Citicoline is a naturally occurring substance that is an essential intermediate in the synthesis of structural phospholipids of cell membrane. Oral dose of Citicoline is metabolized to choline & cytidine. These then enter into the systemic circulation, cross the blood-brain barrier and recombine to form Citicoline within the central nervous system. Citicoline activates the biosynthesis of structural phospholipids in the neuronal membrane, promotes rapid repair of injured cell surface & mitochondrial membrane & increases the level of various neurotransmitters like acetylcholine & dopamine. Citicoline has neuroprotective effects in situations of hypoxia & ischemia, as well as improved learning & memory performance in animal models for the aging brain. Citicoline inhibits the activation of Phospholipase A2 to prevent apoptotic & necrotic cell death.

Citicoline Sodium is indicated in-

• Cerebrovascular disease e.g. ischemia due to stroke, where Citicoline accelerates the recovery of consciousness & overcoming motor deficit. Treatment within the first 24 hours after onset in patients with moderate to severe stroke increases the probability of complete recovery in 3 months.
• Cerebral insufficiency (e.g. dizziness, memory loss, poor concentration & disorientation) due to head trauma or brain injury.
• Cognitive dysfunction due to degenerative disease (Alzheimer's disease)
• Parkinson's disease: Citicoline has been shown to be effective as co-therapy for Parkinson's disease.

Oral:

• Immediate treatment of stroke due to a clot (ischemic stroke): 500-2000 mg of Citicoline per day, start within 24 hours of stroke.
• For decline in thinking skills due to stroke: 1000-2000 mg of Citicoline per day.
• Chronic cerebrovascular disease: 1000 mg daily in divided dose with or between meals for ongoing disease of the blood vessels that serve the brain.

Injection:

• 1 to 2 injections daily.
• Adjust dosage according to the severity.
• Can be administered through intramuscular (IM), or intravenous (IV) [ 3 to 5 minutes] route.

Patients with hypertonic of the parasympathetic nervous system.

Occasionally Citicoline may exert stimulating action of the parasympathetic system as well as a fleeting & discrete hypotensive effect.

In case of persistent intracranial hemorrhage, it is recommended not to exceed the dose of 1000 mg of Citicoline daily.

Use in Special Populations

Geriatric use: No dosage adjustment is required & the usual dose can be administered.

Pregnancy & Lactation

There are no adequate & well controlled studies of Citicoline during pregnancy & lactation. Citicoline should be used during pregnancy & lactation only if the potential benefits justify the potential risks.