Piracetam

Uses and Administration

Piracetam acts on the CNS and has been described as a nootropic; it is said to protect the cerebral cortex against hypoxia. It is also reported to inhibit platelet aggregation and reduce blood viscosity at high doses. Piracetam is used as an adjunct in the treatment of myoclonus of cortical origin, and has also been used in dementia (see also Refer to and Refer to ). Other disorders or states in which it has been tried (on the basis of a supposed 'cerebrocortical insufficiency' responsive to piracetam) include alcoholism, vertigo, cerebrovascular accidents, dyslexia, behavioural disorders in children, and after trauma or surgery.

In cortical myoclonus, piracetam is given in oral doses of 7.2 g daily increasing by 4.8 g daily every 3 or 4 days up to a maximum of 24 g daily. It is given in 2 or 3 divided doses. Once the optimal dose of piracetam has been established, attempts should be made to reduce the dose of other drugs. For dosage in renal impairment see Refer to .

Piracetam has been given for various other disorders in a usual oral dose of up to 2.4 g daily in 2 or 3 divided doses; doses of up to 4.8 g daily or higher have been used in severe cases. In severe disorders it has also been given by intramuscular or intravenous injection.

(last reviewed 2013-04-25; last modified 2013-04-26)

General references.

(last reviewed 2013-04-25; last modified 2010-08-25)

References

1. Winblad B. Piracetam: a review of pharmacological properties and clinical uses.CNS Drug Rev. 2005; 11: 169–82. PubMed

2. Malykh AG, Sadaie MR. Piracetam and piracetam-like drugs: from basic science to novel clinical applications to CNS disorders.Drugs. 2010; 70: 287–312. PubMed

Administration in renal impairment

The usual oral dose of piracetam (see Refer to ) should be reduced in patients with renal impairment according to creatinine clearance (CC):

CC between 50 and 79 mL/minute: two-thirds of the usual dose, given in 2 or 3 divided doses

CC between 30 and 49 mL/minute: one-third of the usual dose, given in 2 divided doses

CC between 20 and 29 mL/minute: one-sixth of the usual dose, given as a single dose

Use of piracetam is contra-indicated in those with a CC of less than 20 mL/minute.

(last reviewed 2013-04-25; last modified 2009-01-16)

Dementia

Although piracetam is used in some countries in the management of cognitive impairment and dementia ( Refer to ), a systematic review1 concluded that the evidence from the published literature did not support this use.

(last reviewed 2013-04-25; last modified 2010-08-25)

References

1. Flicker L, Grimley Evans J. Piracetam for dementia or cognitive impairment. Available in The Cochrane Database of Systematic Reviews; Issue 1. Chichester: John Wiley; 2004 (accessed 14/02/06). PubMed

Myoclonus

A review1 of 62 case reports, 3 open studies, and 2 double-blind studies concluded that piracetam is beneficial in the treatment of disabling myoclonus ( Refer to ), either as adjunctive treatment or as monotherapy. Similar conclusions were made in another review2 in which experience of 12 patients with progressive myoclonus epilepsy, 8 of whom benefited from piracetam in doses of up to 45 g daily without significant adverse effects, was described.

(last reviewed 2013-04-25; last modified 2004-03-22)

References

1. Van Vleymen B, Van Zandijcke M. Piracetam in the treatment of myoclonus: an overview.Acta Neurol Belg. 1996; 96: 270–80. PubMed

2. Genton P, et al.. Piracetam in the treatment of cortical myoclonus.Pharmacopsychiatry. 1999; 32 49–53. PubMed

Stroke

Piracetam did not influence the outcome if given within 12 hours of the onset of acute ischaemic stroke in a multicentre, randomised, double-blind study,1 although post hoc analyses suggested that it might confer benefit when given within 7 hours of onset, particularly in patients with stroke of moderate to severe degree. Further analyses of the same data concluded that piracetam did not produce significant adverse effects when given in high doses to patients with acute stroke,2 and significantly more patients had recovered from aphasia on piracetam than placebo.3 The results of two further randomised, double-blind, placebo-controlled studies supporting the role of piracetam as an adjunct to intensive speech therapy in improving aphasia following stroke were also reported.3In contrast, a systematic review including the first study considered that the trend towards an increased risk of early death in patients allocated to piracetam was of concern, and concluded that the data did not support routine use of piracetam in acute ischaemic stroke.4

(last reviewed 2013-04-25; last modified 2008-08-07)

