Piracetam is a drug that has efficacy in cognitive disorders, vertigo, cortical myoclonus, dyslexia, and sickle cell anemia; sources differ on its usefulness for dementia.
Piracetam is in the group, with chemical name 2-oxo-1-pyrrolidine acetamide. It is a cyclic derivative of the neurotransmitter GABA[ and shares the same 2-oxo-pyrrolidone base structure with pyroglutamic acid. Related drugs include the anticonvulsants levetiracetam and brivaracetam, and the putative nootropics aniracetam and phenylpiracetam.
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Efficacy
Dementia
A 2001 Cochrane review concluded that there was not enough evidence to support piracetam for dementia or cognitive problems.[ A 2005 review found some evidence of benefit in older subjects with cognitive impairment.]
There is insufficient evidence of piracetam as a treatment for vascular dementia.
Depression and anxiety
Some sources suggest that piracetam's overall effect on lowering depression and anxiety is higher than on improving memory.[ Nootropil®. Arzneimittel-Kompendium der Schweiz. 2013-09-12. Retrieved 2013-10-27.]
Attention deficit hyperactivity disorder (ADHD)
Several clinical trials have looked at piracetam's efficacy as a treatment for ADHD. Many of these have found that the drug fails to deliver the same therapeutic effects as current standard treatments for the disorder.
While piracetam may be an effective adjuvant therapy for ADHD (when used with specific medications), there is no evidence that it is effective when used in isolation.
Other
Piracetam may facilitate the deformability of erythrocytes in capillary which is useful for cardiovascular disease.
Peripheral vascular effects of piracetam have suggested its use potential for vertigo, dyslexia, Raynaud's phenomenon and sickle cell anemia.
Anti-vasospasm
Piracetam has been found to diminish erythrocyte adhesion to vascular wall endothelium, making any vasospasm in the capillary less severe. This contributes to its efficacy in promoting microcirculation, including to the brain and kidneys.
Side effects
Symptoms including anxiety, insomnia, irritability, headache, agitation, tremor, and hyperkinesia are occasionally reported.
According to a 2005 review, piracetam has been observed to have the following side effects: hyperkinesia, weight gain, anxiety, somnolence, depression, and weakness.[
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Piracetam reduces platelet aggregation as well as fibrinogen concentration, and thus is contraindicated to patients with cerebral hemorrhage.
Toxicity
The for oral consumption in humans has not been determined.
Mechanisms of action
Piracetam's mechanism of action, as with in general, is not fully understood. The drug influences neuronal and vascular functions and influences cognitive function without acting as a sedative or stimulant.[ Piracetam is a positive allosteric modulator of the AMPA receptor, although this action is very weak and its clinical effects may not necessarily be mediated by this action.]
Piracetam increases the action of the neurotransmitter acetylcholine via muscarinic cholinergic (ACh) receptors, which are implicated in memory processes.
Piracetam inhibits N-type calcium channels. The concentration of piracetam achieved in central nervous system after a typical dose of 1200 mg (about 100 μM)
History
Piracetam was first made some time between the 1950s and 1964 by Corneliu E. Giurgea.
Society and culture
In 2009 piracetam was reportedly popular as a cognitive enhancement drug among students.
Legal status
Piracetam is an uncontrolled substance in the United States, meaning it is legal to possess without a license or prescription.
Regulatory status
In the United States, piracetam is not approved by the Food and Drug Administration.[ Nonetheless it is still, for the purposes of U.S. law, a "New Drug" as defined by 21 U.S. Code § 321(p)(1).
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In the United Kingdom, piracetam is approved as a prescription drug
In Japan, piracetam is approved as a prescription drug.
In the Czech Republic, piracetam is available without prescription.
Piracetam has no DIN in Canada, and thus cannot be sold, but can be imported for personal use in Canada.
In Hungary, piracetam was a prescription-only medication, but as of 2020, no prescription is required and piracetam is available as an over-the-counter drug under the name Memoril Mite, and is available in 600 mg pills.
See also
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AMPA receptor positive allosteric modulator
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Aniracetam
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Brivaracetam—an analogue of piracetam with the same additional side chain as levetiracetam and a three–carbon chain. It exhibits greater antiepileptic properties than levetiracetam in animal models, but with a somewhat smaller, although still high, therapeutic range.
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Ergoloid
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Levetiracetam—an analogue of piracetam bearing an additional CH3–CH2– sidechain and bearing antiepileptic pharmacological properties through a poorly understood mechanism probably related to its affinity for the vesicle protein SV2A.
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Oxiracetam
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Phenylpiracetam—a phenylated analog of the drug piracetam which was developed in 1983 in Russia where it is available as a prescription drug.
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Pramiracetam
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