Emoxypine succinate

updated

Emoxypine succinate (Mexidol) is registered in Russia for uses that include stroke, chronic brain ischemia, anxiety disorders and ischemic heart disease, and no FDA-approved product turned up. Efficacy data are three sponsor-run, double-blind, placebo-controlled trials in stroke and chronic brain ischemia (150, 304 and 318 patients) in Russia, Uzbekistan and Kazakhstan. PubMed searches on 10 October 2026 found no placebo-controlled trial in patients with a primary anxiety disorder and no trial of cognition or stress resilience in healthy people.

3-hydroxypyridine derivative, marketed as the succinate salt

  • Two Russian leaflets list stroke, chronic brain ischemia, mild cognitive disorders, anxiety disorders in neurotic and neurosis-like states and cardiac uses as part of combined therapy.
  • openFDA Drugs@FDA and DailyMed searches on 10 October 2026 found no FDA-approved emoxypine or Mexidol product or label.
  • EPICA (150 stroke patients) and MIR (304 stroke patients) were double-blind and placebo-controlled, and modified Rankin and NIHSS scores favored Mexidol in both.
  • A stroke meta-analysis found lower scores but significant heterogeneity, and only 2 of its 11 Russian-language studies were randomized.
  • A PubMed search on 10 October 2026 returned 45 anxiety records, none a placebo-controlled trial in patients with a primary anxiety disorder.
  • In 16 patients given a single tablet, 0.31% of the dose appeared in urine unchanged and 49.6% as the glucuronide over 11.5 hours.

What is emoxypine succinate, and where is it registered?

Emoxypine succinate is sold as Mexidol, a Russian prescription medicine. No FDA-approved product turned up, and a Russian registration is not an FDA or EMA review.

Two Russian patient leaflets describe Mexidol: one for 50 mg/mL solution (active substance ethylmethylhydroxypyridine succinate, registration holder NPK Pharmasoft LLC, Moscow) and one for 125 mg film-coated tablets. Both were read as copies hosted on a drug-information site, not on the Russian state register, so version dates are not confirmed.

The injection leaflet lists adult uses that include ischemic stroke, acute cerebrovascular accident without infarction, head injury, chronic brain ischemia, mild cognitive disorders, anxiety disorders in neurotic and neurosis-like states, and acute myocardial infarction from day 1 as part of combined therapy. The tablet leaflet lists, among others, anxiety disorders in neurotic and neurosis-like states, ischemic heart disease as part of combined therapy, asthenic states with prevention of somatic disease under extreme factors and loads, exposure to extreme (stress) factors, and attention deficit hyperactivity disorder in children. These are regional labels, not an FDA or EMA review.

On 10 October 2026, openFDA Drugs@FDA searches on the generic names emoxypine and mexidol each returned no matches, and DailyMed label searches for emoxypine, mexidol and ethylmethylhydroxypyridine returned no labels. A 2023 review lists emoxypine (mexidol) among unapproved pharmaceuticals found in nootropic dietary supplements.

Emoxypine (2-ethyl-6-methylpyridin-3-ol), the free base, is PubChem CID 114681 (C8H11NO, 137.18 g/mol, CAS 2364-75-2). Emoxypine succinate, the salt in Mexidol, is CID 122298 (C12H17NO5, 255.27 g/mol, CAS 127464-43-1), and the trials used the succinate. A 2018 crystallography paper describes other emoxypine salts (maleate, malonate, adipate) made to raise solubility. A vendor emoxypine may therefore be the free base or another salt, and none of those has the trial data.

Mexidol injection leaflet: stroke, brain ischemia, anxiety and myocardial infarction uses

Official label

Russian-language patient leaflet for Mexidol 50 mg/mL solution (active substance ethylmethylhydroxypyridine succinate), registration holder NPK Pharmasoft LLC, Moscow. Copy hosted on medi.ru; version date not shown.

The leaflet lists adult uses that include ischemic stroke, acute cerebrovascular accident without infarction, head injury, chronic brain ischemia, mild cognitive disorders, anxiety disorders in neurotic and neurosis-like states, and acute myocardial infarction from day 1 as part of combined therapy. It contraindicates use in pregnancy and breastfeeding. The listed side effects are very rare (under 1 in 10,000): anaphylactic shock and angioedema among the serious ones, and dry mouth, nausea and skin reactions among the others.

Participants / model
Adults over 18
Treatment
Mexidol 50 mg/mL solution, intravenous or intramuscular
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

A regional label, not an FDA or EMA review. The copy was read on a commercial drug-information site, not on the Russian state register, so the version date is not confirmed.

Read the original source
Mexidol tablet leaflet: anxiety, ischemic heart disease, stress-factor and ADHD uses

Official label

Russian-language patient leaflet for Mexidol 125 mg film-coated tablets. Copy hosted on medi.ru; version date not shown.

The leaflet lists, among other uses, anxiety disorders in neurotic and neurosis-like states, ischemic heart disease as part of combined therapy, asthenic states with prevention of somatic disease under extreme factors and loads, exposure to extreme (stress) factors, and attention deficit hyperactivity disorder in children. Side effects are listed as very rare (under 1 in 10,000), including angioedema, urticaria, drowsiness, headache, dry mouth, nausea and stomach discomfort. It is contraindicated in pregnancy and breastfeeding.

Participants / model
Adults and, for the attention deficit hyperactivity disorder use, children
Treatment
Mexidol 125 mg oral film-coated tablets
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

The injection leaflet says adults over 18 only, so the two leaflets do not agree on children. The copy was read on a commercial drug-information site, not on the Russian state register.

Read the original source
Searches, 10 October 2026: no FDA application or label

Regulatory record

U.S. Food and Drug Administration. openFDA Drugs@FDA searches on the generic names emoxypine and mexidol, with DailyMed label searches for emoxypine, mexidol and ethylmethylhydroxypyridine, all run on 10 October 2026.

Each openFDA Drugs@FDA search returned No matches found, and each DailyMed search returned no labels. No FDA-approved emoxypine or Mexidol product turned up. A 2023 review (PMID 37357012) lists emoxypine (mexidol) among unapproved pharmaceuticals found in nootropic dietary supplements.

