N-acetyl Cysteine (nac) - Orenitram (Treprostinil) Interaction
Herbal: N-acetyl Cysteine (nac)
Also Known As: Acetyl Cysteine, Mucomyst
Drug: Treprostinil
Brand names:
Orenitram
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jun 16, 2024
Interaction Details
Treprostinil is classified as belonging to the following category: Antihypertensive Drugs
Theoretically, N-acetyl cysteine might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research suggests that N-acetyl cysteine potentiates the hypotensive effects of the angiotensin-converting enzyme inhibitors (ACEIs) captopril and enalaprilat. Theoretically, combining N-acetyl cysteine with other antihypertensive drugs might increase the risk of hypotension.
Interaction Rating
Likelihood of Occurrence
PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
Pharmacist Analysis
Although NAC has been associated with causing hypotension (low blood pressure), it appears to be relatively uncommon.
Reports of hypotension appear only to be associated when the drug has been administered IV (intravenously) for the treatment of acetaminophen overdose. Even then, it was only rarely reported (0.1% of adults) to have occurred.
The prescribing information for Mucomyst, a brand-name inhalation solution of NAC, does not list hypotension at all as a reported side effect.
Based on all the available information, the risk of clinically significant hypotension occurring when taking NAC orally as a dietary supplement is quite low, but nonetheless, remains a precaution in our drug interaction pages.
- Dr. Brian Staiger, PharmDReferences
- Ruiz FJ, Salom MG, Inglés AC, et al. N-acetyl-L-cysteine potentiates depressor response to captopril and enalaprilat in SHRs. Am J Physiol. 1994;267(3 Pt 2):R767-72.
Interaction Details
Treprostinil is classified as belonging to the following category: Anticoagulant/Antiplatelet Drugs
Theoretically, N-acetyl cysteine might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
Clinical research suggests that intravenous N-acetyl cysteine decreases prothrombin time, prolongs coagulation time, decreases platelet aggregation, and increases blood loss in surgical patients. Furthermore, in vitro research suggests that N-acetyl cysteine increases the anticoagulant activity of nitroglycerin.
Interaction Rating
Likelihood of Occurrence
PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
Pharmacist Analysis
There are some concerns about the safety of taking NAC with certain medications, including anticoagulants or antiplatelet drugs.
Anticoagulants and antiplatelet drugs are medications that help prevent blood clots, which can be dangerous and potentially life-threatening. Research suggests that taking NAC with these drugs can potentially increase the risk of bleeding, which can also be dangerous.
Clinical research has suggested that intravenous N-acetyl cysteine may decrease prothrombin time, prolong coagulation time, decrease platelet aggregation, and increase blood loss in surgical patients. This means that NAC can interfere with the normal clotting process and increase the risk of bleeding.
However, and this is an important note, these findings were based on intravenous administration of NAC, and it is unclear if the same effects would occur with oral supplementation. However, caution should still be exercised when taking NAC with anticoagulants or antiplatelet drugs.
Be sure to let your doctor know about everything you are taking so you can be monitored appropriately.
- Dr. Brian Staiger, PharmDReferences
- Loscalzo J. N-Acetylcysteine potentiates inhibition of platelet aggregation by nitroglycerin. J Clin Invest. 1985;76(2):703-8.
- Niemi, T. T., Munsterhjelm, E., Poyhia, R., Hynninen, M. S., and Salmenpera, M. T. The effect of N-acetylcysteine on blood coagulation and platelet function in patients undergoing open repair of abdominal aortic aneurysm. Blood Coagul.Fibrinolysis 2006;1
- Wijeysundera, D. N., Karkouti, K., Rao, V., Granton, J. T., Chan, C. T., Raban, R., Carroll, J., Poonawala, H., and Beattie, W. S. N-acetylcysteine is associated with increased blood loss and blood product utilization during cardiac surgery. Crit Care Me
- Chirkov, Y. Y. and Horowitz, J. D. N-Acetylcysteine potentiates nitroglycerin-induced reversal of platelet aggregation. J Cardiovasc.Pharmacol 1996;28(3):375-380.
N-acetyl Cysteine (nac) Overview
N-acetyl Cysteine (nac) - More Interactions
N-acetyl Cysteine (nac) interacts with 290 drugs
Interaction Rating Key
These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.
Major | The combined use of these agents is strongly discouraged as serious side effects or other negative outcomes could occur. |
Moderate | Use cautiously under the care of a healthcare professional or avoid this combination. A significant interaction or negative outcome could occur. |
Minor | Be aware that there is a chance of an interaction. Watch for warning signs of a potential interaction. |
Unknown | No interactions have been reported or no interaction data is currently available. |
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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
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Drug descriptions are provided by MedlinePlus.