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Am J Addict. 2017 Oct;26(7):660-666. doi: 10.1111/ajad.12620. Epub 2017 Sep 12.

N-acetylcysteine in the treatment of craving in substance use disorders: Systematic review and meta-analysis.

Author information

1
Santa Casa School of Medical Sciences, São Paulo, São Paulo, Brazil.
2
Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
3
Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD), São Paulo State Secretariat of Health, São Paulo, São Paulo, Brazil.
4
Department of Psychiatry, Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, South Carolina.
5
School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia.
6
Department of Psychiatry, The Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia.

Abstract

BACKGROUND AND OBJECTIVES:

Recent neurobiological evidences along with clinical observations justify the use of N-acetylcysteine (NAC) as a medication for craving. The objective of our study was to assess the evidence of efficacy of NAC for craving in substance use disorders in randomized clinical trials (RCTs).

METHODS:

Systematic review of the RCTs literature (PROSPERO number 56698) until February, 2017, using MEDLINE, Cochrane Library and clinicaltrials.gov. We included seven RCTs (n = 245); most with small-to-moderate sample sizes. The main outcome was the Hedges' g for continuous scores in a random-effects model. Heterogeneity was evaluated with the I2 and the χ2 test. Publication bias was evaluated using the Begg's funnel plot and the Egger's test. Meta-regression was performed using the random-effects model.

RESULTS:

Comparing NAC versus placebo, NAC was significantly superior for craving symptoms (Hedges' g = 0.94; 95%CI 0.55-1.33). The funnel plot showed the risk of publication bias was low and between-study heterogeneity was not significant (I2  = 44.4%, p = 0.07 for the χ2 test). A subgroup analysis performed using meta-regression showed no particular influence.

DISCUSSION AND CONCLUSIONS:

NAC was superior to placebo for craving reduction in SUDs. The relatively small number of trials and their heterogeneous methodology were possible limitations; however, these positive thrilling results stimulate further studies for clarifying the potential impact of NAC for craving symptoms in SUDs.

SCIENTIFIC SIGNIFICANCE:

The safety profile of NAC and favorable tolerability, in addition to being an over-the-counter medication, presents with an interesting potential clinical use for craving in SUDs.

SCIENTIFIC SIGNIFICANCE:

The safety profile of NAC and its favorable tolerability, in addition to being anover-the-counter medication, presents with an interesting potential clinical use for craving in SUDs. (Am J Addict 2017;26:660-666).

KEYWORDS:

acetylcysteine; addiction; alcohol; cannabis; cocaine; craving; dependence; meta-analysis; nicotine; opioid; substance-related disorders; systematic review

PMID:
28898494
DOI:
10.1111/ajad.12620
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