Deproteinized hemoderivative from calf blood

Other metabolic agents (local classification)

ATC code: V03AX-ACTOVEGIN (Deproteinized hemoderivative (local code))

Mechanism of action

The biologically active component is a low-molecular-weight fraction of a deproteinized calf blood extract. The manufacturer claims improved tissue glucose and oxygen utilization. The mechanism is not described in international pharmacological literature. The product is not registered in the United States or Canada and was withdrawn from the market in Switzerland. It is not available in most Western European countries.

Indications

Diabetic polyneuropathy

Not recommended

A single published RCT (Ziegler 2009) showed a modest improvement in subjective diabetic polyneuropathy symptoms with intravenous administration. The study has not been replicated in independent multicenter work since. International guidelines from ADA 2024 and AAN 2022 on painful diabetic neuropathy do not mention Actovegin; first-line options are pregabalin, gabapentin, duloxetine, and venlafaxine.

Sources

Cognitive impairment

Not recommended

For cognitive impairment and 'chronic cerebral ischemia', the product is not mentioned in international guidelines (AAN, ESO).

Sources

AAN: Practice Guideline Update: Mild Cognitive Impairment (2018)

Ischemic stroke

Not recommended

International guidelines for acute ischemic stroke management (AHA/ASA 2019, ESO 2021) do not mention the product. Proven acute therapies are reperfusion (thrombolysis, thrombectomy) and standard secondary prevention.

Sources

AHA/ASA: Guidelines for the Early Management of Patients With Acute Ischemic Stroke (2019)

Practical notes

Russian practice note

Actovegin is manufactured by Takeda and registered in Russia and several Eastern European, Asian, and CIS countries. It has never been registered in the United States or Canada. It was withdrawn from the market in Switzerland. It is not available in most Western European countries. The active component is biological (derived from calf blood), historically discussed in the context of theoretical prion risk. Large independent efficacy trials meeting current GCP standards are lacking; the existing evidence base is limited to studies partly funded by the manufacturer.

Safety

Contraindications

Decompensated heart failure
Pulmonary edema
Oliguria, anuria
Fluid retention
Hypersensitivity

Serious adverse effects

Anaphylactic reactions (rare but described)
Anaphylactic shock (very rare)

Common adverse effects

Allergic reactions
Injection site redness and pain

Pregnancy

Use in pregnancy only under strict indication and supervision. International recommendations are unavailable.