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Similar behavior has previously been observed for some other organic molecules [13]

Intravenous delivery bypasses first-pass metabolism in the liver and intestinal wall, allowing more rapid attainment of therapeutic concentrations, as seen in its use for paracetamol poisoning.36 In healthy adults, intravenous NAC (600 mg) has a terminal half-life of approximately 2.3 hours, with virtually no detectable plasma levels after 12 hours.35 NAC is primarily excreted renally, with about 30% of the administered dose recovered in the urine,35 whilst faecal excretion accounts for approximately 3%.2,37 In paediatric patients, differences in pharmacokinetics and pharmacodynamics compared with adults require dosing adjustments to ensure optimal drug efficacy and safety.38,39 Mechanism of action of NAC NAC exerts its therapeutic effects through multiple mechanisms, primarily involving its mucolytic, antioxidant and anti-inflammatory properties.40 As an acetylated precursor of L-cysteine, NAC plays a pivotal role in maintaining cellular redox homeostasis and modulating inflammatory pathways.40 NAC is widely recognized for its mucolytic properties, particularly in respiratory diseases characterized by excessive mucus production such as CF, COPD and idiopathic pulmonary fibrosis.40 The mucolytic effect of NAC is multifactorial, combining direct and indirect mechanisms that facilitate mucus clearance

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Plant glutathione S-transferases: enzymes with multiple functions in sickness and in health

The Prx4, which is mainly expressed in the endoplasmic reticulum compartment can be enhanced at the post-transcriptional level by calpain [67]

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