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The dad-test answer
Cerebrolysin is a porcine-brain-derived neuropeptide cocktail used clinically for stroke and TBI recovery in Europe and Russia, with the CARS and CAPTAIN trials behind it. Semax is a synthetic 7-amino-acid ACTH fragment used as a Russian-approved nasal spray for cognitive support and stroke. Cerebrolysin has stronger trial evidence for major neurological events; Semax is the easier daily-use cognitive nootropic.
Who wins for what
| Use case | Who wins, and why |
|---|---|
| ischemic stroke recovery |
cerebrolysin CARS trial (Muresanu et al., 2016) and CAPTAIN II trial showed motor function recovery benefit in early-window stroke. |
| traumatic brain injury |
cerebrolysin Multiple TBI trials in Eastern European and Asian programs show sustained cognitive recovery vs placebo. |
| daily cognitive support / focus |
semax Approved in Russia as a nasal spray for normal cognitive support; easier delivery than IV/IM cerebrolysin infusions. |
| convenience and access |
semax Nasal spray vs IV/IM infusion course; cerebrolysin requires clinic infusion or supervised injection. |
What the head-to-head data shows
Both peptides are approved in Russia and several non-US jurisdictions; neither is FDA-approved in the US. Cerebrolysin's strongest evidence comes from the CARS trial (Muresanu et al., Stroke 2016) which showed improved motor function recovery in early-window ischemic stroke when given as a 21-day infusion. The CAPTAIN II trial (Heiss et al., 2012) replicated the signal in a larger cohort. Semax's evidence base is mostly Russian publications - Kaplan et al. 1996 and follow-up work characterize the peptide as an N-terminal ACTH fragment with neurotropic and anxiolytic effects via BDNF upregulation. The Russian Ministry of Health approved Semax as a 0.1% and 1% nasal spray in 1995. US access is gray-market for both molecules in 2026.
Our honest call
These two solve different problems. For a major neurological event - ischemic stroke, traumatic brain injury, post-surgical neurological recovery - cerebrolysin is the molecule with the actual trial evidence and a 21-day infusion course is what the CARS protocol used. For daily cognitive support and focus, semax is the easier protocol - intranasal, no clinic visit, and the Russian regulatory record gives some confidence in long-term safety. We have not personally validated either molecule. The cerebrolysin stroke recovery protocol covers the infusion path; semax remains an editorial-only entry without a published Protocol One protocol page.
Sources and citations
- Muresanu et al., CARS trial (cerebrolysin in early stroke), Stroke 2016 (PMID 27365443)
- Heiss et al., CAPTAIN II trial, J Stroke Cerebrovasc Dis 2012 (PMID 22261736)
- Kaplan et al., Semax neurotropic effects, Neurosci Behav Physiol 1996 (PMID 9148939)
- Russian Ministry of Health Semax registration (1995)
- Ever Pharma cerebrolysin prescribing information (EU)
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Last reviewed · 2026-05-07 · Page generated by Protocol One matrix engine. None of this replaces a doctor. Peptides are gray-market in the US for most uses. Talk to a real prescriber before you change anything.