Thiamine pyrophosphate tetrahydrate is the coenzyme form of vitamin B1 and acts as a crucial intermediate in the pyruvate dehydrogenase complex and alpha-ketoglutarate dehydrogenase complex. It functions as a cofactor for α-keto acid dehydrogenases, which are essential for oxidative phosphorylation and the pentose phosphate pathway.

Thiamine pyrophosphate (25 mg/kg, intraperitoneal injection) tetrahydrate inhibits oxidative damage induced by ischemia-reperfusion in rat ovarian tissue. Additionally, thiamine pyrophosphate (20 mg/kg, intraperitoneal injection, once daily for 14 days) tetrahydrate prevents cisplatin-induced cardiotoxicity in rats, as well as the associated oxidative stress and cardiac injury.