Citicoline in clinical practice Review article

Abstract

Citicoline (cytidine-5’-diphosphocholine, CDP-choline) is a neuromodulator with a well-described pharmacological profile, exhibiting neuroprotective and neuroregenerative effects across a range of clinical conditions. As a precursor of membrane phospholipids, it contributes to the maintenance of neuronal integrity, myelin sheath stability, and proper cholinergic neurotransmission. Its mechanisms of action include enhancement of phosphatidylcholine synthesis, improvement of mitochondrial bioenergetics, reduction of oxidative stress, modulation of neurotransmission, and attenuation of microglial activation. Preclinical and clinical evidence indicate that citicoline supports repair processes in acute central nervous system injuries, such as ischemic stroke and traumatic brain injury, by promoting neuronal plasticity and metabolic stability. In chronic cognitive disorders of vascular, neurodegenerative, and post-COVID-19 origin, its use has been associated with improvements in cognitive performance, particularly in memory, attention, and executive functions. In ophthalmology, citicoline has demonstrated beneficial effects on retinal ganglion cell function, visual pathway conduction, and the progression of neurodegeneration in glaucoma and diabetic retinopathy. Citicoline is characterized by a favorable safety profile, with infrequent and generally mild adverse effects, confirmed across diverse patient populations. Overall, current evidence supports citicoline as a relevant component of contemporary neuroprotective strategies targeting phospholipid metabolism and mitochondrial function in both neurological and ophthalmic disorders.