Recommended dose:

Adult: Take 1-2 caplets daily with a meal or as directed by a health care practitioner.

Recommended duration of use:

• Consult a health care practitioner for use beyond 4 weeks.

Recommended use or purpose:

• Helps to relieve symptoms of chronic bronchitis.
• A supportive therapy in the treatment of inflammation of the respiratory system.
• Helps to reduce the severity & frequency of influenza-like symptoms.
• Antioxidant for the maintenance of good health in individuals under oxidative stress.

Cautions and Warnings:

• Consult a health care practioner prior to use:
  a) if you are pregnant or breastfeeding
  b) or have kidney stones.
• Consult a health care practitioner if symptoms persist or worsen.
• Do not use if you are taking antibiotics or nitroglycerin.
• If seal around cap is broken or missing, do not use.

NAC (N-Acetyl Cysteine) is an analogue of the dietary amino acid cysteine. It is known for its mucolytic (mucous breaking) and anti-inflammatory effects. NAC acts as a potent antioxidant (free radical quencher). NAC is a thiol compound thereby providing sulfhydryl groups which act as direct free radical scavengers and also stimulate the production of the endogenous (internal) antioxidant glutathione (γ-glutamylcysteinylglycine; GSH).

GSH is a potent antioxidant that maintains vitamins C and E in there antioxidant state, and it also acts as a scavenging antioxidant that removes reactive oxygen species once they are formed. GSH is a critical phase 2 detoxification factor. Essentially it acts to conjugate fat soluble toxins (i.e. heavy metals), thereby converting them to neutral water soluble compounds that can easily be excreted out of the body.
GSH supplementation however is not a viable option as it has negligent systemic availability in man ⁽¹⁾ Oral administration of GSH alone does not adequately restore GSH levels. It is rapidly hydrolyzed by the liver and intestines ⁽²⁾ and penetration through the blood–brain barrier is poor. Similarly, oral administration of L-cysteine has also been shown to have little effect on brain GSH levels owing to first-pass metabolism ⁽³⁾ ⁽⁴⁾. Oral NAC administration results in increased plasma cysteine levels, ultimately leading to increases in plasma GSH. ⁽⁴⁾ The proven way to increase intercellular glutathione is with NAC supplementation.

Glutathione has been suggested as an important anti-cancer and anti-ageing nutrient but to experience the significant benefits, the precursor NAC must be supplemented.

The characteristic antioxidant properties of NAC help to stabilize the cellular redox status, thereby regulating cellular apoptosis, angiogenesis, cell growth and inflammatory response. Both in vivo and in vitro studies confirm the strong antioxidant properties of NAC. Interestingly, it reduces oxidative stress (free radicals in the body) at both high and low concentrations, and in both acute and chronic conditions. The unique antioxidant properties of NAC may explain its strong capacity to attenuate the adverse effects caused by toxic chemicals and drug reactions. The anti-inflammatory properties of this compound are experienced even at low dosages, with effects being dose-dependent. Greater dosages appear to improve bioavailability to exert greater therapeutic potentials.⁽⁶⁾

NAC is well recognized as an effective antidote for acetaminophen and carbon monoxide poisoning. Research also demonstrates that NAC has much other therapeutic potential. For instance, NAC was found to prevent ethanol induced hypertension and adverse renal vascular changes in rats via its ability to bind blood acetaldehyde. ⁽⁷⁾ NAC is also being considered as a treatment alternative to help with inflammatory conditions associated with Cystic Fibrosis. In a group of 18 Cystic Fibrosis (CF) patients with neutrophil airway inflammation (a pulmonary disorder), markers for CF pulmonary function were significantly improved as reflected by decreased sputum elastase activity, and decreased airway neutrophils. The authors stated that high dose oral NAC has the potential to correct antioxidant and inflammatory imbalances associated with CF thereby improving pulmonary health. ⁽⁸⁾ NAC has also demonstrated hepatoprotective effects independent of its effects on elevating the antioxidant glutathione. ⁽⁹⁾

Studies have shown both oral and intravenous administration of NAC significantly improves the management of unstable angina. A prior study conducted in the Journal of the American College of Cardiology (1997) reported that NAC combined with transdermal nitroglycerin was associated with only 13 % of outcome events (i.e. death, myocardial infarction, and refractory angina) versus 39 % and 31 % in placebo and nitroglycerin groups, respectively. The authors concluded that NAC potentiates the therapeutic effects of nitroglycerin.⁽¹⁰⁾

An open, randomized, controlled study published in Respiration (1999) using 169 patients, reported that 6 month standard therapy of Chronic Obstructive Pulmonary Disease (COPD) with NAC (600mg/day) showed a 41 % reduction of exacerbations. The number of sick days was substantially less (82) in the NAC group verses the standard therapy group alone (155). There were no reported adverse events with the supplemental intake of NAC. The authors concluded that NAC is well tolerated and improves the management of both moderate to severe COPD. ⁽¹¹⁾

The evidence shows that NAC may also benefit many other health conditions including:

