when taking a certain amount of NAC - for example 500mg. NAC and 1500mg. vitamin C. If memory serves vit C keeps NAC in a form that is available to the body. Just my 2 cents.

[Nagognog2]

Keep doing those CWE's folks. Taking poison and then taking it's antidote sounds like a pretty ridiculous state of affairs - as a day-to-day thing!

That's my 2¢.

[Dr.Jones]

APAP is metoblized into acetlyhide then acetic acid. Just like alchohol. Thats why you don't take the two together. Too much acetlyhide is hepatoxic (livertoxic)

[Nicaine]

Originally Posted by Dr.Jones

APAP is metoblized into acetlyhide then acetic acid. Just like alchohol. Thats why you don't take the two together. Too much acetlyhide is hepatoxic (livertoxic)

This information is false. Fwiw: http://en.wikipedia.org/wiki/Paracetamol#Metabolism

P.S. and it's acetaldehyde, not "acetlyhide."