What is the role of Altibrain S (nicotinamide supplement) in the treatment and recovery of an acute cerebrovascular accident (stroke)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 24, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Altibrain S (Nicotinamide) Has No Established Role in Stroke Treatment

Based on the highest quality evidence from the American Heart Association/American Stroke Association guidelines, no agent with putative neuroprotective effects, including nicotinamide (the active ingredient in Altibrain S), can be recommended for the treatment of patients with acute ischemic stroke. 1, 2

Why Nicotinamide Is Not Recommended

Guideline Position

  • The AHA/ASA explicitly states that despite over 1000 experimental studies and more than 100 clinical trials of various neuroprotective agents, most have produced disappointing results, with some treated patients experiencing worse outcomes than control subjects 1
  • While nicotinamide is mentioned as a single agent with multiple effects on the ischemic cascade (targeting energy metabolism, DNA repair, and mitochondrial function), it has not undergone the rigorous clinical trials needed to demonstrate safety and efficacy in human stroke patients 1

The Evidence Gap

  • No large-scale human trials exist: All available evidence for nicotinamide comes from animal studies in rats and mice, not from human stroke patients 3, 4, 5
  • The animal studies show nicotinamide reduced brain damage when given within 2-6 hours after experimental stroke, with optimal doses around 500 mg/kg 3, 5
  • However, the translation from animal models to human stroke treatment has historically failed for numerous neuroprotective agents that showed promise in laboratory settings 1

What Actually Works for Stroke

Proven Acute Treatments

  • Intravenous tPA (tissue plasminogen activator) within 3-4.5 hours of symptom onset for eligible patients is the only FDA-approved medication that improves stroke outcomes 1, 2
  • Endovascular thrombectomy for large vessel occlusions within 6 hours (or longer in selected patients) 1
  • Aspirin started within 24-48 hours after stroke onset in patients who did not receive thrombolysis 2

Essential Supportive Care

  • Admission to a specialized stroke unit, which significantly improves outcomes 1, 2
  • Blood pressure management according to specific protocols (avoiding aggressive lowering in acute phase unless BP >220/120 mmHg or patient is receiving tPA) 1
  • Prevention of complications: deep vein thrombosis prophylaxis with subcutaneous anticoagulants or compression stockings, early mobilization, pneumonia prevention 1

The Mechanism Problem with Nicotinamide

While the theoretical mechanisms are interesting, they remain unproven in humans:

  • Nicotinamide serves as a precursor for NAD+ (nicotinamide adenine dinucleotide), which is depleted during stroke 3, 4
  • It inhibits PARP (poly(ADP-ribose) polymerase), an enzyme that consumes NAD+ and can lead to energy depletion in injured neurons 3, 4
  • Animal studies showed partial restoration of ATP levels and mitochondrial function 4
  • However, these laboratory findings have not translated into demonstrated clinical benefit in stroke patients 1

Critical Pitfalls to Avoid

Do not delay proven treatments: The most dangerous mistake would be administering unproven supplements like Altibrain S while delaying or forgoing evidence-based interventions like tPA or thrombectomy 1, 2

Time is brain: Every minute of delay in acute stroke treatment results in loss of approximately 1.9 million neurons 1. Focus on rapid evaluation and treatment with proven therapies rather than experimental agents 1, 2

The neuroprotection failure pattern: The stroke field has witnessed repeated failures of neuroprotective agents that worked in animals but failed in humans, including calcium channel blockers (nimodipine), NMDA antagonists, free radical scavengers (NXY-059), and many others 1

Bottom Line for Clinical Practice

Use established stroke protocols: Focus on rapid tPA administration (if within time window and eligible), thrombectomy evaluation for large vessel occlusions, stroke unit care, and evidence-based secondary prevention 1, 2

Nicotinamide/Altibrain S should not be used as a stroke treatment outside of a formal clinical trial, as it lacks the necessary human efficacy data and could provide false reassurance while delaying proven interventions 1, 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Citicoline in Acute Ischemic Stroke

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

What pre‑operative evaluations and criteria are required for physician clearance to surgically treat a hepatic hydatid (echinococcal) cyst?
Which laboratory test best assesses pyridoxine (vitamin B6) status and what is the normal reference range?
How should a woman bitten by a pet dog that was vaccinated against rabies one year ago be managed regarding wound care, tetanus prophylaxis, antibiotics, and rabies post‑exposure prophylaxis?
In a patient with an elevated total immunoglobulin A (IgA) level and a normal tissue transglutaminase IgA (tTG IgA) test, what does this indicate and what initial work‑up should be performed?
I am an asymptomatic adult with labs showing low iron saturation (21 %), low ferritin (19 ng/mL), normal serum iron, high‑normal transferrin (302 mg/dL), positive antinuclear antibody (ANA) screen, borderline pre‑diabetes (glycated hemoglobin 5.7 %), LDL cholesterol 111 mg/dL, modestly elevated C‑reactive protein (4.9 mg/L), normal thyroid function, normal renal function (eGFR ≈ 82 mL/min/1.73 m²), and past Lyme disease IgG bands (41 kD and 93 kD) without symptoms. What is the overall interpretation of this laboratory profile and the recommended management?
How long is generalized pruritus expected to persist after it begins one day after the first dose of gabapentin?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question