Compare Actovegin and Cerebrolysin | Determine the best

In the Russian pharmacological market, Actovegin and Cerebrolysin are positioned as agents that improve blood flow and metabolism in the vessels of the brain. These drugs are trying to treat senile dementia and Alzheimer's disease. They are prescribed after a stroke and traumatic brain injury in the acute period and at the stage of rehabilitation. Pharmaceutical companies say: Actovegin and Cerebrolysin normalize the functioning of the nervous system, improve attention and memory, and speed recovery. Scientists and practitioners doubt: there is no data on the effectiveness of drugs. Who to believe and how to figure it out?

The experts of our magazine studied the effect of Actovegin and Cerebrolysin on the human body. We found out that both drugs belong to drugs with unproven efficacy, and it is incorrect to compare their effects. Many scientists say that we are dealing with a placebo. And if both drugs are pacifiers, there is no difference between them for the patient.

Let's find out what drugs are made to improve blood flow, why they are appointed, and what effect is expected from them.

Drugs on the blood: what are they made of?

We looked into the instructions for use of drugs and found out what is included in their composition:

1. Actovegin is obtained from deproteinized hemoderivat blood of calves. Available in tablets and solution for injection. One tablet contains 200 µg of the active substance. Ampoules are represented by 2, 5 and 10 ml (80, 200 and 400 mg, respectively).

2. Cerebrolysin is a complex of proteins derived from the brain of pigs. Available in the form of a solution for injection. In one ampoule - 215 mg.

The cost of drugs is different. 5 ampoules of solution (5 ml each) of Cerebrolysin will cost 1000-1200 rubles. The same amount of Actovegin costs 500-600 rubles. The high cost of Cerebrolysin does not mean that he copes better with his task - and now you can see for yourself.

How do they work?

Let's see what is indicated in the instructions for drugs.

Actovegin

Actovegin is a drug from the group of stimulants of regeneration. Its action is explained by three key mechanisms:

1. Metabolic effect: enhances the absorption of oxygen by cells, improves energy metabolism and facilitates the transport of glucose.

2. Neuroprotective effect: protects nerve cells from destruction under conditions of ischemia (insufficient blood supply) and hypoxia (lack of oxygen).

3. Microcirculatory effect: activates blood flow in the tissues.

It is not known for certain how Actovegin affects the work of the nervous system. This is a blood product, and it is impossible to track its path in the body. It is assumed that hemodevice works like this:

1. inhibits apoptosis - programmed cell death;

2. affects the activity of the nuclear factor kappa B (NF-kB), which is responsible for the development of the inflammatory process in the nervous system;

3. restores cell DNA damage.

The instructions for the drug indicated that it accelerates blood flow in the small arteries. The effect is expected 30 minutes after the drug enters the bloodstream.The maximum effect of the drug is observed after 3-6 hours.

Cerebrolysin

Cerebrolysin belongs to the group of nootropics. It contains low molecular weight bioactive peptides that can penetrate the blood-brain barrier. Getting to the brain, peptides work like this:

1. activate metabolic processes in the nervous system;

2. improve protein synthesis in developing and aging cells;

3. protect neurons from aggressive free radicals.

On the background of the use of the drug is expected to improve cognitive functions (memory, attention), the restoration of blood flow in the tissues. But the way Cerebrolysin in the body can not be traced. This is a blood component, like Actovegin, and it is impossible to fully evaluate its effect.

What do pharmacologists say?

Clinical studies with regard to the drugs under consideration are inconclusive. We studied data on Actovegin and Cerebrolysin and found that the effectiveness of drugs is not proven. There is no reliable information that these tools help in the fight against stroke, senile dementia and other neurological diseases. Serious randomized studies suggest that Cerebrolysin and Actovegin do not cope with the task. Now we will tell how we made such conclusions.

Actovegin

Actovegin appeared on the pharmaceutical market more than 40 years ago - before the era of the formation of evidence-based medicine. It was actively used in neurology, surgery and obstetrics and has established itself as a means of restoring blood flow in the tissues. They were treated with patients with stroke and dementia, used in pregnant women with chronic fetal hypoxia. Would continue to use now, but it turned out - the drug does not meet modern requirements. He failed clinical trials, and was recognized as a tool with unproven efficacy.

