Comparison of two different doses of citicoline in patients with traumatic brain injury

Introduction: The ever increasing and common occurrence of head traumas highlight the importance of adopting therapeutic measures for the reduction of the associated morbidity and mortality. Citicoline, as a safe medicine with positive effects on improving traumatic injuries, has been proven to be useful in various studies. However, there are still no data on the specific standard method and dosage of citicoline for the treatment of patients with traumatic head injuries. Regarding this, the present study was performed to determine the effective therapeutic dosage of citicoline and its impact on patients with traumatic head injuries. Methods: This double-blind clinical trial was performed on 30 patients with traumatic concussion (a Glasgow coma scale [GCS] of ≤8) admitted to the intensive care unit and neurosurgery department. The patients were randomly divided into three groups of A (control), B (citicoline with a dosage of 0.5 g/twice a day), and C (citicoline with a dosage of 1.5 g/twice a day). The GCS, degree of muscle strength, Glasgow outcome score (GOS), contusion volume, and cerebral edema (based on brain CT scans) were calculated at specific times and intervals. In addition, the patients' dependency on a ventilator and their length of ICU stay were registered. Results: Mean GCS on the first day of stay, GCS changes on the third and fourth days of stay, first and seventh days of stay, seventh and fourteenth days of stay, and first and fourteenth days of stay in the three study groups showed the significant statistical difference (P<0.05). Significant statistical differences were seen between the GOS of the 30th day of stay in the three study groups (P<0.05). The contusion volume difference was only significant between the first and seventh day of stay in groups A and C (P<0.05). No significant difference was observed in the mean length of stay in ICU and duration of dependency on a ventilator in the three study groups (P<0.05). The mean degree of muscle strength was only significantly different on the first day of stay between groups B and C (P=0.008). Conclusions: In contrary to similar studies, the results of the current study revealed that citicoline had no positive effect on patient healing. This result may be due to the small sample size and the inconsistent first-day GCSs of the patients in all three groups. Therefore, given the confirmation of the effectiveness of citicoline even at higher dosages in other studies in future studies, it is recommended to use populations with a larger number of patients.