References

1. De Deyn PP, et al.. Treatment of acute and ischemic stroke with piracetam.Stroke. 1997; 28: 2347–52. PubMed

2. De Reuck J, Van Vleymen B. The clinical safety of high-dose piracetam—its use in the treatment of acute stroke.Pharmacopsychiatry. 1999; 32 33–7. PubMed

3. Huber W. The role of piracetam in the treatment of acute and chronic aphasia.Pharmacopsychiatry. 1999; 32 38–43. PubMed

4. Ricci S, et al.. Piracetam for acute ischaemic stroke. Available in The Cochrane Database of Systematic Reviews; Issue 2. Chichester: John Wiley; 2006 (accessed 23/05/08). PubMed

Vertigo

Piracetam has been reported to be of benefit in patients with vertigo ( Refer to ) of both central or peripheral origin.1

(last reviewed 2013-04-25; last modified 2006-01-24)

References

1. Oosterveld WJ. The effectiveness of piracetam in vertigo.Pharmacopsychiatry. 1999; 32 54–60. PubMed

Adverse Effects, Treatment and Precautions

Adverse Effects and Precautions

Piracetam is reported to produce insomnia or somnolence, weight gain, hyperkinesia, nervousness, and depression. Other reported adverse effects include gastrointestinal disorders such as abdominal pain, diarrhoea, nausea and vomiting, hypersensitivity reactions, ataxia, vertigo, confusion, hallucinations, angioedema, and rashes. Piracetam should not be given to patients with hepatic impairment or severe renal impairment; dosage reduction is recommended for those with mild to moderate renal impairment (see under Uses and Administration, Refer to ). Therapy with piracetam should not be withdrawn abruptly in myoclonic patients due to the risk of inducing seizures. When used to treat cortical myoclonus, piracetam is contra-indicated in patients with cerebral haemorrhage, and should be used with caution after major surgery and in those with haemostatic disorders or severe haemorrhage.

(last reviewed 2013-04-25; last modified 2009-01-14)

Porphyria

The Drug Database for Acute Porphyria, compiled by the Norwegian Porphyria Centre (NAPOS) and the Porphyria Centre Sweden, classifies piracetam as probably not porphyrinogenic; it may be used as a drug of first choice and no precautions are needed.1

(last reviewed 2013-04-25; last modified 2011-11-15)

References

1. The Drug Database for Acute Porphyria. Available at: Link (accessed 25/10/11)

Interactions

Anticoagulants

For reference to the effect of piracetam on warfarin therapy, see Refer to .

(last reviewed 2013-04-25; last modified 2008-08-07)

Pharmacokinetics

Piracetam is rapidly and extensively absorbed from the gastrointestinal tract; peak plasma concentrations are reached within 1.5 hours after oral doses. The plasma half-life is reported to be 5 hours and it crosses the blood-brain barrier. Piracetam is excreted almost completely in the urine. It crosses the placenta and is distributed into breast milk.

(last reviewed 2013-04-25; last modified 2006-03-04)

