Piracetam

Drug Nomenclature
Synonyms: CI-871; Piracetam; Piracetamum; Pyrrolidone Acetamide; UCB-6215
BAN: Piracetam
USAN: Piracetam
rINN: Piracetam
Chemical name: 2-(2-Oxoyrrolidin-1-yl!acetamide
Molecular formula: C6"1#$2O2 %1&2'2
CAS: 7&(1-7&-(
ATC code: $#6B)#*
Read code: y#2+U
Pharmacopoeias:
In Eur. (see ).
Ph. Eur. 5.0 (Piracetam). A white or almost white powder. It
exhibits polymorphism. Freely soluble in water; soluble in alcohol.
Protect rom li!ht.
Date of monoraph re!ision: #6-,ay-1((8; #1--e-1((8; #5-.e/-2##1; 1&-$o0-
2##1; #7-1ul-2##&;
Adverse Efects and Precautions
Piracetam is reported to produce insomnia or somnolence" wei!ht
!ain" hyper#inesia" ner$ousness" and depression. %iarrhoea and
rashes may occur at a lower re&uency. Piracetam should not be !i$en
to patients with hepatic impairment or se$ere renal impairment;
dosa!e reductions are recommended or patients with lesser de!rees
o renal impairment. 'herapy with piracetam should not be withdrawn
abruptly.
Interactions
Anticoagulants.
For reerence to the e(ect o piracetam on wararin" see .
Uses and Administration
Piracetam acts on the )*+ and has been described as a ,nootropic,; it
is said to protect the cerebral cortex a!ainst hypoxia. It is also
reported to inhibit platelet a!!re!ation and reduce blood $iscosity at
hi!h doses. Piracetam is used as an ad-unct in the treatment o
myoclonus o cortical ori!in. It has also been used in dementia. .ther
disorders or states in which it has been tried (on the basis o a
supposed ,cerebrocortical insu/ciency, responsi$e to piracetam)
include alcoholism" $erti!o" cerebro$ascular accidents" dyslexia"
beha$ioural disorders in children" and ater trauma or sur!ery.
In cortical myoclonus" piracetam is !i$en in doses o 0.1 ! daily
increasin! by 2.3 ! daily e$ery 4 or 2 days up to a maximum o 10 !
daily. It is !i$en by mouth in 1 or 4 di$ided doses. .nce the optimal
dose o piracetam has been established" attempts should be made to
reduce the dose o other dru!s. For dosa!e in renal impairment see
.
Piracetam has been !i$en or $arious other disorders in doses o 0.3
to 5 ! three times daily by mouth. In se$ere disorders it has been
!i$en by intramuscular or intra$enous in-ection.
Administration in renal impairment.
%osa!e should be reduced in patients with mild to moderate renal
impairment accordin! to creatinine clearance ()))6
)) between 70 and 20 m89minute6 hal the usual dose
)) between 20 and 10 m89minute6 one:&uarter o the usual dose
Dementia.
Althou!h piracetam is used in some countries in the mana!ement
o co!niti$e impairment and dementia ( )" a recent systematic
re$iew
5
concluded that the e$idence rom the published literature
did not support this use.
1' 1' .lic2er 34 5rimley +0an6 1' Piracetam 7or dementia or co8niti0e imairment'
A0aila/le in 9:e Coc:rane 3i/rary; I66ue 2' C:ic:e6ter; 1o:n <iley; 2##&'
Myoclonus.
A re$iew
5
o 71 case reports" 4 open studies" and 1 double:blind
studies concluded that piracetam is bene;cial in the treatment o
disablin! myoclonus ( )" either as ad-uncti$e treatment or as
monotherapy. +imilar conclusions were made in another re$iew
1
in
which experience o 51 patients with pro!ressi$e myoclonus
epilepsy" 3 o whom bene;ted rom piracetam in doses o up to 25 !
daily without si!ni;cant ad$erse e(ects" was described.
1' 1' =an =leymen B4 =an >andi?c2e ,' Piracetam in t:e treatment o7 myoclonu6; an
o0er0ie@' Acta Neurol Belg 1((6; 96: 27#A8#' Pu/,ed
2' 2' 5enton P4 et al. Piracetam in t:e treatment o7 cortical myoclonu6'
Pharmacopsychiatry 1(((; 32 (6ul!; &(A5*' Pu/,ed
Stroke.
Piracetam did not in<uence the outcome i !i$en within 51 hours o
the onset o acute ischaemic stro#e in a multicentre" randomised"
double:blind trial"
5
althou!h post hoc analyses su!!ested that it
mi!ht coner bene;t when !i$en within 0 hours o onset"
particularly in patients with stro#e o moderate to se$ere de!ree.
Further analyses o the same data concluded that piracetam did not
produce si!ni;cant ad$erse e(ects when !i$en in hi!h doses to
patients with acute stro#e"
1
and si!ni;cantly more patients had
reco$ered rom aphasia on piracetam than placebo.
4
'he results o
two urther randomised" double:blind" placebo:controlled trials
supportin! the role o piracetam as an ad-unct to intensi$e speech
therapy in impro$in! aphasia ollowin! stro#e were also reported.
4

