AIM: The aim was to assess the efficacy of treatment of asthenic syndrome in patients with combined injuries by means of succinate containing metabolic drugs (Mexidol, Cytoflavine, Metaprot plus) in comparison with non-succinate containing drugs of analogic structure or composition (Emoxipine, Riboxine, Metaprot) to clear up the significance of succinate as a functional structural element of the molecule. MATERIALS AND METHODS: In 134 surgical patients and sufferers with combined injuries, an asthenic syndrome (high anxiety, depression, high psychic and physical tiredness, weakness, absent-mindedness, attention disorders, reduced physical and psychical ability, need in durative rest, high psychic exhaustion, social disadaptation) was revealed by clinical, psychological and instrumental methods. RESULTS: Metabolic drugs containing succinate (Mexidol, Cytoflavine, Metaprot plus) in more degree than non-containing succinate in their structure (Emoxipine, Riboxine, Metaprot) were clinically effective in abolition or reduction of the asthenic syndrome in such patients. Antiasthenic action was represented by proper antiasthenic, antidepressant, anxiolytic, nootropic (cognitive) and positive general somatic effects of the drugs. CONCLUSION: The data confirm that succinate in the structure (composition) of the metabolic drugs significantly enhances protective action against asthenic syndrome in surgical patients with combined injuries.