Rachel L. Tomko, PhD Research Assistant Professor Department of Psychiatry and Behavioral Sciences
Jennifer L. Jones, MD Resident Physician Departments of Psychiatry and Behavioral Sciences and Internal Medicine
Amanda K. Gilmore, PhD Research Assistant Professor College of Nursing and Department of Psychiatry and Behavioral Sciences
Kathleen T. Brady, MD, PhD Distinguished University Professor Department of Psychiatry and Behavioral Sciences
Sudie E. Back, PhD Professor Department of Psychiatry and Behavioral Sciences
Kevin M. Gray, MD Professor Department of Psychiatry and Behavioral Sciences
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Medical University of South Carolina Charleston, South Carolina
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products. This article was supported by National Institutes of Health grants from the National Institute of Drug Abuse (R25 DA020537, R01 DA042114, R01 DA038700, R01 DA026777, K23 DA042935, K02 DA039229, UG1 DA013727) and the National Institute on Alcohol Abuse and Alcoholism (T32 AA007474, R01 AA025086) and the Department of Defense (W81XWH-13-2-0075 9261sc).
Cessation and relapse prevention.Several pilot studies found that adult smokers who received NAC (alone or in combination with another treatment) had lower carbon monoxide levels,31,32 smoked fewer cigarettes,32,33 and had fewer self-reported symptoms of nicotine dependence34 and/or less craving for cigarettes.31 However, one study of 33 smokers did not find a reduction in craving or carbon monoxide for NAC compared with placebo.33 Another pilot study of 22 young adult smokers found that those who received NAC rated their first cigarette after treatment (smoked in the laboratory) as less rewarding, relative to smokers who received a placebo.35
Secondary analyses of adults with bipolar disorder36 and adolescents with cannabis use disorder37 found no decreases in tobacco use among those who received NAC compared with placebo. However, the studies in these analyses did not specifically recruit tobacco users, and participants who were tobacco users were not necessarily interested in quitting. This may partially explain discrepant findings.
Appropriate populations.NAC has been studied mostly in adult cigarette smokers.
Safety and dosing.Suggested dosages for treating tobacco use disorder range from 1,200 to 3,600 mg/d (600 to 1,800 mg twice daily).
