Recently, a psychiatrist Dr. Daniel Amen shared how N-acetylcysteine (NAC), a precursor to glutathione and a modulator of glutamatergic neurotransmission, may offer therapeutic benefits in reducing nicotine cravings associated with vaping. 

NAC

While traditional smoking cessation tools such as nicotine replacement therapy (NRT), bupropion, and varenicline are helpful, effective management of vaping addiction remains limited. 

Cysteine is an amino acid that serves as a building block for proteins in the body. When taken as a supplement, it is typically in the form of N-acetyl-L-cysteine (NAC), which the body converts into cysteine and then uses to produce glutathione, a potent antioxidant.[1]

Antioxidants like glutathione help neutralise free radicals, which are believed to contribute to ageing and various health issues, including heart disease and cancer. NAC is also known for its ability to reduce the side effects of drugs and toxins and help break down mucus.

It is most often used as a treatment for acetaminophen poisoning, and it has shown potential in managing respiratory conditions, such as bronchitis and chronic obstructive pulmonary disease.[1]

How it helps vapers quit

According to Rostislav Ignatov, MD, Chief Medical Officer at The Haven Detox, NAC can serve as an adjunct therapy for nicotine dependence. “NAC modulates glutamatergic and dopaminergic pathways in the brain. This modulation can stabilise glutamate levels, reducing the impulsivity and compulsive behaviours associated with cravings.”

Though promising, reports are mixed when it comes to NAC’s effectiveness as monotherapy; consider the following: 

1. In a 2024 randomised controlled trial (RCT), smokers treated with NAC at 2,400 mg twice daily had a 38% abstinence rate compared to 7% in the placebo group (p=0.02), significantly reducing weekly cigarette use and lower CO levels.[2]
2. Conversely, a similar 2021 trial using a lower dose of 1,200 mg twice daily found no significant difference between NAC and placebo in terms of abstinence and relapse rates.[3]
3. Nonetheless, another trial demonstrated that NAC, when used as an adjunct with first-line therapies consisting of NRT and bupropion), significantly improved smoking cessation outcomes.[4]
4. The researchers also noted that NAC, when combined with first-line therapies, may help reduce inflammation and metabolic distress associated with smoking.

Michael Kane, MD, medical director at the Indiana Center for Recovery, says, "I have observed NAC showing promise in managing nicotine cravings." Other physicians have also reported positive outcomes in their clinical practice using NAC for nicotine cravings, though the evidence largely stems from broader addiction studies.

However, all three experts caution against using NAC as a primary treatment, recommending it as an adjunct to traditional therapies like NRT, bupropion, and varenicline. Combining NAC with these and behavioural support may address both neurobiological and psychological aspects of nicotine addiction.

Lastly, a proactive approach is equally important to address vaping before it escalates. Dr. Kane advocates for a harm-reduction approach, stressing that patients need clear information on why vaping isn’t a safe alternative, adding, “Neither smoking nor vaping is truly ‘safe.’”

"The rise of vaping among younger patients is concerning due to its potential to establish early and strong nicotine dependence,” says Dr. Kane. “The ease of access, appealing flavours, and cultural acceptance of vaping has significantly increased its popularity among adolescents and young adults."

Disclaimer: This story is contributed by Alpana Mohta and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.