• Bronchopulmonary disorders,
• Bronchitis,
• Epilepsy,
• Hyperhomocysteinemia,
• End stage renal disease,
• Influenza,
• Cocaine addiction,
• Obsessive–compulsive disorder,
• Trichotillomania and grooming disorders,
• Schizophrenia,
• Bipolar disorder

Effective Dosage Protocols:

The therapeutic dosage of NAC varies according to the condition being treated. For instance, for COPD the supplemental dose is 600mg daily while for reducing plasma homocysteine levels 1.2 grams daily have been used. Unfortunately, many products in the commercial market typically contain very low levels of NAC. For this reason Vitex Nutrition has developed a formula containing 1000 mg of pharmaceutical grade NAC per caplet for improved therapeutic potentials. Consult with your natural health practitioner to determine the most effective dose to manage your particular health condition. Otherwise a daily dose of 1-2 caplets (NAC-1000) or 2-4 DRcaps (C-NAC-500) is a general health recommendation.

Adverse Reactions:

Generally, NAC is well tolerated with occasional mild gastrointestinal upset reported at very high dosages.

Drug Interactions:

Taking NAC with intravenous nitroglycerin may cause severe hypotension and intolerable headaches. Check with health care professional prior to supplemental intake.

References:

1. Witschi A, Reddy S, Stofer B, Lauterburg BH. The systemic availability of oral glutathione. Department of Clinical Pharmacology, University of Bern, Switzerland. Eur J Clin Pharmacol. 1992;43:667–9.
2. Sjodin K, Nilsson E, Hallberg A, et al. Metabolism of N-acetyl-L-cysteine. Some structural requirements for the deacetylation and consequences for the oral bioavailability. Biochem Pharmacol.1989;38:3981–5.
3. Vina J, Reginald H, Krebs HA. Maintenance of glutathione content in isolated hepatocytes. Biochem J. 1978;170:627–30.
4. Borgström L, Kågedal B. Dose dependent pharmacokinetics of N-acetylcysteine after oral dosing to man. Biopharm Drug Dispos. 1990;11:131–6.
5. Holdiness MR. Clinical pharmokinetics of N-acetylcysteine. Clin Pharmacokinet. 1991; 20:123–34.
6. Sadowska AM et al. Antioxidant and Anti-inflammatory Efficacy of NAC in the Treatment of COPD: Discordant in Vitro and in Vivo Dose-Effects: A review. Pulm Pharmacol Ther. 2006 Feb 1.
7. Vasdev S et al. N-Acetyl Cysteine Attenuates Ethanol Induced Hypertension in Rats. Artery. 1995; 21(6): 312-6.
8. Tirouvanziam R et al. High-dose Oral N-Acetyl cysteine, A Glutathione Prodrug, Modulates Inflammation in Cystic Fibrosis. Proc Natl. Acad. Sci. 2006 Mar 21; 103(12):4628-33.
9. Zwingmann C and Bilodeau M. Metabolic Insights into the Hepatoprotective Role of N-Acetyl Cysteine in Mouse Liver. Hepatology. 2006 Feb 22; 43(3): 454-463.
10. Ardissino D et al. Effect of Transdermal Nitroglycerin or N-Acetyl Cysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll. Cardiol. 1997 Apr; 29(5): 941-7.
11. Pela R et al. N-Acetyl Cysteine reduces the exacerbation rate in patients with moderate to severe COPD. Respiration. 1999 Nov-Dec; 66(6): 491-2.
12. Summary of additional research

DRcaps Improve Absorption

To assure that the fragile nutrients in the formula are not affected by the strong acids in the stomach, Vitex employs the new DRcaps technology. These special capsules resist the acid environment of the stomach and will dissolve only in the higher Ph of the small intestine. This assures maximum bio-availability of the nutrients.

DRcaps have many advantages over the traditional enteric coating of tablets and capsules. This new technology eliminates the costly enteric coating process which requires the use of solvents and heat which can have destructive effect on the active ingredients in the formula. DRcaps are resistant to moisture and provide a more precise and consistent dissolution rate compared to traditional enteric coated capsules or tablets.

For a more detailed description of NAC visit Vitex's articles.

NOTE: For maximum benefit, take the SOURCE Optimum, SONA based vitamin/mineral/enzyme formula and VEGAN Omega 3-6-9 to provide the body with optimum levels of other essential nutrients necessary to help maintain long term good health.

Packaging: Packed in light & oxygen resistant recyclable PETE (Bisphenol A free) bottles.
Gluten Free: Contains no animal substance, artificial preservatives, colours, flavours, sugar, starch, salt, dairy, wheat or yeast.
Excipients: Croscarmellose sodium, vegetable magnesium stearate, microcrystalline cellulose, silicon dioxide, vegetable stearin. Ingredient details can be read here.
Aqueous coating: microcrystalline cellulose, carrageenan.
DRcaps: Hypromellose polymer, gellan gum (designed to dissolve in the small intestine)
DRCaps is a reg. trademark of Capsugel.

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