Effect of citicoline on cognitive function in patients with COVID-19

Prohibited during pregnancy

Prohibited during breastfeeding

Not suitable for children

Citicoline is a nootropic drug with a wide spectrum of action. It is developed based on the component of the same name, citicoline. Penetrating into the body, the substance helps reduce brain swelling, restore damaged cell membranes, and prevent excessive formation of free radicals. Citicoline analogues also have identical properties.

Packaging of the drug Citicoline

A medicinal product (hereinafter referred to as medicinal product) is prescribed for:

Ischemic stroke.
Traumatic brain injuries (TBI) to eliminate their consequences and prevent the development of complications.
Degenerative/vascular pathologies that are accompanied by cognitive impairment.

The product can also be used during the rehabilitation period after a hemorrhagic or ischemic stroke.

It is strictly forbidden to prescribe the medication to patients with intolerance to the main substance, pronounced signs of vagotonia, during pregnancy and lactation. According to the manufacturer's instructions, it is not recommended to use this drug in children.

Modern pharmaceutical companies produce many drugs that can be used to replace Citicoline. They can only be purchased with a prescription from your doctor.

Prices of Citicoline and its analogues

The cost of the medicine depends on many factors: manufacturer, quantity, release form, dosage. The average cost of Citicoline in syrup is 710 rubles (30 ml), and in solution form – 1130 rubles. If the patient is not satisfied with the price of the drug, you can choose an analogue at a more affordable price, after consulting with your doctor.

Substitutes may have the same chemical formula or principle of action.

Name of medicine	Dosage/quantity	Price (in rubles)
Recognan	100 ml 30 ml 4 ml No. 5 100 ml 10 pcs.	406 544 1283
Ceresil	125 ml 5 amp. 250 ml 5 amp.	411 836
Naypilept	100 ml 30 ml 250 ml No. 5	447 1168 Read also: Ceftriaxone, 1 g, powder for the preparation of solution for intravenous and intramuscular administration, 25 pcs.
Cerakson	4 ml No. 5 100 ml 30 ml (syrup) 100 ml 10 sachets	671 704 1565

Analogs, like the original, are available with a prescription.

Structural analogues of Citicoline in Russia

Medicines that can be used to replace the original drug are divided into two large groups. One of them includes those developed with the same active ingredient. They have identical mechanisms of action, indications and similar methods of use.

It is worth noting that in Russia Citicoline is not sold under the same name. The trade name of the drug is Ceraxon.

Generic drugs include:

Naypilept.
Recognan.
Ceresil.
Somazina.

Before replacing a prescribed drug, you should consult your doctor.

Cerakson

Ceraxon was developed on citicoline and is also included in the group of nootropic drugs. Under its influence, the function of ion exchange pumps in the cell membranes of the central nervous system (CNS) is normalized due to the formation of new phospholipids.

The drug affects the mechanisms of apoptosis, thereby protecting cells from death. In case of oxygen starvation of the brain, the drug helps eliminate cognitive deviations.

Prescribed for diagnosis:

acute ischemic stroke;
hemorrhagic stroke;
vascular diseases of the brain.

LP also helps reduce the duration of post-traumatic coma and is used during the rehabilitation period after a traumatic brain injury.

The list of contraindications includes:

individual intolerance to components;
pronounced vagotonia;
fructose intolerance.

For the treatment of acute stroke, doctors prescribe 1000 mg twice a day. It is recommended to give 50 mg to newborns, and 10 mg to children over 3 months. Treatment of children should be carried out under the supervision of a doctor.

Ceraxon is a structural analogue of Citicoline. These are absolutely identical drugs.

Naypilept

The role of the main active ingredient in the nootropic drug is citicoline. This substance is a natural endogenous compound. After penetration into the body, it restores damaged membranes, prevents excessive release of free radicals, and blocks the effects of phospholipases.

The therapeutic effect occurs when treating:

Acute form of ischemic stroke (IS).
Cognitive or behavioral disorders that manifest themselves against the background of vascular pathologies.
Traumatic brain injuries.

Often drugs are prescribed to eliminate the consequences of a hemorrhagic stroke.

Doctors include the following conditions for which it is not recommended to use Neypilept:

increased susceptibility to components;
childhood;
pregnancy/lactation;
vagotonia.

