Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity

Eur J Gastroenterol Hepatol. 2010 Oct;22(10):1235-8. doi: 10.1097/MEG.0b013e32833aa11b.


Introduction: Isoniazid, rifampicin, and pyrazinamide, the first-line antituberculosis (anti-TB) drugs, are associated with hepatotoxicity.

Aims and objectives: To study the hepatoprotective effect of N-acetylcysteine (NAC) on liver injury induced by anti-TB drugs.

Methods: A randomized clinical trial was conducted on 60 new TB patients who were aged 60 years or more. Patients were randomized into two groups. In group I (n=32), drug regimen included daily doses of isoniazid, rifampicin, pyrazinamide, and ethambutol. Patients in group II (n=28) were treated with the same regimen and NAC. The patients were followed up for 2 weeks. Liver enzymes and bilirubins were measured at baseline, after 1 and 2 weeks of treatment, and whenever the patients presented with clinical symptoms of hepatotoxicity.

Results: The mean+/-SD values of aspartate aminotransferase and alanine aminotransferase were significantly higher in group I than in group II after 1 and 2 weeks of treatment. Hepatotoxicity occurred in 12 patients with (37.5%) group I and none in group II. The mean duration of treatment before the onset of hepatotoxicity was 4.67+/-4.58 days.

Conclusion: NAC protects against anti-TB drug-induced hepatotoxicity.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / administration & dosage*
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / adverse effects*
  • Chemical and Drug Induced Liver Injury / etiology
  • Chemical and Drug Induced Liver Injury / prevention & control*
  • Drug Interactions
  • Drug Therapy, Combination
  • Ethambutol / adverse effects
  • Female
  • Free Radical Scavengers / administration & dosage*
  • Humans
  • Isoniazid / adverse effects*
  • Liver / drug effects
  • Male
  • Pyrazinamide / adverse effects
  • Rifampin / adverse effects
  • Tuberculosis, Pulmonary / drug therapy*


  • Antitubercular Agents
  • Free Radical Scavengers
  • Pyrazinamide
  • Ethambutol
  • Isoniazid
  • Rifampin
  • Acetylcysteine