Participants / model
Records reviewed, not a population
Treatment
Not applicable
Follow-up
Searches run on 10 October 2026
Study design
Dated regulator database search
Funding
not stated in the source

The result covers FDA application and label records only.

Read the original source
PubChem: emoxypine free base and succinate identity

Chemical identity record

National Library of Medicine. PubChem compound records CID 114681 (emoxypine) and CID 122298 (emoxypine succinate).

Emoxypine (2-ethyl-6-methylpyridin-3-ol), the free base: PubChem CID 114681, C8H11NO, 137.18 g/mol, CAS 2364-75-2. Emoxypine succinate, the salt in Mexidol: CID 122298, C12H17NO5, 255.27 g/mol, CAS 127464-43-1. The trials used the succinate. A 2018 crystallography paper (PMID 29973419) describes other emoxypine salts (maleate, malonate, adipate) made to raise solubility.

Participants / model
Chemical identity, not a clinical population
Treatment
Defined free base and succinate salt
Follow-up
Not applicable
Study design
NLM chemical record
Funding
not stated in the source

A vendor emoxypine may be the free base or another salt, and none of those has the trial data. Identity record only; it says nothing about efficacy or safety.

Read the original source

What did the stroke trials find?

Two sponsor-run, double-blind, placebo-controlled trials in ischemic stroke (150 and 304 patients) found better modified Rankin and NIHSS scores with Mexidol. A meta-analysis found the same direction with significant heterogeneity, and only 2 of its 11 studies were randomized.

EPICA randomized 150 patients aged 40 to 79 with hemispheric ischemic stroke, double-blind and placebo-controlled across Russian centers, to intravenous then oral Mexidol or placebo. At the end of treatment the mean modified Rankin score was lower with Mexidol (p = 0.04), more patients scored 0 to 2 (p = 0.039), and the mean NIHSS was lower (p = 0.035). Side-effect frequency did not differ significantly. The abstract gives no effect sizes.

MIR randomized 304 patients with ischemic stroke of moderate severity in Russia, Uzbekistan and Kazakhstan, double-blind and placebo-controlled, to intravenous then oral Mexidol or placebo on top of standard therapy. Change in modified Rankin score favored Mexidol (p = 0.003), as did NIHSS (p < 0.001) and the Rivermead Mobility Index (p = 0.014). Adverse events occurred in 35 patients (23%) in each group.

The registry records name Pharmasoft as sponsor for both trials. EPICA's record (NCT02793687) was first posted on 8 June 2016, after the stated primary completion date of 27 May 2016. MIR's record (NCT06437626) shows a start on 18 November 2019, primary completion on 18 August 2023 and first posting on 31 May 2024, after completion.

A systematic review and meta-analysis of Mexidol in ischemic stroke included 11 Russian-language studies, only 2 randomized controlled and 9 non-randomized, unblinded cohort studies. It found lower NIHSS and modified Rankin scores than comparison groups, but the authors report significant statistical heterogeneity and say the evidence needs further examination as new data appear.

EPICA: 150 stroke patients, double-blind, placebo-controlled, Russian centers

Randomized controlled trial

Stakhovskaya LV et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(3. Vyp. 2):55-65. PMID 28665371.

At the end of treatment the mean modified Rankin score was lower with Mexidol (p = 0.04), more patients scored 0 to 2 (p = 0.039), and the mean NIHSS was lower (p = 0.035). Side-effect frequency did not differ significantly. The abstract gives no effect sizes.

Participants / model
150 patients aged 40 to 79 with acute and early-recovery hemispheric ischemic stroke
Treatment
Mexidol 500 mg a day by infusion for 10 days then 125 mg three times a day by mouth for 8 weeks, or placebo
Follow-up
10 days by infusion then 8 weeks by mouth
Study design
Double-blind, placebo-controlled randomized trial across Russian centers
Funding
Registry record NCT02793687 names Pharmasoft as sponsor

A sponsor-run trial reported in Russian in a supplement issue. The registry record was first posted on 8 June 2016, after the stated primary completion date of 27 May 2016.

Read the original source
MIR: 304 stroke patients in Russia, Uzbekistan and Kazakhstan, placebo-controlled

Randomized controlled trial

Shamalov NA et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(8. Vyp. 2):40-53. PMID 40898634.

Change in modified Rankin score favored Mexidol (p = 0.003), as did NIHSS (p < 0.001) and the Rivermead Mobility Index (p = 0.014). Adverse events occurred in 35 patients (23%) in each group.

Participants / model
304 patients with ischemic stroke of moderate severity, in Russia, Uzbekistan and Kazakhstan
Treatment
Mexidol 500 mg twice a day intravenously for 10 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo, on top of standard therapy
Follow-up
10 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial, multinational but regional
Funding
Registry record NCT06437626 names Pharmasoft as sponsor

A sponsor-run trial. The registry record shows a start on 18 November 2019, primary completion on 18 August 2023 and first posting on 31 May 2024, after completion.

Read the original source
Stroke meta-analysis: 11 Russian-language studies, 2 randomized

Systematic review and meta-analysis

Voznyuk IA et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(12. Vyp. 2):49-60. PMID 38148698.

The review included 11 Russian-language studies, only 2 randomized controlled and 9 non-randomized, unblinded cohort studies. It found lower NIHSS and modified Rankin scores than comparison groups. The authors report significant statistical heterogeneity and say the evidence needs further examination as new data appear.

Participants / model
Adults with ischemic stroke in pooled Russian studies
Treatment
Mexidol in varied regimens
Follow-up
Pooled studies
Study design
Systematic review and meta-analysis of 11 studies
Funding
not stated in the source

This is the quality caveat for the stroke literature.

Read the original source

Did Mexidol improve cognition in chronic brain ischemia?

In 318 patients with chronic brain ischemia, the primary endpoint, change in MoCA, favored Mexidol, with the lower bound of the 95% confidence interval for the group difference at 1.51 points. The Beck anxiety scale, a secondary endpoint, also favored Mexidol, but this was not a trial in people with an anxiety disorder.