When diagnosing an acute period of IS, it is recommended to take the medicine 1000 mg every 12 hours. During the recovery period, the daily dose ranges from 500 to 2000 mg, depending on the severity and characteristics of the disease.

Neypilept and Citicoline are complete analogues. They have the same composition and indications for use. The drugs differ by country of origin. The generic is a domestic drug, and the original is produced in Spain.

Recognan

The drug is included in the pharmacotherapeutic group of nootropics. Its mechanism of action is due to citicoline. It has nootropic and neuroprotective properties. Shows therapeutic activity in chronic forms of cerebral ischemia, cognitive impairment, and dementia. Gently eliminates absent-mindedness, lack of initiative and apathy, normalizes self-care skills and improves memory.

It is recommended to use this medication for the treatment of:

Acute AI.
Traumatic brain injuries (hereinafter referred to as TBI).
Behavioral disorders and cognitive disorders.

In general, the medicine is quite well tolerated by patients, but doctors highlight a list of conditions in the presence of which it can negatively affect the general condition. It includes pregnancy, breastfeeding, childhood, hypersensitivity to components, fructose intolerance and increased tone of the parasympathetic part of the autonomic nervous system.

The solution is intended for oral administration. Should be taken before or after meals. For the treatment of acute stages of IS, 1000 mg is prescribed twice every 24 hours. The maintenance dose is 500-2000 mg. The exact amount of drugs is determined by the attending physician.

Recognan, like the original medication, effectively eliminates unpleasant symptoms and exhibits a high degree of therapeutic activity. These are complete analogues that have no differences except the price.

Ceresil

Ceresil is a nootropic drug. Manufacturers used citicoline as the main component. This natural compound has a fairly wide spectrum of action and is prescribed for vascular diseases, injuries, and motor neurological disorders. It has a nootropic and neuroprotective effect.

Helps improve attention and memory, prevent cell death, and accelerate the recovery process after a TBI.

Main indications for use:

AI in the acute period;
TBI and rehabilitation period;
behavioral/cognitive disorders that manifest themselves with the progression of vascular or degenerative diseases;
recovery period after hemorrhagic stroke.

Before use, you must read the list of contraindications. It includes:

obvious signs of vagotonia;
increased susceptibility to components;
poor tolerance to fructose.

The standard instructions indicate that the product is not suitable for use in pediatrics. However, doctors often prescribe it to children with problems with speech development and other neurological pathologies.

Syrup for internal use can be diluted with a small amount of water. A single dose for adult patients is 1000 mg. The course of treatment can last for six weeks. To maintain the condition, doctors recommend taking from 500 to 2000 mg per 24 hours. In old age, you do not need to adjust the daily dose if the drug does not cause negative reactions.

The structural analogue fully corresponds to the original drug. They have identical properties and are based on the same substance, but the analogue is slightly cheaper.

Somazina

The nootropic drug is available in the form of syrup for oral administration. It is developed on the basis of citicoline. It has nootropic and psychostimulating properties. Leads to normalization of the functioning of ion pumps and receptors, reabsorption of brain swelling, and reduction in the production of free radicals.

It is advisable to take the medicine when diagnosing:

AI in the acute stage.
TBI and its consequences.
Cognitive deviations.
Behavioral disorders under the influence of progressive vascular disease.

If you have vagotonia and hypersensitivity to the components of the medication, taking it is strictly prohibited. It is also not advisable to prescribe the drug to patients who exhibit impaired tolerance to fructose, since it contains sorbitol.

The duration of treatment and dosage are selected by the attending physician, based on the diagnosis. The manufacturer's instructions indicate that the product is taken three times a day, 200 mg. The maximum allowable amount is 2000 mg.

Somazina is a complete analogue of Citicoline. The only difference is the cost.

Introduction

Although SARS-CoV-2 primarily affects the respiratory tract and flu-like symptoms, COVID-19 is now recognized as a multiorgan disease, often affecting the nervous system [1–3].
Neurological manifestations of varying severity have been reported in 36.4–82.3% of those hospitalized with COVID-19 worldwide [4, 5]. Neurological, pulmonary, cardiac and gastrointestinal dysfunction may persist after illness [6, 7]. A number of studies have shown significant deterioration in working memory and attention after COVID-19 [8, 9]. Symptoms such as fatigue, depression, or anxiety can affect patients' perceptions of their cognitive function. In this regard, it seems important to evaluate the role of anxiety and depression, as well as sleep quality in patients who have recovered from COVID-19.

