Agmatine SulfatevsEmoxypine (Mexidol)

Agmatine is a polyamine neuromodulator with multiple targets: (1) NMDA receptor antagonist at the polyamine binding site (GluN1/GluN2B) — reduces excitotoxicity, pain signaling, and blocks the receptor's open channel. (2) Imidazoline I1 and I2 receptor agonist — I1 in the rostral ventrolateral medulla reduces sympathetic tone; I2 modulates monoamine oxidase and provides anxiolytic/antidepressant effects. (3) Selective nNOS (neuronal nitric oxide synthase) inhibitor — reduces peroxynitrite formation and oxidative stress while preserving eNOS (endothelial) function for vascular health. (4) Alpha-2 adrenergic receptor agonist — reduces norepinephrine release from locus coeruleus, promoting calm. (5) Modulates opioid receptors — enhances mu-opioid analgesia, potentiates delta-opioid, and may reduce tolerance via nitric oxide and NMDA mechanisms.

Emoxypine (2-ethyl-6-methyl-3-hydroxypyridine succinate) has a 3-hydroxypyridine structure similar to vitamin B6 (pyridoxine). It is one of the most potent inhibitors of lipid peroxidation in brain tissue — it scavenges hydroxyl radicals and peroxyl radicals, inhibits Fe2+-induced lipid peroxidation, and may chelate transition metals. It modulates the GABA-benzodiazepine receptor complex (GABA-A), enhancing GABAergic transmission through positive allosteric modulation — possibly at a site distinct from the classical benzodiazepine binding site, explaining the lack of sedation and tolerance. It improves mitochondrial function (Complex I protection, membrane stabilization), stabilizes cell membranes (reducing fluidity changes during oxidative stress), and enhances cerebral microcirculation (possibly via nitric oxide or prostaglandin modulation). The anxiolytic mechanism may involve partial agonism or different subunit selectivity.