N-Acetylcysteine Use to Prevent Contrast Medium–induced Nephropathy: Premature Phase III Trials
Received 16 August 2007; received in revised form 31 October 2007; accepted 1 November 2007.
To date there has been no general consensus regarding the effectiveness of N-acetylcysteine as a protective therapy against contrast medium–induced nephropathy. Several phase III clinical trials have been conducted without a proper understanding of N-acetylcysteine pharmacology, particularly with regard to first-pass hepatic metabolism. A review was conducted of the literature concerning contrast medium–induced nephropathy and new studies of human N-acetylcysteine pharmacology were performed. After an analysis was performed, it was concluded that further phase I and phase II trials are needed. The efficacy of N-acetylcysteine in the prevention of contrast medium–induced nephropathy may be demonstrated with the use of higher doses than used in earlier studies, in combination with parenteral administration.
aDepartment of Neurology, Oregon Health & Science University, Portland, Oregon
bDepartment of Neurosurgery, Oregon Health & Science University, Portland, Oregon
cDepartment of Cell and Developmental Biology, Oregon Health & Science University, Portland, Oregon
dDepartment of Angiography, Oregon Health & Science University, Portland, Oregon
ePharmacy Department, Oregon Health & Science University, Portland, Oregon
fDivision of Hospital and Specialty Medicine, Nephrology Section, Portland, Oregon
gPortland Veterans Administration Medical Center, Portland, Oregon
hDepartment of Physiology and Biophysics, Rosalind Franklin University of Medicine and Science, The Chicago Medical School, North Chicago, Illinois.
Address correspondence to E.A.N., Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Parkway, L603, Portland, OR 97239
E.A.N., L.L.M., Oregon Health & Science University, Portland Veterans Affairs Medical Center, and the Department of Veterans Affairs have significant financial interest in Adherex (Durham, NC), a company that may have a commercial interest in the results of this research and technology. This potential conflict of interest was reviewed and managed by the Oregon Health & Science University Integrity Program Oversight Council and the Portland Veterans Affairs Medical Center Conflict of Interest in Research Committee. E.A.N. has divested his financial interests in Adherex. This work was supported by a Veterans Administration Merit Review Grant and by National Institutes of Health grants NS33618 and NS44687 from the National Institute of Neurological Disorders and Stroke to E.A.N.
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