In contrast" a re$iew o the ;rst study considered that the trend
towards an increased ris# o early death in patients allocated to
piracetam was o concern" and concluded that the data did not
support routine use o piracetam in acute ischaemic stro#e.
2

1' 1' Be Beyn PP4 et al. 9reatment o7 acute and i6c:emic 6tro2e @it: iracetam' Stroke
1((7; 28: 2*&7A52' Pu/,ed
2' 2' Be Ceuc2 14 =an =leyman B' 9:e clinical 6a7ety o7 :i8:-do6e iracetamDit6 u6e
in t:e treatment o7 acute 6tro2e' Pharmacopsychiatry 1(((; 32 (6ul 1!; **A7'
*' *' "u/er <' 9:e role o7 iracetam in t:e treatment o7 acute and c:ronic a:a6ia'
Pharmacopsychiatry 1(((; 32 (6ul 1!; *8A&*' Pu/,ed
&' &' Cicci -4 et al. Piracetam 7or acute i6c:aemic 6tro2e' A0aila/le in 9:e Coc:rane
3i/rary; I66ue 2' C:ic:e6ter; 1o:n <iley; 2##&'
Vertigo.
Piracetam has been reported to be o bene;t in patients with
$erti!o ( ) o both central or peripheral ori!in.
5

1' 1' Oo6ter0eld <1' 9:e e77ecti0ene66 o7 iracetam in 0erti8o' Pharmacopsychiatry'
1(((; 32 (6ul 1!; 5&A6#' Pu/,ed
Preparations
Singleingredient Preparations
'he symbol = denotes a preparation which is discontinued or no
lon!er acti$ely mar#eted.
Arg.6 *oostan; Austria6 )erebryl; *ootropil; *o$ocephal; Pirabene;
Belg.6 >raintop; ?eratam; *oodis; *ootropil; Braz.6 )intilan; *ootro;c;
*ootron; *ootropil=; Chile6 *ootropyl; Fin.6 *ootropil; Fr.6 Axonyl;
?abacet; ?eram; *ootropyl; Ger.6 A$i!ilen; )erebroorte;
)erebrosteril=; )erepar *; )uxabrain; durapitrop=; Encetrop=; @emo:
Puren; *ootrop; *ormabrain; *o$ocetam=; Piracebral; Piracetrop;
+inapsan; Gr.6 Aminotrophylle:33; Arterosol; 8atys; 8obelo; @ecli$in;
@editam; *oorit; *ootrop; .xynium; Piracem; +tamin; Hong Kong6
*ootropil; Hung.6 )erebryl; 8ucetam; @emoril; *ootropil; Pirabene;
Pyramen; India6 Piratam; Ital.6 )erebropan; )etam=; )le$eral=;
Fla$is=; *ootropil; *orAetam; Psycoton; Malaysia6 )ebrotonin;
Bnowul; *ootropil; Mex.6 %ina!en; *ootropil; Neth.6 *ootropil; Norw.6
*ootropil; Port.6 Acetar; *oostan; *ootropil; .xibran; +timubral; S.Ar.6
*ootropil; Singa!ore6 )ebrotonin; )etam; *ootropil; Piratam;
Cacetam; S!ain6 )icloalina; ?eno!ris=; *ootropil; Swed.6 *ootropil;
Switz.6 *ootropil; Pirax; "hai.6 Embol; @empil; *oocetam; *ootropil;
#K6 *ootropil;
Multiingredient Preparations
'he symbol = denotes a preparation which is discontinued or no
lon!er acti$ely mar#eted.
Braz.6 Ener!iclin; Ener!i$it; Exit; Is#etam; Psico!lut=; Dincetron; Port.6
Anacer$ix; )entracetam; Eu$ior; +timilar; S!ain6 Anacer$ix;
%e$incal; %iemil; @emorino=; Peobe=; Piracetam )omplex;