Centrivive Tablet in Stroke: No Established Role
Centrivive (nicotinamide-riboside with celery-derived 3-N-butylphthalide) is not mentioned in any current stroke treatment guidelines, and there is no evidence supporting its use as an adjunctive therapy in acute ischemic stroke.
Understanding the Components
The question asks about "Centrivive," which appears to combine two separate compounds that have been studied individually in stroke research:
Nicotinamide (Vitamin B3) Component
- Nicotinamide showed neuroprotective effects in animal models when given 2 hours after stroke onset, reducing infarct volume by 46% at 3 days and improving neurological function by 38-42% in rats. 1
- However, no neuroprotective agent—including nicotinamide—has demonstrated efficacy in human clinical trials for acute ischemic stroke. 2
- The 2018 American Heart Association/American Stroke Association guidelines explicitly state that no pharmacological agents with putative neuroprotective actions have demonstrated efficacy in improving outcomes after ischemic stroke, and therefore neuroprotective agents are not recommended (Class III; Level of Evidence A). 2
Butylphthalide (NBP) Component
- Butylphthalide, derived from celery seeds, has shown benefit in Chinese clinical trials when started within 6 hours of stroke onset in patients receiving reperfusion therapy. 3
- In a 2023 randomized trial of 1,216 patients, butylphthalide increased favorable 90-day outcomes from 44.0% to 56.7% (odds ratio 1.70,95% CI 1.35-2.14, P<0.001) when combined with thrombolysis and/or thrombectomy. 3
- Standard dosing in trials was 14 days of intravenous infusion followed by 76 days of oral capsules (total 90 days). 4, 5
Critical Limitations
The combination product "Centrivive" does not appear in any stroke guidelines or published clinical trials. The individual components have been studied separately, but:
- Nicotinamide has failed to demonstrate benefit in human stroke trials despite promising animal data. 2
- Butylphthalide trials were conducted primarily in Chinese populations and the drug is not approved or recommended in American Heart Association, European Stroke Organisation, or other major international stroke guidelines. 2
- No evidence exists for the specific combination of nicotinamide-riboside with butylphthalide that the question describes.
Established Acute Stroke Treatment
Instead of unproven neuroprotective agents, focus on evidence-based acute stroke management:
- Intravenous alteplase (0.9 mg/kg, maximum 90 mg) within 3-4.5 hours of onset is the definitive first-line treatment (Class I; Level of Evidence A). 6
- Aspirin 160-325 mg within 24-48 hours after excluding hemorrhage, or 24 hours after thrombolysis (Class I; Level of Evidence A). 7, 6, 8
- Dual antiplatelet therapy (aspirin + clopidogrel) for 21 days in minor stroke (NIHSS ≤3) or high-risk TIA (ABCD² ≥4) presenting within 24 hours. 7
- Mechanical thrombectomy for large vessel occlusion within the appropriate time window. 2
Common Pitfall to Avoid
Do not delay or substitute proven reperfusion therapies (thrombolysis, thrombectomy) with unproven neuroprotective agents. The 2018 guidelines explicitly warn that aspirin—let alone experimental agents—is not a substitute for definitive acute interventions. 2
If you encounter a product marketed as "Centrivive" for stroke, verify its regulatory approval status and demand published clinical trial evidence before considering its use, as it does not appear in current evidence-based stroke treatment algorithms. 2