Citicoline (CDP-choline) has been investigated as a neuroprotective agent in the context of acute ischemic stroke. The rationale for its use is based on its role as a precursor for the synthesis of phosphatidylcholine, a key component of cell membranes, and its potential to support neuronal repair and reduce neuronal damage following stroke. Several clinical trials, including the large multicenter ICTUS trial published in 2012 (Lancet), assessed the efficacy of citicoline in acute ischemic stroke. While some earlier, smaller studies suggested modest improvements in functional outcomes, the ICTUS trial (with over 2,000 participants) found no significant benefit over placebo in terms of recovery at 90 days.

Meta-analyses have produced mixed results: some suggest a possible small benefit in functional recovery, especially when treatment is started early and in less severe strokes, but the overall evidence is inconsistent and not robust. Major stroke guidelines (e.g., American Heart Association/American Stroke Association) do not recommend citicoline as standard therapy for stroke, citing insufficient evidence of efficacy. Citicoline is generally considered safe, with few reported side effects, which has contributed to its continued study and use in some regions. In summary, while there is a scientific rationale and some clinical investigation, the evidence supporting citicoline’s routine use for stroke recovery is moderate at best and not definitive.