Home \ Pharmacology and Biochemistry \ Known and new concepts about the mechanism of action and spectrum of effects of Mexidol

Known and new ideas about the mechanism of action and spectrum of effects of Mexidol

Author:
© T.A. VORONINA1, S.A. LITVINOVA1, N.A. GLADYSHEVA1, A.V. SHULYNDIN2

1Federal Research Center for Original and Promising Biomedical and Pharmaceutical
Technologies, Moscow, Russia;
2Volga Region Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia

Place of publication:
S.S. Korsakov Journal of Neurology and Psychiatry 2025, Vol. 125, No. 5, pp. 22–33

Abstract: The article
presents the results of a study of the multimodal mechanism of action of the original Russian drug Mexidol (2-ethyl-6-methyl-3-hydroxypyridine succinate), which provides a neuroprotective effect and a broad spectrum of clinical effects. The Mexidol molecule is represented by two related and functionally significant components: 2-ethyl-6-methyl-3-hydroxypyridine and succinate. The presence of 3-hydroxypyridine in the structure of Mexidol is associated with the antioxidant and membranotropic activity of the drug, the ability to reduce glutamate excitotoxicity, and modulate the functioning of receptors and ion channels. Succinate in Mexidol provides the ability to induce the succinate receptor SUCNR1, improve succinate signaling, stimulate mitochondriogenesis, restore mitochondrial respiration, activate the Krebs cycle, and improve the energy status of the cell, which determines the antihypoxic effect. Mexidol enhances the expression of transcription factors HIF-1α and Nrf2 under hypoxic conditions. It exhibits neuroregenerative activity mediated by increased levels of key regulatory molecules—neurotrophic factors NGF, IGF1, BDNF, and VEGF—in areas of ischemic brain injury. It also positively influences PGC-1α, which coordinates aerobic metabolism and cellular energy stability. These properties distinguish Mexidol from other succinic acid preparations.

Key words: Mexidol, ethylmethylhydroxypyridine succinate, antioxidant, antihypoxant, neuroprotection, mitochondriogenesis
, succinate signaling, neurotrophic factors, transcription factors.

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Actual

Results of an international multicenter, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of sequential therapy with ethylmethylhydroxypyridine succinate in patients in the acute and early recovery periods of ischemic stroke (IS)
Results of an international multicenter, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of sequential therapy with ethylmethylhydroxypyridine succinate in patients in the acute and early recovery periods of ischemic stroke (IS)
Cognitive disorders in the practice of a primary link: Focus for patients with arterial hypertension
Cognitive disorders in the practice of a primary link: Focus for patients with arterial hypertension
Resolution of the Council of Experts "The possibilities of neuroprotective therapy in patients with arterial hypertension and cognitive disorders"
Resolution of the Council of Experts "The possibilities of neuroprotective therapy in patients with arterial hypertension and cognitive disorders"
The results of an international multicenter randomized double-blind-controlled study of evaluating the effectiveness of the effectiveness and safety of consistent therapy of patients with chronic brain ischemia with Mexidol and Mexidol Forte 250 (study of Memo)
The results of an international multicenter randomized double-blind-controlled study of evaluating the effectiveness of the effectiveness and safety of consistent therapy of patients with chronic brain ischemia with Mexidol and Mexidol Forte 250 (study of Memo)
Reproduced drugs: Benefit ratio/risk
Reproduced drugs: Benefit ratio/risk
Treatment of patients with ischemic stroke in the vertebral-baslar system in the acute period: Experience in the use of the neuroprotective drug Mexidol
Treatment of patients with ischemic stroke in the vertebral-baslar system in the acute period: Experience in the use of the neuroprotective drug Mexidol
The use of Mexidol in patients with mild (moderate) cognitive disorders: the results of meta -analysis
The use of Mexidol in patients with mild (moderate) cognitive disorders: the results of meta -analysis
The effect of therapy with the drug Mexol on the regression of neurological deficiency and a functional outcome in patients with ischemic stroke: a systematic review and meta analysis
The effect of therapy with the drug Mexol on the regression of neurological deficiency and a functional outcome in patients with ischemic stroke: a systematic review and meta analysis
Arterial hypertension and cognitive disorders. The gaze of a neurologist
Arterial hypertension and cognitive disorders. The gaze of a neurologist
The effectiveness of Mexidol in patients of different age groups with chronic brain ischemia with cognitive disorders (the results of subanalysis of the international multicenter randomized double blind placebo-controlled study of memes)
The effectiveness of Mexidol in patients of different age groups with chronic brain ischemia with cognitive disorders (the results of subanalysis of the international multicenter randomized double blind placebo-controlled study of memes)
The effectiveness and safety of Mexidol in patients of different age groups in the acute and early recovery periods of the hemisphere ischemic stroke (the results of subanarized a randomized double blind multicenter placebo-controlled in parallel groups of the study of epic)
The effectiveness and safety of Mexidol in patients of different age groups in the acute and early recovery periods of the hemisphere ischemic stroke (the results of subanarized a randomized double blind multicenter placebo-controlled in parallel groups of the study of epic)
The results of a multicenter dual blind randomized placebo-controlled clinical study on the assessment of the effectiveness and safety of the drug Mexidol in the treatment of attention deficit syndrome in children (mega)
The results of a multicenter dual blind randomized placebo-controlled clinical study on the assessment of the effectiveness and safety of the drug Mexidol in the treatment of attention deficit syndrome in children (mega)