MEMO randomized 318 patients aged 40 to 90 with chronic brain ischemia at 15 centers in Russia and Uzbekistan, double-blind and placebo-controlled, to intravenous then oral Mexidol or placebo. The primary endpoint, change in the Montreal Cognitive Assessment (MoCA), favored Mexidol, with the lower bound of the 95% confidence interval for the group difference at 1.51 points. Among secondary endpoints the Beck anxiety scale also favored Mexidol at the last visit, and the safety profile was reported as comparable to placebo.

The anxiety result is a secondary endpoint in older patients with brain ischemia, not a trial in people with an anxiety disorder. The registry record (NCT06834490) names Pharmasoft as sponsor, shows primary completion on 8 December 2020 and was first posted on 19 February 2025, after completion.

MEMO: 318 patients with chronic brain ischemia, MoCA primary endpoint

Randomized controlled trial

Fedin AI et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(11):7-16. PMID 34932280.

The primary endpoint, change in the Montreal Cognitive Assessment (MoCA), favored Mexidol, with the lower bound of the 95% confidence interval for the group difference at 1.51 points. Among secondary endpoints the Beck anxiety scale also favored Mexidol at the last visit, and the safety profile was reported as comparable to placebo.

Participants / model
318 patients aged 40 to 90 with chronic brain ischemia, at 15 centers in Russia and Uzbekistan
Treatment
Mexidol 500 mg intravenously once a day for 14 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo
Follow-up
14 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial
Funding
Registry record NCT06834490 names Pharmasoft as sponsor

The anxiety result is a secondary endpoint in older patients with brain ischemia, not a trial in people with an anxiety disorder. The registry record shows primary completion on 8 December 2020 and first posting on 19 February 2025, after completion.

Read the original source

What is known about Mexidol and the heart?

Only a small Russian-language report supports a cardiac benefit. In 100 patients followed for 3 years after myocardial infarction, the abstract reports fewer complications, deaths and rehospitalizations with Mexidol but gives no numbers and does not state randomization.

In 100 patients followed for 3 years after myocardial infarction with chronic heart failure, 52 received Mexidol plus conventional therapy and 48 conventional therapy alone. The abstract reports fewer complications, deaths and rehospitalizations with Mexidol but gives no numbers, and does not state randomization or blinding. A single small Russian-language report supports only a hypothesis of cardiac benefit.

The Russian leaflets list acute myocardial infarction and ischemic heart disease as uses, as part of combined therapy. Those are label statements, not trial results.

Russian-language report: 100 patients over 3 years, fewer complications reported

Human study

Sidorenko GI et al. Kardiologiia. 2011;51(6):44-8. PMID 21878070.

The abstract reports fewer complications, deaths and rehospitalizations with Mexidol but gives no numbers, and does not state randomization or blinding.

Participants / model
100 patients followed for 3 years after myocardial infarction with chronic heart failure: 52 on Mexidol plus conventional therapy and 48 on conventional therapy alone
Treatment
Mexidol (ethylmethylhydroxypyridine succinate) added to conventional therapy
Follow-up
3 years of follow-up
Study design
Clinical study; randomization and blinding not stated in the abstract
Funding
not stated in the source

A single small Russian-language report, so it supports only a hypothesis of cardiac benefit. Endpoints were complications, mortality, rehospitalization and myocardial function.

Read the original source
Mexidol injection leaflet: stroke, brain ischemia, anxiety and myocardial infarction uses

Official label

Russian-language patient leaflet for Mexidol 50 mg/mL solution (active substance ethylmethylhydroxypyridine succinate), registration holder NPK Pharmasoft LLC, Moscow. Copy hosted on medi.ru; version date not shown.

The leaflet lists adult uses that include ischemic stroke, acute cerebrovascular accident without infarction, head injury, chronic brain ischemia, mild cognitive disorders, anxiety disorders in neurotic and neurosis-like states, and acute myocardial infarction from day 1 as part of combined therapy. It contraindicates use in pregnancy and breastfeeding. The listed side effects are very rare (under 1 in 10,000): anaphylactic shock and angioedema among the serious ones, and dry mouth, nausea and skin reactions among the others.

Participants / model
Adults over 18
Treatment
Mexidol 50 mg/mL solution, intravenous or intramuscular
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

A regional label, not an FDA or EMA review. The copy was read on a commercial drug-information site, not on the Russian state register, so the version date is not confirmed.

Read the original source
Mexidol tablet leaflet: anxiety, ischemic heart disease, stress-factor and ADHD uses

Official label

Russian-language patient leaflet for Mexidol 125 mg film-coated tablets. Copy hosted on medi.ru; version date not shown.

The leaflet lists, among other uses, anxiety disorders in neurotic and neurosis-like states, ischemic heart disease as part of combined therapy, asthenic states with prevention of somatic disease under extreme factors and loads, exposure to extreme (stress) factors, and attention deficit hyperactivity disorder in children. Side effects are listed as very rare (under 1 in 10,000), including angioedema, urticaria, drowsiness, headache, dry mouth, nausea and stomach discomfort. It is contraindicated in pregnancy and breastfeeding.

Participants / model
Adults and, for the attention deficit hyperactivity disorder use, children
Treatment
Mexidol 125 mg oral film-coated tablets
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

The injection leaflet says adults over 18 only, so the two leaflets do not agree on children. The copy was read on a commercial drug-information site, not on the Russian state register.

Read the original source

Do the claims of anxiety relief, stress resilience and heart protection hold up?

The prescribed-in-Russia part matches the leaflets, but efficacy is shown only in patients with stroke or chronic brain ischemia. No placebo-controlled trial in patients with an anxiety disorder turned up in 45 records, and none of 67 records tested cognition or stress resilience in healthy people.

Sellers say emoxypine succinate (Mexidol) gives neuroprotection, anxiolysis, cognitive preservation under stress and cardiovascular protection, and is prescribed in Russia for stroke, cardiac ischemia and anxiety. The Russian leaflets match the prescribing statement. Efficacy is shown only for stroke and chronic brain ischemia in patients, and a Russian registration is not equivalent to FDA or EMA review.

