Evigrade
DrugsCosmetic ingredientsCalculatorsInteractionsEvigrade SkinEvigrade Meds ↗
ConditionsJournalMethodologyPro for practitioners
ESRU

Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex)

Other metabolic agents (local classification)

ATC code: A16AX-CYTOFLAVIN

Updated · Methodology

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Ischemic stroke

Not recommended

Cytoflavin combines succinic acid, nicotinamide, riboflavin and inosine, and is promoted as a metabolic and neuroprotective remedy for ischemic stroke. Convincing benefit for this use has not been shown: there is no solid evidence that it changes stroke outcomes. What actually helps in ischemic stroke is calling emergency services early, thrombolysis or thrombectomy within the first hours, and supervised rehabilitation. Cytoflavin should not be used instead of treatments with proven benefit, or you risk losing the time when real help works.

Sources

  1. Zh Nevrol Psikhiatr Im S S Korsakova: [Improving the effectiveness of treatment of patients with post-stroke aphasia]. (2024)
  2. Zh Nevrol Psikhiatr Im S S Korsakova: [A multicenter, international observational study of the efficacy of Cytoflavin solution for intravenous administration in patients with ischemic stroke not receiving reperfusion therapy]. (2026)
  3. AHA/ASA: Guidelines for the early management of patients with acute ischemic stroke: 2019 update (2019)

ICD-10: I63 · ICD-11: 8B11

F

Chronic fatigue

Not recommended

Cytoflavin is a Russian combination of succinic acid, nicotinamide, riboflavin, and inosine. It is not included in international clinical guidelines, and the , , and AEMPS have not approved it. Cytoflavin is prescribed for the Soviet-era diagnoses asthenic syndrome, nervous-system exhaustion, post-infectious asthenia, and dyscirculatory encephalopathy, none of which exist in ICD-11 or international neurology. There are no independent international clinical studies with endpoints on validated fatigue or cognitive scales. For chronic-fatigue complaints, the workup should include anemia, B12 deficiency, hypothyroidism, depression, obstructive sleep apnea, and chronic infections: the cause is often one of these. For dizziness attributed to blood pressure, check blood pressure, hemoglobin, and rule out cardiac arrhythmia. If cytoflavin was prescribed for asthenia or after an acute respiratory infection, consider seeking a second opinion.

Sources

  1. Zh Nevrol Psikhiatr Im S S Korsakova: [Clinical efficacy of neurometabolic therapy of dissomical disorders in asthenic syndrome]. (2019)
  2. Bull Exp Biol Med: Comparative Analysis of Stress-Protective Activity and Prevention of Fatigue during Physical Load of Standardized Humic Acids from Peat and Officinal Preparations of Succinic Acid in Experiment. (2023)
  3. Zh Nevrol Psikhiatr Im S S Korsakova: [The result of prospective randomized study CITADEL - the efficacy and safety of drug cytoflavin in postcovid rehabilitation]. (2021)

ICD-10: R53 · ICD-11: MG22

F

Post-stroke recovery

Not recommended

In post-stroke rehabilitation, Cytoflavin is not mentioned in Stroke Rehabilitation Guidelines 2016 or . Effective approaches: early mobilization, physical and occupational therapy, speech therapy, psychological support. CIMT helps hemiparesis; intensive speech therapy helps dysphasia. Pharmacotherapy is largely limited to antidepressants for post-stroke depression.

Sources

  1. Stroke: Guidelines for Adult Stroke Rehabilitation and Recovery (2016)
  2. Canadian Journal of Physiology and Pharmacology: Early predictive blood markers of hemorrhagic stroke — influence of cytoflavin therapy (2021)
  3. Zh Nevrol Psikhiatr Im S S Korsakova: [Improving the effectiveness of treatment of patients with post-stroke aphasia]. (2024)

ICD-10: I69 · ICD-11: 8B25

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

The manufacturer claims metabolic, anti-hypoxic, and antioxidant effects from a four-component composition — succinic acid, nicotinamide, riboflavin, and inosine. Claimed indications include ischemic brain or myocardial injury, post-hypoxic states, asthenia, and prolonged intoxications. International , , and recommendations do not mention the product as a therapeutic agent. Independent multicenter RCTs by current standards are absent. The manufacturer and the related clinical research base are located in Russia.

Safety

Contraindications

  • Hypersensitivity
  • Pregnancy (parenteral forms)
  • Breastfeeding
  • Gout, hyperuricemic nephrolithiasis (inosine component)

Serious adverse effects

  • Anaphylactic reactions (rare)
  • Hyperuricemia and gout flare (due to inosine)
  • Independent data on other serious adverse events are insufficient

Common adverse effects

  • Facial flushing, warmth sensation
  • Nausea
  • Injection site pain
  • Allergic reactions

Pregnancy: can you take Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex)?

Parenteral forms are contraindicated in pregnancy per manufacturer label. No international recommendations.

Breastfeeding: can you take Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex)?

Contraindicated during breastfeeding per manufacturer label.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Russian practice note

Cytoflavin is produced and used primarily in Russia by Polysan. It is not registered internationally. Included in some Russian Ministry of Health protocols for ischemic stroke, hypoxic states, and post-infectious asthenia under the Russian evidence scale. This creates divergence from international practice. Independent international RCTs of clinical efficacy are absent.

Common myths

Myth: 'IV Cytoflavin courses after stroke or COVID speed recovery'. Fact: international guidelines do not support these regimens. Evidence-based rehabilitation includes early mobilization, physical and occupational therapy, speech therapy, and psychotherapy or antidepressants when needed.

Myth: 'the components are vitamins and amino acids, so the combination is safe and useful'. Fact: mixing nutrients in a pharmaceutical form does not make the combination therapeutically effective. Evidence comes from clinical RCTs, not composition. Independent international RCTs of Cytoflavin do not exist.

Check interaction with another drug

Opens the checker prefilled with this drug. Pick the second one from your regimen.

Open checker

Summary of a multi-drug list →

Medicine list: everything you take in one place →

Frequently asked

What is Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex) used for?

Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex) is evaluated for the following indications with varying evidence strength: Ischemic stroke (evidence tier D), Post-stroke recovery (evidence tier F), Chronic fatigue (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex)?

Common side effects of Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex) (≥ 1 in 100): Facial flushing, warmth sensation, Nausea, Injection site pain, Allergic reactions. See the Safety section for uncommon and serious reactions.

Is Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex) safe during pregnancy?

Parenteral forms are contraindicated in pregnancy per manufacturer label. No international recommendations.

Is Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex) compatible with breastfeeding?

Contraindicated during breastfeeding per manufacturer label.

Who should not take Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex)?

Cytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex) is contraindicated in: Hypersensitivity; Pregnancy (parenteral forms); Breastfeeding; Gout, hyperuricemic nephrolithiasis (inosine component). Full list in the Safety section.

IV Cytoflavin courses after stroke or COVID speed recovery

international guidelines do not support these regimens. Evidence-based rehabilitation includes early mobilization, physical and occupational therapy, speech therapy, and psychotherapy or antidepressants when needed.

the components are vitamins and amino acids, so the combination is safe and useful

mixing nutrients in a pharmaceutical form does not make the combination therapeutically effective. Evidence comes from clinical RCTs, not composition. Independent international RCTs of Cytoflavin do not exist.

Other drugs in this group

D-aspartic acid (DAA), Gamma-aminobutyric acid (GABA), Glutathione, Beta-hydroxy beta-methylbutyrate (HMB), L-arginine, L-ornithine, Medium-chain triglycerides (MCT, coconut oil C8–C10), Alpha-lipoic acid (thioctic acid, ALA)