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
- Traumatic brain injury3
- 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.
Traumatic brain injury
Citicoline use based on randomized controlled trials in traumatic brain injury (Bavali Oleyayi MS et al, Neuroscience 2026).
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.