A PubMed search on 10 October 2026 for Mexidol, emoxypine, ethylmethylhydroxypyridine and 2-ethyl-6-methyl-3-hydroxypyridine with anxiety disorder, generalized anxiety, anxiolytic, neurotic or adjustment disorder returned 45 records. No placebo-controlled trial in patients with a primary anxiety disorder turned up. The records were mostly rodent stress and anxiety models and patient studies where mood was a secondary measure.

The closest human study is a 2-week report in 70 patients with panic disorder and insomnia (mean age 34.5 years) given fevarin (a fluvoxamine brand) 150 mg a day with or without Mexidol 375 mg a day. It says Mexidol enhanced the fall in anxiety and improved insomnia on polysomnography, but the abstract does not state blinding or placebo.

A second search for Mexidol, emoxypine or ethylmethylhydroxypyridine with healthy volunteers, healthy subjects, athletes, students, operators or military returned 67 records. They covered patients with stroke, surgery, eye, kidney and abdominal disease, rodent models and a sports-doping marker paper. None tested cognition or stress resilience in healthy people. The cardiac claim rests on the small report above.

PubMed search, 10 October 2026: 45 records, no placebo-controlled anxiety-disorder trial

PubMed search record

PubMed search run on 10 October 2026: (mexidol OR emoxypine OR ethylmethylhydroxypyridine OR "2-ethyl-6-methyl-3-hydroxypyridine") AND (anxiety disorder OR generalized anxiety OR anxiolytic OR neurotic OR adjustment disorder). 45 records returned.

The search returned 45 records. No placebo-controlled trial in patients with a primary anxiety disorder turned up. The records were mostly rodent stress and anxiety models and patient studies where mood was a secondary measure. The closest human study is a 2-week report in 70 patients with panic disorder and insomnia (mean age 34.5 years) given fevarin (a fluvoxamine brand) 150 mg a day with or without Mexidol 375 mg a day (PMID 23528580). It says Mexidol enhanced the fall in anxiety and improved insomnia on polysomnography, but the abstract does not state blinding or placebo.

Participants / model
Records returned, not a population
Treatment
Not applicable
Follow-up
Search run on 10 October 2026
Study design
Literature search
Funding
not stated in the source

A search result shows what PubMed returned on that date. It is not proof that no unindexed study exists.

Read the original source
PubMed search, 10 October 2026: 67 records, none on healthy-people cognition or stress

PubMed search record

PubMed search run on 10 October 2026: (mexidol OR emoxypine OR ethylmethylhydroxypyridine) AND (healthy volunteers OR healthy subjects OR athletes OR students OR operators OR military). 67 records returned.

The search returned 67 records. They covered patients with stroke, surgery, eye, kidney and abdominal disease, rodent models and a sports-doping marker paper. None tested cognition or stress resilience in healthy people. The cognitive preservation under stress claim has no healthy-human trial among these records.

Participants / model
Records returned, not a population
Treatment
Not applicable
Follow-up
Search run on 10 October 2026
Study design
Literature search
Funding
not stated in the source

A search result shows what PubMed returned on that date. It is not proof that no unindexed study exists.

Read the original source
Mexidol injection leaflet: stroke, brain ischemia, anxiety and myocardial infarction uses

Official label

Russian-language patient leaflet for Mexidol 50 mg/mL solution (active substance ethylmethylhydroxypyridine succinate), registration holder NPK Pharmasoft LLC, Moscow. Copy hosted on medi.ru; version date not shown.

The leaflet lists adult uses that include ischemic stroke, acute cerebrovascular accident without infarction, head injury, chronic brain ischemia, mild cognitive disorders, anxiety disorders in neurotic and neurosis-like states, and acute myocardial infarction from day 1 as part of combined therapy. It contraindicates use in pregnancy and breastfeeding. The listed side effects are very rare (under 1 in 10,000): anaphylactic shock and angioedema among the serious ones, and dry mouth, nausea and skin reactions among the others.

Participants / model
Adults over 18
Treatment
Mexidol 50 mg/mL solution, intravenous or intramuscular
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

A regional label, not an FDA or EMA review. The copy was read on a commercial drug-information site, not on the Russian state register, so the version date is not confirmed.

Read the original source
Mexidol tablet leaflet: anxiety, ischemic heart disease, stress-factor and ADHD uses

Official label

Russian-language patient leaflet for Mexidol 125 mg film-coated tablets. Copy hosted on medi.ru; version date not shown.

The leaflet lists, among other uses, anxiety disorders in neurotic and neurosis-like states, ischemic heart disease as part of combined therapy, asthenic states with prevention of somatic disease under extreme factors and loads, exposure to extreme (stress) factors, and attention deficit hyperactivity disorder in children. Side effects are listed as very rare (under 1 in 10,000), including angioedema, urticaria, drowsiness, headache, dry mouth, nausea and stomach discomfort. It is contraindicated in pregnancy and breastfeeding.

Participants / model
Adults and, for the attention deficit hyperactivity disorder use, children
Treatment
Mexidol 125 mg oral film-coated tablets
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

The injection leaflet says adults over 18 only, so the two leaflets do not agree on children. The copy was read on a commercial drug-information site, not on the Russian state register.

Read the original source

How does emoxypine work, and what does the body do with it?

The sources reviewed do not show how Mexidol acts in people, and most mechanism-type records in the searches were rodent models. In 16 patients given a single tablet, 0.31% of the dose appeared in urine unchanged and 49.6% as the glucuronide over 11.5 hours.

No source reviewed here tests how Mexidol acts in people. Most of the 45 records in the anxiety search were rodent stress and anxiety models, so the mechanism work is largely animal work and its human relevance is not established by these sources.

In 16 patients with neurosis or traumatic central nervous system injury given a single 500 mg Mexidol tablet, 0.31% of the dose appeared in urine unchanged and 49.6% as the glucuronide conjugate over 11.5 hours, with substantial person-to-person variability. This is the only human pharmacokinetic report found. It is small, measures urine only, and gives no plasma half-life.