Purpose of the study:

to study the effect of citicoline therapy on the cognitive functions and emotional status of patients who have had COVID-19.

Substitutes from the group of nootropics

The second group of analogues includes drugs that have similar properties and characteristics, but differ in chemical formulas. They may only partially coincide in their readings.

You need to be as careful as possible with such substitutes. To avoid complications of the situation, you cannot replace the prescribed drug yourself. You can purchase another medicine only with the permission of your doctor.

A qualified specialist, taking into account the patient’s condition and the characteristics of his illness, will help choose the most optimal remedy.

Among the substitutes that are popular today are:

Phezam.
Aminalon.
Cavinton.
Vinpotropil.

These drugs are also available by prescription. Before use, you must familiarize yourself with the features of the drug and the instructions.

Cavinton

Cavinton represents a pharmacological group of drugs that help improve cerebral blood flow. The mechanism of action is determined by the active component of the drug, vinpocetine. After penetration into the body, the substance normalizes brain metabolism, saturates the brain with oxygen and glucose, and increases the ability of neurons to withstand hypoxia. The medication also has an inhibitory effect on platelet aggregation and reduces excessive blood viscosity.

Widely used in the fields of ophthalmology, neurology and otolaryngology. Main indications for use:

secondary glaucoma;
atherosclerosis;
vasospasms of the retina;
embolism;
age-related decrease in hearing acuity;
ischemia;
vascular dementia;
mental and neurological disorders;
vertebrobasilar insufficiency.

Contraindications include increased susceptibility, pregnancy, breastfeeding, coronary artery disease, arrhythmia.

The method of use of the drug depends on its dosage form:

The solution is intended for intravenous administration. To prepare an infusion solution, you need to add 20 mg of the drug to 500 ml of saline solution. It is important to ensure that the rate of administration into the body does not exceed 80 drops. in a minute.
The drug in the form of tablets is taken after meals three times a day, one tablet at a time.

Cavinton and Citicoline differ in composition, release form and administration characteristics. Moreover, they both have a positive effect on brain function.

Fezam

This nootropic has a combined composition. The role of the active component is performed by two substances at once: cinnarizine and piracetam. It is characterized by nootropic, vasodilating, antihypoxic properties.

Under the influence of the drug, brain function is activated, metabolism is improved and the rate of glucose consumption increases. Helps relax smooth muscles and increase their ability to resist the effects of factors that provoke narrowing of blood vessels.

It is recommended to take the medication for:

Atherosclerosis of blood vessels.
Intoxication.
Asthenic syndrome.
AI.
Meniere's syndrome.
TBI.
Pathologies of the central nervous system.
Asthenia.
Psychoorganic syndrome in children, which leads to a decrease in the degree of learning.

Experts do not prescribe medications to patients with:

Huntington's chorea;
hypersensitivity to components;
manifestations of psychomotor agitation;
renal or liver failure.

The list of contraindications also includes pregnancy and lactation. In the field of pediatrics, it is used to treat patients over 5 years of age.

It is prescribed with extreme caution in the presence of Parkinson's disease, impaired hemostasis, liver or kidney dysfunction.

The instructions from the pharmaceutical manufacturing company indicate that you need to take 1-2 capsules three times a day. Children over 5 years old are prescribed 1-2 capsules twice. The duration of the course depends on the severity of the pathology.

Unlike the original medicine, the substitute is developed on the basis of two active ingredients at once. It has a wider range of effects. They also differ in dosage forms.

Vinpotropil

Due to its combined composition, the medicine is included in the group of nootropic and cerebrovasodilating agents. Helps improve blood circulation in the brain, dilates blood vessels, supplies the brain with oxygen and glucose, and increases blood supply to the ischemic area. Leads to a decrease in platelet formation and blood viscosity.

Acting as a nootropic drug, Vinpotropil enhances beta and alpha activity, protects the brain from hypoxia or intoxication. Leads to an increase in the rate of glucose utilization, improves memory and the ability to reproduce new information, and facilitates the learning process.

