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The pathogenesis of MTX-induced renal impairment is thought to be mediated by either MTX and its metabolites precipitating in the renal tubules or MTXs direct toxic impact on the renal tubules (Reference Widemann and Adamson6)

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Children NAC has been used safely in children and adolescents at doses of 6002400 mg per day in a number of clinical trials, 78,94,95,105 although one RCT in autistic children reported constipation (16.1%), increased appetite (16.1%), fatigue (12.9%), nervousness (12.9%) and daytime drowsiness (12.9%), which occurred significantly more commonly in the NAC than in the placebo group

McCrae K

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