Cerebrolysin Administration Protocol
Cerebrolysin should be administered intravenously at a dose of 30-50 mL once daily for 10-21 days, diluted in standard saline solution and infused over 15-30 minutes. 1
Route of Administration
- Intravenous infusion is the standard and preferred route for cerebrolysin administration in neurological conditions 2, 1
- Intramuscular injection has been used in specific cases (e.g., post-stroke spasticity at 10 mL daily), though this is not the primary route for most indications 3
- The FDA-labeled sublingual spray formulation (2 sprays under tongue, three times daily) appears to be a different product formulation and is not the standard hospital/clinical preparation 4
Dosing Regimens by Clinical Context
Acute Ischemic Stroke (Most Common Indication)
- Dose: 30-50 mL once daily 1
- Duration: 10-21 days of consecutive treatment 1
- Timing: Initiate within 72 hours of stroke onset for optimal efficacy 1
- A 15 mL daily dose over 21 days has also been studied with positive outcomes 2
Chronic Neurological Conditions
- Dementia/Cognitive Impairment: 5-30 mL daily administered over treatment courses up to 28 weeks 5
- Extrapyramidal Symptoms: 5-10 mL every other day for 28 days, administered by slow IV infusion 6
Preparation and Infusion Technique
- Dilute cerebrolysin in 100-250 mL of normal saline (0.9% NaCl) or other compatible IV solution 2, 1
- Infuse over 15-30 minutes to minimize infusion-related reactions 2
- Administer once daily, preferably at the same time each day for consistency 1
Important Clinical Considerations
Safety Profile:
- Cerebrolysin demonstrates a safety profile comparable to placebo in controlled trials 1
- The most frequently reported adverse event is dizziness/vertigo, which is generally mild 5
- No significant drug interactions or contraindications have been established in major trials 5, 1
Efficacy Evidence:
- Meta-analysis of 1,879 patients showed significant improvement in NIHSS scores at day 21-30 (Mann-Whitney effect size 0.60, P < 0.0001) 1
- Number needed to treat for clinically relevant early neurological improvement is 7.7 (95% CI 5.2-15.0) 1
- Benefits extend to 90-day functional outcomes in moderate-to-severe stroke patients 1
Common Pitfalls to Avoid
- Do not administer as rapid IV push—this may increase the risk of infusion reactions; always dilute and infuse slowly 2
- Do not delay initiation beyond 72 hours in acute stroke—efficacy is optimized with early treatment 1
- Do not confuse with the sublingual spray formulation listed in some FDA databases, which represents a different product form 4
- Monitor for dizziness during and after infusion, particularly during the first few doses 5
Monitoring Parameters
- Assess neurological status using validated scales (NIHSS for stroke, MAS for spasticity) at baseline and serially during treatment 1, 3
- Monitor vital signs during infusion, particularly with first dose 5
- Evaluate functional outcomes at treatment completion (day 21-30) and at 90 days for stroke patients 1