Background: Acute liver failure (ALF) is a rare syndrome, characterized by acute derangement of liver function and carries high mortality. Indeterminate ALF still forms a significant number of cases in India as well in the world. A prospective case-control study was carried with the aim to determine the effect of N-Acetylcysteine (NAC) on the survival of indeterminate ALF patients. Methods: A total of 30 patients with a diagnosis of indeterminate ALF were included in the study. 14 patients received NAC infusion for 72hrs whereas 16 patients in control group received placebo. The parameters evaluated were demographic, clinical, biochemical, outcome and length of hospital stay. Results: The two groups were comparable for the various baseline characteristics (demographic, clinical, biochemical etc.). A total of 18 of 30 (60%) patients died with ALF complications; 6 (42.8%) patients belonged to NAC group and 12 (75%) patients to Control group (P = 0.077). The overall survival was not improved by NAC in indeterminate ALF. Use of NAC also did not reduce the duration of hospital stay of survived patients (P = 0.409). Conclusion: The overall survival was not improved by NAC in indeterminate ALF. NAC administration did not reduce the duration of hospital stay.