PubMed search, 10 October 2026: 45 records, no placebo-controlled anxiety-disorder trial

PubMed search record

PubMed search run on 10 October 2026: (mexidol OR emoxypine OR ethylmethylhydroxypyridine OR "2-ethyl-6-methyl-3-hydroxypyridine") AND (anxiety disorder OR generalized anxiety OR anxiolytic OR neurotic OR adjustment disorder). 45 records returned.

The search returned 45 records. No placebo-controlled trial in patients with a primary anxiety disorder turned up. The records were mostly rodent stress and anxiety models and patient studies where mood was a secondary measure. The closest human study is a 2-week report in 70 patients with panic disorder and insomnia (mean age 34.5 years) given fevarin (a fluvoxamine brand) 150 mg a day with or without Mexidol 375 mg a day (PMID 23528580). It says Mexidol enhanced the fall in anxiety and improved insomnia on polysomnography, but the abstract does not state blinding or placebo.

Participants / model
Records returned, not a population
Treatment
Not applicable
Follow-up
Search run on 10 October 2026
Study design
Literature search
Funding
not stated in the source

A search result shows what PubMed returned on that date. It is not proof that no unindexed study exists.

Read the original source
Urine PK: 16 patients, 0.31% unchanged and 49.6% as glucuronide over 11.5 hours

Human study

Sariev AK et al. Eksp Klin Farmakol. 1999;62(5):42-6. PMID 10572752.

0.31% of the dose appeared in urine unchanged and 49.6% as the glucuronide conjugate over 11.5 hours, with substantial person-to-person variability.

Participants / model
16 patients with neurosis or traumatic central nervous system injury
Treatment
Single oral Mexidol 500 mg tablet
Follow-up
Urine collected over 11.5 hours
Study design
Clinical pharmacokinetic study, small and urine only, Russian-language
Funding
not stated in the source

This is the only human pharmacokinetic report found. It reports no plasma half-life.

Read the original source

What side effects and warnings do the leaflets and trials report?

The Russian leaflets list very rare (under 1 in 10,000) side effects, including anaphylactic shock and angioedema, and contraindicate use in pregnancy and breastfeeding. In the sponsor-run trials, adverse events did not differ significantly from placebo, with 35 patients (23%) in each group in MIR.

The injection leaflet lists very rare (under 1 in 10,000) side effects: anaphylactic shock and angioedema among the serious ones, and dry mouth, nausea and skin reactions among the others. The tablet leaflet lists very rare side effects including angioedema, urticaria, drowsiness, headache, dry mouth, nausea and stomach discomfort. Both contraindicate use in pregnancy and breastfeeding.

The two leaflets do not agree on children: the injection leaflet says adults over 18 only, while the tablet leaflet lists attention deficit hyperactivity disorder in children.

Side-effect frequency did not differ significantly from placebo in EPICA, adverse events occurred in 35 patients (23%) in each group in MIR, and MEMO reported a safety profile comparable to placebo. All three trials were sponsor-run and enrolled patients, so they say little about healthy people or long-term use.

Mexidol injection leaflet: stroke, brain ischemia, anxiety and myocardial infarction uses

Official label

Russian-language patient leaflet for Mexidol 50 mg/mL solution (active substance ethylmethylhydroxypyridine succinate), registration holder NPK Pharmasoft LLC, Moscow. Copy hosted on medi.ru; version date not shown.

The leaflet lists adult uses that include ischemic stroke, acute cerebrovascular accident without infarction, head injury, chronic brain ischemia, mild cognitive disorders, anxiety disorders in neurotic and neurosis-like states, and acute myocardial infarction from day 1 as part of combined therapy. It contraindicates use in pregnancy and breastfeeding. The listed side effects are very rare (under 1 in 10,000): anaphylactic shock and angioedema among the serious ones, and dry mouth, nausea and skin reactions among the others.

Participants / model
Adults over 18
Treatment
Mexidol 50 mg/mL solution, intravenous or intramuscular
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

A regional label, not an FDA or EMA review. The copy was read on a commercial drug-information site, not on the Russian state register, so the version date is not confirmed.

Read the original source
Mexidol tablet leaflet: anxiety, ischemic heart disease, stress-factor and ADHD uses

Official label

Russian-language patient leaflet for Mexidol 125 mg film-coated tablets. Copy hosted on medi.ru; version date not shown.

The leaflet lists, among other uses, anxiety disorders in neurotic and neurosis-like states, ischemic heart disease as part of combined therapy, asthenic states with prevention of somatic disease under extreme factors and loads, exposure to extreme (stress) factors, and attention deficit hyperactivity disorder in children. Side effects are listed as very rare (under 1 in 10,000), including angioedema, urticaria, drowsiness, headache, dry mouth, nausea and stomach discomfort. It is contraindicated in pregnancy and breastfeeding.

Participants / model
Adults and, for the attention deficit hyperactivity disorder use, children
Treatment
Mexidol 125 mg oral film-coated tablets
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

The injection leaflet says adults over 18 only, so the two leaflets do not agree on children. The copy was read on a commercial drug-information site, not on the Russian state register.

Read the original source
EPICA: 150 stroke patients, double-blind, placebo-controlled, Russian centers

Randomized controlled trial

Stakhovskaya LV et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(3. Vyp. 2):55-65. PMID 28665371.

At the end of treatment the mean modified Rankin score was lower with Mexidol (p = 0.04), more patients scored 0 to 2 (p = 0.039), and the mean NIHSS was lower (p = 0.035). Side-effect frequency did not differ significantly. The abstract gives no effect sizes.

Participants / model
150 patients aged 40 to 79 with acute and early-recovery hemispheric ischemic stroke
Treatment
Mexidol 500 mg a day by infusion for 10 days then 125 mg three times a day by mouth for 8 weeks, or placebo
Follow-up
10 days by infusion then 8 weeks by mouth
Study design
Double-blind, placebo-controlled randomized trial across Russian centers
Funding
Registry record NCT02793687 names Pharmasoft as sponsor

A sponsor-run trial reported in Russian in a supplement issue. The registry record was first posted on 8 June 2016, after the stated primary completion date of 27 May 2016.