Doctors recommend taking the drug for:

Ischemic stroke.
Cerebrovascular insufficiency.
Asthenic syndrome.
Meniere's syndrome.
TBI.
Intoxications.
Labyrinthopathies.
Psychoorganic syndrome.

Experts identify a number of conditions for which this remedy cannot be used. These include intolerance to the main components, childhood (up to 14 years), arrhythmia, liver and kidney failure, and an acute period of hemorrhagic stroke.

The recommended single dose is 1-2 capsules. Two to three doses per day are allowed. It is advisable to distribute them in such a way that the last one is before 18 hours.

The spectrum of influence of Vinpotropil is somewhat wider than that of the original product, since it contains several main components. Medicines differ in the form of release.

Aminalon

The nootropic drug is produced on the basis of gamma-aminobutyric acid. It has nootropic and neurostimulating properties. Leads to the restoration of metabolic processes, stimulates memory, increases the productivity of thinking, and normalizes high blood pressure.

The product also has antihypoxic and anticonvulsant properties. When used by patients with diabetes, it normalizes blood glucose levels.

The effectiveness of the drug is manifested in the treatment of:

arterial hypertension;
TBI;
encephalopathy;
cerebral palsy;
atherosclerosis;
polyneuritis;
kinetosis.

This product has a high degree of safety. Do not use only if you are allergic to the components.

The daily adult dose is 3-3.75 g. It should be divided into three doses.

The substitute has a number of differences from the original drug. First of all, they consist of different components. Aminalon is a safer medication. They also differ in dosage form.

Reviews from doctors and patients about the choice of Citicoline analogues

It is quite difficult to say with certainty which product is better. The choice of a suitable drug depends on many factors: characteristics of the disease, patient’s condition, personal preferences. With the help of reviews from doctors and people who have encountered the problem of selecting drugs, you can form a certain idea about them:

Lotsmanova O.O., pediatric neurologist: “Among analogues, Ceraxon (Citicoline) stands out for its convenient dosage form. It is quite difficult for kids to take pills, not to mention injections or IVs. It is much easier to drink a pleasant-tasting and aromatic syrup. The medicine has high rates of effectiveness. In my practice, I prescribe it to premature babies or after difficult births. The only drawback is the high cost."

Svetlana, 37 years old: “After a stroke in the hospital, my mother was prescribed Cerakson (iv). Symptoms included weakness in the left arm and leg. The drug eliminated sensory disorders. However, in addition to the positive effect, side effects appeared in the form of diarrhea. I also had to take antidiarrheal drugs. After some time it was replaced with Fezam. The form is more convenient and there were no side effects.”

Vladimir, 47 years old: “I went to the doctor with unpleasant symptoms. Severe and incessant dizziness developed. The pressure jumped. I was prescribed a 5-day course of Ceraxon. After a couple of days, anxiety, irritability and panic appeared. The pressure became even higher. I consulted the doctor again, and he replaced the drug with Aminalon. This effective and safe remedy helped me return to my normal lifestyle.”

Many patients prefer to use analogues, since the original often causes side effects. There are also people who took it and were satisfied with the results. It should be understood that the selection of drugs is a purely individual matter. Only with the help of a doctor can you create an optimal treatment regimen. Citicoline (Cerakson) and its substitutes are based on high-quality raw materials and are characterized by a mild effect.

Research results

Patients in the main and control groups did not differ significantly in gender, age, blood pressure, lipid and carbohydrate profiles (Table 1). The groups were comparable in the number of smoking patients and people with higher education.

The majority of patients who recovered from COVID-19 complained of persistent fatigue, poor sleep, palpitations, and memory loss (Table 2).

In the main group, compared with the control group, there was initially a statistically significant (p <0.05) decrease in short-term memory, the result of the MMSE test, the Coding test, and an increase in the level of anxiety.

During therapy with citicoline, there was a significant improvement in the results of neuropsychological testing (Table 3). In subgroup A, in comparison with subgroup B, a significant (p <0.05) increase in short-term memory, cognitive functions in general, the result of the “Coding” test, improved sleep, and a decrease in the level of anxiety on the HADS scale were revealed (Fig. 1).