Facts vs Actovegin:

1. Not received FDA approval - there is no convincing evidence that the drug improves blood flow in vessels with complicated diabetes mellitus (review from the journal Diabetes Obesity & Metabolism).

2. It is ineffective in disorders of blood flow after an injury (review from the journal British Journal of Sports Medicine).

3. The positive effect of the drug has been noted in some sources (Effective Pharmacotherapy magazine), but we cannot completely trust this data. Many trials do not meet international standards — a double-blind, randomized, placebo-controlled trial was not conducted.

4. Since 2017, Actovegin has been recommended for use only in neurological practice. A large randomized study showed that the drug effectively copes with impaired cerebral blood flow. The translated review was presented in the journal of the Russian Association for the fight against stroke.

Cerebrolysin

The main problem of clinical studies on Cerebrolysin is a small sample. Even if the tests meet international standards, too few patients take part in it. For example, in one study 60 patients were enrolled, in another - only 32. This is not enough to draw conclusions about the effectiveness of the drug.

In such a situation, reviews of scientific articles come to the rescue. Of interest are the reviews of the Cochrane Library:

1. In 2013, a review was published on the effect of Cerebrolysin on vascular dementia. The results are disappointing. The authors say that Cerebrolysin may be useful for mild dementia, but evidence is not enough.

2. In 2017, a review on the effect of Cerebrolysin on the course of acute ischemic stroke was published. The authors can not definitely recommend the drug. Scientists have not found evidence that Cerebrolysin reduces mortality in ischemic stroke and has a positive effect on the prognosis of the disease. The authors also indicated that the use of the drug may cause complications.

On a note

The Cochrane Library is a database of the Cochrane co-operation medical non-profit organization. Scientists and practitioners consider the Cochrane reviews a reliable source of information. Current guidelines for the treatment of diseases are based on the publications of this library. The reviews that entered the database were rigorously screened based on the standards of evidence-based medicine.

When are they appointed?

According to the instructions Actovegin appointed in the complex therapy of such diseases:

1. post-stroke condition;

2. dementia;

3. violation of peripheral blood flow;

4. diabetic neuropathy.

In the acute period, the drug is administered intravenously for 5-7 days. When the process is subsided, the patient is transferred to a pill form. The course of therapy lasts from 4-6 weeks to six months.

Cerebrolysin is also prescribed for ischemic stroke and dementia. Instructions to the drug adds other indications:

1. effects of brain injury;

2. endogenous depression;

3. mental retardation in children.

4. The drug is administered intravenously in an individual dosage. The course of therapy is 10-20 days.

How are they transferred?

Serious side effects against the use of Actovegin not identified. In rare cases, it leads to the development of an allergic reaction - redness of the skin, the appearance of rashes.

When receiving Cerebrolysin, side effects are more often detected:

1. insomnia;

2. dizziness;

3. cardiopalmus;

4. diarrhea or constipation;

5. nausea, vomiting;

6. arterial hypertension;

7. feelings of heat.

Cerebrolysin is more commonly used in elderly patients, and similar reactions may be caused by other conditions - chronic heart, kidney, digestive tract diseases, etc.

findings

Let's sum up:

1. Actovegin and Cerebrolysin are drugs with unproven efficacy. Both of them can not be considered reliable means in the fight against neurological and vascular diseases.

2. Actovegin has proven itself in the treatment of ischemic stroke. Today it is the only application where the drug actually works (according to the results of clinical studies). With respect to Cerebrolysin, there is no such data. We cannot name the sphere where it could be applied from the standpoint of evidence-based medicine.

3. Actovegin easy to use. It is available in tablets and can be used for a long course - up to six months. Cerebrolysin is presented only in the form of a solution for injection. He is not appointed for more than 20 days in a row.

4. Actovegin is better tolerated and practically does not cause adverse reactions.

Choosing a drug, do not rush to the decision. Consult with a specialist - the doctor will tell you which tool is suitable in your situation. Remember that the action of Actovegin and Cerebrolysin is not fully understood, and the use of these drugs is not always justified.