Preparations: Single-Ingredient

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

ARGENTINA: Noostan;AUSTRIA: Cerebryl; Nootropil¤; Novocephal¤; Pirabene¤;BELGIUM: Braintop¤; Docpirace¤; Geratam¤; Noodis¤; Nootropil; Piracemed¤; Piracetop¤;BRAZIL: Cintilan; Nootrofic¤; Nootron; Nootropil;CHILE: Nootropyl;CHINA: Hong Wei Li Di (宏威利迪); Kang Ling (康灵); Kang Rong (康容); Ke Jie (克捷); Lu Si Qi (路思齐); Mai En Xi (迈恩希); Ning Xiu Xin (宁秀欣); Qing Da (庆达); Si Bi Ke (斯必克); Si Tai (思泰); Tan Fu (坦复); Tong Tan Kang (通坦康); Xin Ao Xin (欣奥欣); Yi An Nuo (益安诺); YiTing (易汀); Zhen Xi (真昔);CZECH REPUBLIC: Cerebryl¤; Geratam; Kalicor¤; Nootropil; Oikamid¤; Pirabene;FINLAND: Nootropil;FRANCE: Axonyl¤; Gabacet; Geram¤; Nootropyl;GERMANY: Avigilen¤; Cerebroforte¤; Cerebrosteril¤; Cerepar N¤; Cuxabrain¤; durapitrop¤; Encetrop¤; Memo-Puren¤; Nootrop; Normabrain¤; Novocetam¤; Piracebral¤; Piracetrop¤; Sinapsan¤;GREECE: Aminotrophylle-88¤; Arterosol¤; Cebragil; Celebral¤; Centracetam¤; Cetrop¤; Cosmoxim¤; Espritam¤; Latys¤; Lobelo¤; Logofren¤; Lowtens¤; Meclivin¤; Meditam; Noforit¤; Nootrop¤; Oxynium; Piracem¤; Psycoton¤; Stamin¤; Zalipan¤;HONG KONG: Bumedim; Knowful; Nootropil; Piratin; Racetex; Syntam; Syntropil; Vick-Tropil;HUNGARY: Cerebryl¤; Cognit; Lucetam; Memoril; Nootropil; Pirabene; Pyramen¤;INDIA: Alcetam; Amritam; Axetam; Brentor; Ceact; Cerecetam; Cetam; E-Tam; Enpir; Etotam; Floracetam; Gencephal; Mincetam; Neopiram; Neurocetam; Neuropil; Nicetam; Nootropil; Normabrain; Normenta¤; Nupic; Nurest; Nutam; Orotam; Pirament; Piratam;INDONESIA: Antikun; Benocetam; Brenaris; Cervas; Cetoros; Chepamed; Ciclobrain; Cytropil; Dexpira; Encebion¤; Ethopil; Fepiram; Galtropil; Gotropil; Gracetam; Latropil; Lutrotam; Mersitropil; Neurocet; Neurotam; Noocephal; Noocetam; Nootrisol; Nootropil; Notrotam; Nufacetam¤; Nurozetam; Pirabrain; Piratrof; Pratropil; Primatam¤; Procetam; Resibron; Revolan; Scantropil; Sevotam; Sotropil; Tropilex¤; Zetropil;IRELAND: Nootropil¤;ITALY: Cerebropan¤; Cetam¤; Cleveral¤; Flavis¤; Nootropil; Norzetam¤; Psycoton;JAPAN: Myocalm; Nootropil¤;MALAYSIA: Cebrotonin; Ceretam; Knowful; Neurocetam; Nootropil; Syntam¤;MEXICO: Dinagen¤; Nootropil;NETHERLANDS: Nootropil;NORWAY: Nootropil;PHILIPPINES: Cebrotonin; Irahex; Memozet; Neurocetam; Neuroton; Nootrocet; Nootropil; Normabrain; Nurocer; Pirasam¤; Rizetam;POLAND: Biotropil; Lucetam; MemoniQ; Memotropil; Nootropil; Recodium;PORTUGAL: Acetar; Noostan; Nootropil¤; Oxibran¤; Stimubral¤;RUSSIAN FEDERATION: Eskotropil (Эскотропил); Fescetam (Фесцетам); Lucetam (Луцетам); Memotropil (Мемотропил); Nootropil (Ноотропил); Phezam (Фезам); Piratropil (Пиратропил)¤;SOUTH AFRICA: Nootropil¤;SINGAPORE: Cebrotonin; Cetam; Neurocetam; Nootropil; Piratam; Racetam;SPAIN: Ciclofalina; Genogris¤; Nootropil;SWEDEN: Nootropil;SWITZERLAND: Nootropil; Pirax¤;THAILAND: Embol; Knoful¤; Mancetam; Mempil; Noocetam; Nootropil; Scarda;TURKEY: Cerebrofil; Nootropil; Norotrop; Opemin;UNITED KINGDOM: Nootropil;UKRAINE: Lucetam (Луцетам); Nootropil (Ноотропил);VENEZUELA: Breinox; Nootropil¤;

Preparations: Multi-Ingredient

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

BRAZIL: Energiclin; Energivit¤; Exit; Isketam; Psicoglut¤; Vincetron¤;CHINA: Jiesilin (杰思林);INDIA: Neuromin-M; Nutam Plus;MEXICO: Metadiemil;PORTUGAL: Anacervix; Centracetam¤; Euvifor¤; Stimilfar¤;RUSSIAN FEDERATION: Combitropil (Комбитропил); NooCam (НооКам); Omaron (Омарон); Piracezine (Пирацезин); Thiocetam (Тиоцетам); Vinpotropile (Винпотропил);SPAIN: Anacervix; Devincal¤; Diemil; Memorino¤; Peobe¤; Piracetam Complex¤;UKRAINE: Cinatropil (Цинатропил); Evrisam (Эвризам); Memokor (Мемокор); Memosam (Мемозам); Neuro-Norm (Нейро-Норм); Noozam (Ноозам); Olatropil (Олатропил); Omaron (Омарон); Phezam (Фезам); Thiocetam (Тиоцетам);VENEZUELA: Devincal¤;

Therapeutic Use

• Antidementia Drugs

Last Updated 1/21/20