Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Citicoline (also known as CDP-choline) has been investigated as a treatment to support recovery after stroke, particularly ischemic stroke. The rationale behind its use is based on its role as an intermediate in the biosynthesis of phosphatidylcholine, a key component of cell membranes, which is thought to help repair neuronal membranes and reduce neuronal damage. Early preclinical studies showed neuroprotective effects, and some small clinical trials suggested potential benefits in improving neurological outcomes and functional recovery after stroke.

However, the overall scientific evidence is mixed. Some meta-analyses and systematic reviews (e.g., Dávalos et al., 2002; Saver, 2008) initially suggested modest improvement in functional recovery, particularly if citicoline was administered early after stroke. Nevertheless, a large, high-quality randomized controlled trial (the ICTUS trial, 2012) involving over 2,000 patients failed to demonstrate significant benefit of citicoline over placebo in improving recovery at 90 days post-stroke. Subsequent reviews have concluded that while citicoline is generally safe and well-tolerated, its efficacy for stroke recovery is uncertain and not robustly proven.

As such, citicoline is used in some countries to support stroke recovery, but it is not universally recommended in major stroke treatment guidelines due to insufficient evidence. The evidence rating of 2 reflects this mixed and inconclusive data: there is scientific investigation, but not strong, consistent support for efficacy.

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