Why Citicoline (A Medical Food) Should Not be Prescribed to Treat People with Acute Ischemic Stroke: The Certainty of the Evidence

Background: Citicoline, a medical food prescribed for ischemic stroke, faces scrutiny due to itsb unproven ef icacy and potential harms. This essay, drawing on a recent Cochrane review and focusing solely on all-cause mortality, advocates for a critical reevaluation of its use. Rather than of ering an updated Cochrane review, this analysis provides a reflective perspective through the lens of Evidence-based Medicine and Philosophy of Science. Question Research: Why citicoline (a medical food) should not be prescribed to treat people with acute ischemic stroke: The certainty of the Evidence.? Objective: Demonstrate from evidence-based medicine and philosophy of science perspective that citicoline should not be prescribed for acute ischemic stroke due to lack of ef icacy and harm uncertainties. Search publications: We searched in PubMed and Cochrane Library from 2020 until 30 October 2023. We, furthermore, used engineering machines Bing and Google Scholar to detec additional papers. Additionally, we also reviewed reference lists of the retrieved publications and review articles and searched the websites of the U. S. Food and Drug Administration (FDA) and European Medicines Agency (EMA). Selection criteria: We included systematic reviews, meta-analyses, randomized clinical trials, clinical guidelines focused on acute ischemic stroke and comparing citicoline versus placebo or no intervention. We excluded narrative reviews, observational studies and ongoing trials.