The present invention provides the use of analogues and derivatives of dinucleoside polyphosphates with formula (I) or a pharmaceutically acceptable salt thereof, in the manufacture of a medicament for use in one or more of: the treatment of ischemia, inducing ischemic tolerance, modulating cerebral ischemia, to delay the onset of a hypoxic depolarisation stage when ischemic events are initiated; as a neurological protection agent; as a tissue protection agent; the treatment of pain; and the treatment of inflammation, wherein X, is selected from wherein X.sup.1 and X.sup.2 are independently selected from H, Cl, Br and F; each Y is independently selected from S and O; each Z is independently selected from --CX.sup.3X.sup.4--,--NH--,--O--; wherein X.sup.3 and X.sup.4 are selected from H, Cl, Br and F; B1 and B2 are independently selected from adenine, guanine, xanthine, thymine, uracil, cytosine and inosine; S.sub.1 and S.sub.2 are independently selected from ribose, open chain ribose, 2'-deoxyribose, 3'deoxyribose and arabinofuranoside. V is selected from 0, 1, 2, 3, 4 and 5; W is selected from 0, 1, 2, 3, 4 and 5; and V plus W is an integer from 2 to 6.