Citicoline
CAM (neuroprotective, synthesis of phosphatidylcholine for neuronal cell membranes, enhances acetylcholine production)
- Cocaine1 and Methamphetamine1 (improves mood and cognition)
- Cognition in bipolar (proven only with comorbid stimulant use disorder)
- Age related cognitive decline
- Vascular depression (positive case series)3
- Schizophrenia (negative symptoms)
- Major depressive disorder3
Features
Dosing
Depression and meth/cocaine: 2,000 mg/day, age-related cognitive decline 500 mg/day. Start 500mg/d raise by 500mg each week. As antidepressant augmentation: 200 mg bid
$40-90/mth for 2,000 mg dose
Management
Well-tolerated, low-risk. Neuroprotective. May improve dementia, Parkinson’s disease, traumatic brain injury, glaucoma, and stroke. It only improved cognition in bipolar if there was cocaine/meth use disorder.
EMR Text
Methamphetamine & Cocaine
Citicoline use based on randomized controlled trials where it improved drug use, mood, cognitive function in people with cocaine or stimulant/methamphetamine use disorders (Brown ES et al, Am J Psychiatry. 2015;172(10):1014-21; Brown ES et al, J Affect Disord. 2012;143(1-3):257-60; Brown ES et al, J Clin Psychopharmacol. 2007 Oct;27(5):498-502).
Citicoline’s side effects reviewed with patient.
Depression
Citicoline use based on a randomized controlled trial in major depressive disorder, as well as studies where it improved mood and cognition in other populations (Roohi-Azizi M et al, Clin Neuropharmacol. 2017;40(1):1-5).
Citicoline’s side effects reviewed with patient.
Cognitive impairment
Citicoline use based on randomized controlled trials for mild cognitive impairment, age-related cognitive decline, and post-stroke cognitive impairment (Nakazaki E et al, J Nutr. 2021;151(8):2153-2160.
Citicoline’s side effects reviewed with patient.
Vascular disease
Citicoline use based on a large randomized controlled trial where it improved cognition in patients with vascular ischemic disease, as well as trials where it improved depression in various populations (Alvarez-Sabín J et al, Cerebrovasc Dis. 2013;35(2):146-54).
Citicoline’s side effects reviewed with patient.
Negative symptoms of schizophrenia
Citicoline use based on a randomized controlled trial in negative symptoms of schizophrenia (Ghajar A et al, Hum Psychopharmacol. 2018;33(4):e2662).
Citicoline’s side effects reviewed with patient.