Read the original source
MIR: 304 stroke patients in Russia, Uzbekistan and Kazakhstan, placebo-controlled

Randomized controlled trial

Shamalov NA et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(8. Vyp. 2):40-53. PMID 40898634.

Change in modified Rankin score favored Mexidol (p = 0.003), as did NIHSS (p < 0.001) and the Rivermead Mobility Index (p = 0.014). Adverse events occurred in 35 patients (23%) in each group.

Participants / model
304 patients with ischemic stroke of moderate severity, in Russia, Uzbekistan and Kazakhstan
Treatment
Mexidol 500 mg twice a day intravenously for 10 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo, on top of standard therapy
Follow-up
10 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial, multinational but regional
Funding
Registry record NCT06437626 names Pharmasoft as sponsor

A sponsor-run trial. The registry record shows a start on 18 November 2019, primary completion on 18 August 2023 and first posting on 31 May 2024, after completion.

Read the original source
MEMO: 318 patients with chronic brain ischemia, MoCA primary endpoint

Randomized controlled trial

Fedin AI et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(11):7-16. PMID 34932280.

The primary endpoint, change in the Montreal Cognitive Assessment (MoCA), favored Mexidol, with the lower bound of the 95% confidence interval for the group difference at 1.51 points. Among secondary endpoints the Beck anxiety scale also favored Mexidol at the last visit, and the safety profile was reported as comparable to placebo.

Participants / model
318 patients aged 40 to 90 with chronic brain ischemia, at 15 centers in Russia and Uzbekistan
Treatment
Mexidol 500 mg intravenously once a day for 14 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo
Follow-up
14 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial
Funding
Registry record NCT06834490 names Pharmasoft as sponsor

The anxiety result is a secondary endpoint in older patients with brain ischemia, not a trial in people with an anxiety disorder. The registry record shows primary completion on 8 December 2020 and first posting on 19 February 2025, after completion.

Read the original source

Why does emoxypine sit in C tier?

C reflects three sponsor-run, double-blind, placebo-controlled trials in stroke and chronic brain ischemia, all run in Russia, Uzbekistan or Kazakhstan. No independent replication or FDA or EMA review turned up, and the anxiety, stress and cardiac claims are not supported by adequate human trials.

The C applies to stroke and chronic brain ischemia in patients. The registry records for all three trials were first posted after the studies finished, the one meta-analysis reports significant heterogeneity, and the cardiac, anxiety and stress claims rest on small Russian-language reports or on nothing indexed.

For the supplier's claims, the prescribed-in-Russia statement matches the leaflets. Anxiolysis, cognitive preservation under stress in healthy people and cardiac protection are not supported by adequate human trials among the records reviewed.

EPICA: 150 stroke patients, double-blind, placebo-controlled, Russian centers

Randomized controlled trial

Stakhovskaya LV et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(3. Vyp. 2):55-65. PMID 28665371.

At the end of treatment the mean modified Rankin score was lower with Mexidol (p = 0.04), more patients scored 0 to 2 (p = 0.039), and the mean NIHSS was lower (p = 0.035). Side-effect frequency did not differ significantly. The abstract gives no effect sizes.

Participants / model
150 patients aged 40 to 79 with acute and early-recovery hemispheric ischemic stroke
Treatment
Mexidol 500 mg a day by infusion for 10 days then 125 mg three times a day by mouth for 8 weeks, or placebo
Follow-up
10 days by infusion then 8 weeks by mouth
Study design
Double-blind, placebo-controlled randomized trial across Russian centers
Funding
Registry record NCT02793687 names Pharmasoft as sponsor

A sponsor-run trial reported in Russian in a supplement issue. The registry record was first posted on 8 June 2016, after the stated primary completion date of 27 May 2016.

Read the original source
MIR: 304 stroke patients in Russia, Uzbekistan and Kazakhstan, placebo-controlled

Randomized controlled trial

Shamalov NA et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(8. Vyp. 2):40-53. PMID 40898634.

Change in modified Rankin score favored Mexidol (p = 0.003), as did NIHSS (p < 0.001) and the Rivermead Mobility Index (p = 0.014). Adverse events occurred in 35 patients (23%) in each group.

Participants / model
304 patients with ischemic stroke of moderate severity, in Russia, Uzbekistan and Kazakhstan
Treatment
Mexidol 500 mg twice a day intravenously for 10 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo, on top of standard therapy
Follow-up
10 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial, multinational but regional
Funding
Registry record NCT06437626 names Pharmasoft as sponsor

A sponsor-run trial. The registry record shows a start on 18 November 2019, primary completion on 18 August 2023 and first posting on 31 May 2024, after completion.

Read the original source
MEMO: 318 patients with chronic brain ischemia, MoCA primary endpoint

Randomized controlled trial

Fedin AI et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(11):7-16. PMID 34932280.

The primary endpoint, change in the Montreal Cognitive Assessment (MoCA), favored Mexidol, with the lower bound of the 95% confidence interval for the group difference at 1.51 points. Among secondary endpoints the Beck anxiety scale also favored Mexidol at the last visit, and the safety profile was reported as comparable to placebo.

Participants / model
318 patients aged 40 to 90 with chronic brain ischemia, at 15 centers in Russia and Uzbekistan
Treatment
Mexidol 500 mg intravenously once a day for 14 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo
Follow-up
14 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial
Funding
Registry record NCT06834490 names Pharmasoft as sponsor

The anxiety result is a secondary endpoint in older patients with brain ischemia, not a trial in people with an anxiety disorder. The registry record shows primary completion on 8 December 2020 and first posting on 19 February 2025, after completion.

Read the original source
Stroke meta-analysis: 11 Russian-language studies, 2 randomized

Systematic review and meta-analysis

Voznyuk IA et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(12. Vyp. 2):49-60. PMID 38148698.

The review included 11 Russian-language studies, only 2 randomized controlled and 9 non-randomized, unblinded cohort studies. It found lower NIHSS and modified Rankin scores than comparison groups. The authors report significant statistical heterogeneity and say the evidence needs further examination as new data appear.