Actual

Results of an international multicenter, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of sequential therapy with ethylmethylhydroxypyridine succinate in patients in the acute and early recovery periods of ischemic stroke (IS)
Results of an international multicenter, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of sequential therapy with ethylmethylhydroxypyridine succinate in patients in the acute and early recovery periods of ischemic stroke (IS)
Cognitive disorders in the practice of a primary link: Focus for patients with arterial hypertension
Cognitive disorders in the practice of a primary link: Focus for patients with arterial hypertension
Resolution of the Council of Experts "The possibilities of neuroprotective therapy in patients with arterial hypertension and cognitive disorders"
Resolution of the Council of Experts "The possibilities of neuroprotective therapy in patients with arterial hypertension and cognitive disorders"
The results of an international multicenter randomized double-blind-controlled study of evaluating the effectiveness of the effectiveness and safety of consistent therapy of patients with chronic brain ischemia with Mexidol and Mexidol Forte 250 (study of Memo)
The results of an international multicenter randomized double-blind-controlled study of evaluating the effectiveness of the effectiveness and safety of consistent therapy of patients with chronic brain ischemia with Mexidol and Mexidol Forte 250 (study of Memo)
Reproduced drugs: Benefit ratio/risk
Reproduced drugs: Benefit ratio/risk
Treatment of patients with ischemic stroke in the vertebral-baslar system in the acute period: Experience in the use of the neuroprotective drug Mexidol
Treatment of patients with ischemic stroke in the vertebral-baslar system in the acute period: Experience in the use of the neuroprotective drug Mexidol
The use of Mexidol in patients with mild (moderate) cognitive disorders: the results of meta -analysis
The use of Mexidol in patients with mild (moderate) cognitive disorders: the results of meta -analysis
The effect of therapy with the drug Mexol on the regression of neurological deficiency and a functional outcome in patients with ischemic stroke: a systematic review and meta analysis
The effect of therapy with the drug Mexol on the regression of neurological deficiency and a functional outcome in patients with ischemic stroke: a systematic review and meta analysis
Arterial hypertension and cognitive disorders. The gaze of a neurologist
Arterial hypertension and cognitive disorders. The gaze of a neurologist
The effectiveness of Mexidol in patients of different age groups with chronic brain ischemia with cognitive disorders (the results of subanalysis of the international multicenter randomized double blind placebo-controlled study of memes)
The effectiveness of Mexidol in patients of different age groups with chronic brain ischemia with cognitive disorders (the results of subanalysis of the international multicenter randomized double blind placebo-controlled study of memes)
The effectiveness and safety of Mexidol in patients of different age groups in the acute and early recovery periods of the hemisphere ischemic stroke (the results of subanarized a randomized double blind multicenter placebo-controlled in parallel groups of the study of epic)
The effectiveness and safety of Mexidol in patients of different age groups in the acute and early recovery periods of the hemisphere ischemic stroke (the results of subanarized a randomized double blind multicenter placebo-controlled in parallel groups of the study of epic)
The results of a multicenter dual blind randomized placebo-controlled clinical study on the assessment of the effectiveness and safety of the drug Mexidol in the treatment of attention deficit syndrome in children (mega)
The results of a multicenter dual blind randomized placebo-controlled clinical study on the assessment of the effectiveness and safety of the drug Mexidol in the treatment of attention deficit syndrome in children (mega)

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