Citicolina: revisión farmacológica y clínica, actualización 2022 / Citicoline: pharmacological and clinical review, 2022 update

Esta revisión se basa en la publicada en 2016 –Secades JJ. Citicolina: revisión farmacológica y clínica, actualización 2016. Rev Neurol 2016; 63 (Supl 3): S1-S73–, e incorpora 176 nuevas referencias aparecidas desde entonces, con toda la información disponible para facilitar el acceso a toda la información en un único documento. La revisión se centra en las principales indicaciones del fármaco, como los accidentes cerebrovasculares agudos y sus secuelas, incluyendo el deterioro cognitivo, y los traumatismos craneoencefálicos y sus secuelas. Se recogen los principales aspectos experimentales y clínicos en estas indicaciones

This review is based on the previous one published in 2016 (Secades JJ. Citicoline: pharmacological and clinical review, 2016 update. Rev Neurol 2016; 63 (Supl 3): S1-S73), incorporating 176 new references, having all the information available in the same document to facilitate the access to the information in one document. This review is focused on the main indications of the drug, as acute stroke and its sequelae, including the cognitive impairment, and traumatic brain injury and its sequelae. There are retrieved the most important experimental and clinical data in both indications.(AU)

Citicolina, ¿deberíamos seguir indicándola en ECV isquémica? / Citicolina, devemos continuar a indicá-lo nA DCbV isquemica? / Citicoline, should we continue to indicate it in ischemic CVD?

Resumen: La enfermedad cerebrovascular (ECV) isquémica es una condición médica que implica, según su grado, discapacidad importante para el paciente, además de altos costos para su tratamiento agudo y crónico, así como en el manejo de la discapacidad con alta incidencia y prevalencia a nivel mundial. Desde el punto de vista fisiopatológico, representa una catástrofe en el funcionamiento cerebral que involucra daño estructural y funcional. Se han desarrollado múltiples estrategias para el manejo de esta patología; actualmente, el estándar de oro para su manejo es el rt-PA; sin embargo, por sus características, pocos pacientes tienen acceso al mismo. Razón por la que se han desarrollado estrategias farmacológicas diversas para su manejo: la citicolina se ha usado durante años, no obstante, genera controversias dado que su utilidad, demostrada en estudios experimentales, no se ha reproducido en la práctica clínica; más aún, algunos estudios sugieren que podría empeorar el pronóstico del paciente, lo que justificaría el abandono de su uso en el tratamiento de ECV isquémica (ictus). Por tal motivo ofrecemos esta revisión del tema con el fin de brindar herramientas que permitan aclarar dicha controversia.

Abstract: Ischemic cerebrovascular disease (CVD) is a medical condition that, according to its extension, implies significant disability for the patient, as well as high costs for its acute and chronic treatment, as well in the management of disability, with high incidence and worldwide prevalence, from the physiopathological point of view represents a catastrophe in brain functioning that involves structural and functional damage. Multiple strategies have been developed for the management of this pathology, currently the gold standard for its management is the rt-PA, however, due to its characteristics, and few patients have access to it, because it various pharmacological strategies have been developed. Citicoline has been used for years, nevertheless generates controversies since its usefulness, demonstrated in experimental studies, has not been reproduced in clinical practice but some studies suggest that it could worsen the patient's prognosis, which would justify the abandonment of its use in the treatment of ischemic CVD (ictus), for this reason we offer this review of the subject in order to provide tools to clarify this controversy.

Resumo: A doença cerebrovascular (DCbV) isquêmica é uma condição clínica que de acordo com sua extensão, implica em uma significativa incapacidade para o paciente, ademais de altos custos para seu tratamento agudo e crônico, bem como no manejo da incapacidade com alta incidência e prevalência a nível mundial. Do ponto de vista fisiopatológico representa uma catástrofe no funcionamento do cérebro que envolve danos estruturais e funcionais. Múltiplas estratégias têm sido desenvolvidas para o tratamento dessa patologia, atualmente o padrão ouro para o seu manejo é o rt-PA, porém, devido às suas características, poucos pacientes têm acesso a ele, razão pela qual várias estratégias farmacológicas foram desenvolvidas, a citicolina vem sendo utilizada há anos, gera controvérsias, uma vez que sua utilidade, demonstrada em estudos experimentais não foi reproduzida na prática clínica, mas alguns estudos sugerem que ela poderia piorar o prognóstico do paciente, o que justificaria o abandono do seu uso no tratamento de DCbV isquêmica (ictus), por esse motivo oferecemos esta revisão, a fim de fornecer ferramentas para esclarecer esta controvérsia.

[Prescription appropriateness: Indication of citicoline in Primary Care]. / Adecuación prescripción-indicación de citicolina en atención primaria.

INTRODUCTION: The economic situation has made it necessary to optimize resources by adjusting the pharmaceutical expenditure. Citicoline was (2011) the 10th drug by rank of billed amount. Its approved indications are stroke (acute and sub-acute) and head injury, but not cognitive decline associated with age, the presumed indication for most of its use. OBJECTIVES: To assess the conditions of use of citicoline in the Health Area of Tenerife, in order to detect deviations from the indications of use as stipulated in the prescribing information sheet and the pattern of prescription, with emphasis on the analysis of its use in dementia where currently it has no indication or evidence to support it. METHOD: Cross-sectional study of prescription-indication. A 680 patient sample, segmented by reference hospital (error±5%; CI: 0.95%; P=0.5) was taken from the 4036 patients with a prescription of citicoline billed during august-october 2011 (obtained from the prescription database program, Farmacanarias). RESULTS: We found that 123 patients (18.1%) had an appropriate indication. By including the prescription regimen, 28 patients (4.1%) had adequate indication and dose levels, and in only 2 patients (0.2%) an appropriate indication, dosage and duration were found. CONCLUSIONS: "The correct prescription-indication" of citicoline is inappropiate in almost all patients studied. Impact actions are needed in order to optimize prescription, improve patient safety by reducing potential interactions, and the occurrence of adverse effects, and improve efficiency by promoting savings.