Participants / model
Adults with ischemic stroke in pooled Russian studies
Treatment
Mexidol in varied regimens
Follow-up
Pooled studies
Study design
Systematic review and meta-analysis of 11 studies
Funding
not stated in the source

This is the quality caveat for the stroke literature.

Read the original source
Russian-language report: 100 patients over 3 years, fewer complications reported

Human study

Sidorenko GI et al. Kardiologiia. 2011;51(6):44-8. PMID 21878070.

The abstract reports fewer complications, deaths and rehospitalizations with Mexidol but gives no numbers, and does not state randomization or blinding.

Participants / model
100 patients followed for 3 years after myocardial infarction with chronic heart failure: 52 on Mexidol plus conventional therapy and 48 on conventional therapy alone
Treatment
Mexidol (ethylmethylhydroxypyridine succinate) added to conventional therapy
Follow-up
3 years of follow-up
Study design
Clinical study; randomization and blinding not stated in the abstract
Funding
not stated in the source

A single small Russian-language report, so it supports only a hypothesis of cardiac benefit. Endpoints were complications, mortality, rehospitalization and myocardial function.

Read the original source
PubMed search, 10 October 2026: 45 records, no placebo-controlled anxiety-disorder trial

PubMed search record

PubMed search run on 10 October 2026: (mexidol OR emoxypine OR ethylmethylhydroxypyridine OR "2-ethyl-6-methyl-3-hydroxypyridine") AND (anxiety disorder OR generalized anxiety OR anxiolytic OR neurotic OR adjustment disorder). 45 records returned.

The search returned 45 records. No placebo-controlled trial in patients with a primary anxiety disorder turned up. The records were mostly rodent stress and anxiety models and patient studies where mood was a secondary measure. The closest human study is a 2-week report in 70 patients with panic disorder and insomnia (mean age 34.5 years) given fevarin (a fluvoxamine brand) 150 mg a day with or without Mexidol 375 mg a day (PMID 23528580). It says Mexidol enhanced the fall in anxiety and improved insomnia on polysomnography, but the abstract does not state blinding or placebo.

Participants / model
Records returned, not a population
Treatment
Not applicable
Follow-up
Search run on 10 October 2026
Study design
Literature search
Funding
not stated in the source

A search result shows what PubMed returned on that date. It is not proof that no unindexed study exists.

Read the original source
PubMed search, 10 October 2026: 67 records, none on healthy-people cognition or stress

PubMed search record

PubMed search run on 10 October 2026: (mexidol OR emoxypine OR ethylmethylhydroxypyridine) AND (healthy volunteers OR healthy subjects OR athletes OR students OR operators OR military). 67 records returned.

The search returned 67 records. They covered patients with stroke, surgery, eye, kidney and abdominal disease, rodent models and a sports-doping marker paper. None tested cognition or stress resilience in healthy people. The cognitive preservation under stress claim has no healthy-human trial among these records.

Participants / model
Records returned, not a population
Treatment
Not applicable
Follow-up
Search run on 10 October 2026
Study design
Literature search
Funding
not stated in the source

A search result shows what PubMed returned on that date. It is not proof that no unindexed study exists.

Read the original source

Studies and sources

Mexidol injection leaflet: stroke, brain ischemia, anxiety and myocardial infarction uses

Official label

Russian-language patient leaflet for Mexidol 50 mg/mL solution (active substance ethylmethylhydroxypyridine succinate), registration holder NPK Pharmasoft LLC, Moscow. Copy hosted on medi.ru; version date not shown.

The leaflet lists adult uses that include ischemic stroke, acute cerebrovascular accident without infarction, head injury, chronic brain ischemia, mild cognitive disorders, anxiety disorders in neurotic and neurosis-like states, and acute myocardial infarction from day 1 as part of combined therapy. It contraindicates use in pregnancy and breastfeeding. The listed side effects are very rare (under 1 in 10,000): anaphylactic shock and angioedema among the serious ones, and dry mouth, nausea and skin reactions among the others.

Participants / model
Adults over 18
Treatment
Mexidol 50 mg/mL solution, intravenous or intramuscular
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

A regional label, not an FDA or EMA review. The copy was read on a commercial drug-information site, not on the Russian state register, so the version date is not confirmed.

Read the original source
Mexidol tablet leaflet: anxiety, ischemic heart disease, stress-factor and ADHD uses

Official label

Russian-language patient leaflet for Mexidol 125 mg film-coated tablets. Copy hosted on medi.ru; version date not shown.

The leaflet lists, among other uses, anxiety disorders in neurotic and neurosis-like states, ischemic heart disease as part of combined therapy, asthenic states with prevention of somatic disease under extreme factors and loads, exposure to extreme (stress) factors, and attention deficit hyperactivity disorder in children. Side effects are listed as very rare (under 1 in 10,000), including angioedema, urticaria, drowsiness, headache, dry mouth, nausea and stomach discomfort. It is contraindicated in pregnancy and breastfeeding.

Participants / model
Adults and, for the attention deficit hyperactivity disorder use, children
Treatment
Mexidol 125 mg oral film-coated tablets
Follow-up
Version date not shown
Study design
Russian-language patient leaflet, copy hosted on a drug-information site
Funding
not stated in the source

The injection leaflet says adults over 18 only, so the two leaflets do not agree on children. The copy was read on a commercial drug-information site, not on the Russian state register.

Read the original source
EPICA: 150 stroke patients, double-blind, placebo-controlled, Russian centers

Randomized controlled trial

Stakhovskaya LV et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(3. Vyp. 2):55-65. PMID 28665371.

At the end of treatment the mean modified Rankin score was lower with Mexidol (p = 0.04), more patients scored 0 to 2 (p = 0.039), and the mean NIHSS was lower (p = 0.035). Side-effect frequency did not differ significantly. The abstract gives no effect sizes.

Participants / model
150 patients aged 40 to 79 with acute and early-recovery hemispheric ischemic stroke
Treatment
Mexidol 500 mg a day by infusion for 10 days then 125 mg three times a day by mouth for 8 weeks, or placebo
Follow-up
10 days by infusion then 8 weeks by mouth
Study design
Double-blind, placebo-controlled randomized trial across Russian centers
Funding
Registry record NCT02793687 names Pharmasoft as sponsor

A sponsor-run trial reported in Russian in a supplement issue. The registry record was first posted on 8 June 2016, after the stated primary completion date of 27 May 2016.

Read the original source
MIR: 304 stroke patients in Russia, Uzbekistan and Kazakhstan, placebo-controlled

Randomized controlled trial

Shamalov NA et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(8. Vyp. 2):40-53. PMID 40898634.

Change in modified Rankin score favored Mexidol (p = 0.003), as did NIHSS (p < 0.001) and the Rivermead Mobility Index (p = 0.014). Adverse events occurred in 35 patients (23%) in each group.

Participants / model
304 patients with ischemic stroke of moderate severity, in Russia, Uzbekistan and Kazakhstan
Treatment
Mexidol 500 mg twice a day intravenously for 10 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo, on top of standard therapy
Follow-up
10 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial, multinational but regional
Funding
Registry record NCT06437626 names Pharmasoft as sponsor

A sponsor-run trial. The registry record shows a start on 18 November 2019, primary completion on 18 August 2023 and first posting on 31 May 2024, after completion.

Read the original source
MEMO: 318 patients with chronic brain ischemia, MoCA primary endpoint

Randomized controlled trial

Fedin AI et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(11):7-16. PMID 34932280.

The primary endpoint, change in the Montreal Cognitive Assessment (MoCA), favored Mexidol, with the lower bound of the 95% confidence interval for the group difference at 1.51 points. Among secondary endpoints the Beck anxiety scale also favored Mexidol at the last visit, and the safety profile was reported as comparable to placebo.

Participants / model
318 patients aged 40 to 90 with chronic brain ischemia, at 15 centers in Russia and Uzbekistan
Treatment
Mexidol 500 mg intravenously once a day for 14 days then Mexidol FORTE 250 mg three times a day for 60 days, or placebo
Follow-up
14 days intravenously then 60 days orally
Study design
Double-blind, placebo-controlled randomized trial
Funding
Registry record NCT06834490 names Pharmasoft as sponsor

The anxiety result is a secondary endpoint in older patients with brain ischemia, not a trial in people with an anxiety disorder. The registry record shows primary completion on 8 December 2020 and first posting on 19 February 2025, after completion.

Read the original source
Stroke meta-analysis: 11 Russian-language studies, 2 randomized

Systematic review and meta-analysis

Voznyuk IA et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(12. Vyp. 2):49-60. PMID 38148698.

The review included 11 Russian-language studies, only 2 randomized controlled and 9 non-randomized, unblinded cohort studies. It found lower NIHSS and modified Rankin scores than comparison groups. The authors report significant statistical heterogeneity and say the evidence needs further examination as new data appear.

Participants / model
Adults with ischemic stroke in pooled Russian studies
Treatment
Mexidol in varied regimens
Follow-up
Pooled studies
Study design
Systematic review and meta-analysis of 11 studies
Funding
not stated in the source

This is the quality caveat for the stroke literature.

Read the original source
Russian-language report: 100 patients over 3 years, fewer complications reported

Human study

Sidorenko GI et al. Kardiologiia. 2011;51(6):44-8. PMID 21878070.

The abstract reports fewer complications, deaths and rehospitalizations with Mexidol but gives no numbers, and does not state randomization or blinding.

Participants / model
100 patients followed for 3 years after myocardial infarction with chronic heart failure: 52 on Mexidol plus conventional therapy and 48 on conventional therapy alone
Treatment
Mexidol (ethylmethylhydroxypyridine succinate) added to conventional therapy
Follow-up
3 years of follow-up
Study design
Clinical study; randomization and blinding not stated in the abstract
Funding
not stated in the source

A single small Russian-language report, so it supports only a hypothesis of cardiac benefit. Endpoints were complications, mortality, rehospitalization and myocardial function.

Read the original source
Urine PK: 16 patients, 0.31% unchanged and 49.6% as glucuronide over 11.5 hours

Human study

Sariev AK et al. Eksp Klin Farmakol. 1999;62(5):42-6. PMID 10572752.

0.31% of the dose appeared in urine unchanged and 49.6% as the glucuronide conjugate over 11.5 hours, with substantial person-to-person variability.

Participants / model
16 patients with neurosis or traumatic central nervous system injury
Treatment
Single oral Mexidol 500 mg tablet
Follow-up
Urine collected over 11.5 hours
Study design
Clinical pharmacokinetic study, small and urine only, Russian-language
Funding
not stated in the source

This is the only human pharmacokinetic report found. It reports no plasma half-life.

Read the original source
PubChem: emoxypine free base and succinate identity

Chemical identity record

National Library of Medicine. PubChem compound records CID 114681 (emoxypine) and CID 122298 (emoxypine succinate).

Emoxypine (2-ethyl-6-methylpyridin-3-ol), the free base: PubChem CID 114681, C8H11NO, 137.18 g/mol, CAS 2364-75-2. Emoxypine succinate, the salt in Mexidol: CID 122298, C12H17NO5, 255.27 g/mol, CAS 127464-43-1. The trials used the succinate. A 2018 crystallography paper (PMID 29973419) describes other emoxypine salts (maleate, malonate, adipate) made to raise solubility.

Participants / model
Chemical identity, not a clinical population
Treatment
Defined free base and succinate salt
Follow-up
Not applicable
Study design
NLM chemical record
Funding
not stated in the source

A vendor emoxypine may be the free base or another salt, and none of those has the trial data. Identity record only; it says nothing about efficacy or safety.

Read the original source

Why is Emoxypine succinate in C tier?

C fits three sponsor-run, double-blind, placebo-controlled trials in stroke and chronic brain ischemia, all run in Russia, Uzbekistan or Kazakhstan, with registry records first posted after the studies finished and no independent replication or FDA or EMA review turning up. The mechanism work in the searches is mostly in rodents, and the cardiac, anxiety and stress claims rest on small Russian-language reports or on nothing indexed. The grade covers patients with stroke or chronic brain ischemia, not the supplier's anxiolysis or stress claims.