Piracetam is an effective medicine and the main representative of the group of neurometabolic stimulants (nootropics), designed to improve higher mental functions. With high therapeutic effectiveness, it is used in the treatment of neurological pathologies of psychotic conditions, narcotic and alcohol withdrawal conditions. The medication activates blood flow and metabolic energy processes, restores the activity of brain functions.

Composition and release forms


 

The therapeutic basis of all pharmaceutical forms of the drug is piracetam. A medicine is produced in the following types:

  1. Conventional tablets containing 200 mg of the therapeutic substance, packaged in cellular blisters of 10 pieces and in packs of 60 units.
  2. White convex elongated cylindrical tablets in the shell, which have a special risk (to facilitate dosing). They produce tablets with the amount of piracetam 800 and 1200 mg, packaged in blisters or polymer cans.
  3. Red-black capsules with 400 mg of therapeutic substance. In a translucent blister - 10, 15, 20 units.
  4. A 20% injection solution, poured into ampoules of polymer or glass with a volume of 5 ml, containing 1000 mg of the active ingredient, 200 mg is contained in 1 ml, respectively. Used for jet and drip intravenous infusion and injections into the muscle. The package contains 2 contour trays with 5 ampoules.

Pharmacological properties and pharmacokinetics

Piracetam pharmacologically affects cerebral tissues, accelerating excitation pulses, activating metabolic and energetic processes in neurons, and blood circulation in microvessels.

Piracetam, as the first synthesized nootropic medicine, has the following therapeutic properties:

  • stimulates intellectual activity, mental performance,
  • enhances the processes of memorization, increases the ability to communicate and learn, positively affects cognitive functions of the brain;
  • possesses antihypoxic effect, increasing the resistance of brain cells to oxygen starvation in case of impaired vascular patency,
  • protects tissues from the effects of poisons in case of poisoning, from damage due to injuries, excessive loads, during electroconvulsive therapy;
  • blocks the adhesion of blood cells to clots (blood clots), preventing thrombosis in the brain and heart vessels;
  • improves blood flow in ischemic (deprived of blood supply) parts of the brain;
  • activates microcirculation;
  • increases the production of RNA, ATP - the main source of tissue energy, and glucose and phosphorus compounds that are essential for brain function.

Piracetam does not dilate blood vessels, does not cause a sedative and psychostimulating effect.

It is absorbed into the blood quickly and almost completely, spreading to all tissues, including the placenta. At the same time, bioavailability - the amount of a therapeutic substance reaching the focus of exposure - is almost 100%. Selectively concentrated in the cerebral cortex.

It does not bind to protein compounds of the blood, it is practically not processed in the liver and does not harm the organ.
The main part of the therapeutic substance (more than 95%) is removed with the urine after about 28 - 30 hours in its original form.

With renal dysfunction, the time taken to remove the drug from the body lengthens.

After intravenous infusion, the largest amount of active substance is found in the blood after half an hour, in the cerebrospinal fluid - after 5 hours.

What helps the drug

Nootropic helps with many different diseases and pathological conditions associated with damage to brain structures and blood vessels.

Piracetam is used as a single drug or as one of the medications in the combination therapy of cerebral disorders that occur against a background of impaired patency of the cerebral vessels, metabolic disturbances.


 

The main indications in neurology:

  • ischemic stroke (recovery), cerebral infarction;
  • manifestations of cerebral vascular disorders: worsening of the process of memorization, weakness in the legs, impaired coordination, emotional instability, dizziness and pain in the head, nausea, loss of sensation, convulsive phenomena, speech disorders;
  • dementia of different origin (senile, vascular);
  • cerebral atherosclerosis;
  • manifestations of cerebral growth (abnormal fatigue, unstable mood, restlessness, inability to prolonged intellectual and physical stress);
  • weakening of mental functions, attention, behavior disorder (including Parkinson's disease, Alzheimer's);
    concussion, brain injury;
  • infectious-viral damage to the neuro-brain structures (meningitis, myelitis, encephalitis, arachnoiditis);
  • encephalopathies (brain damage) of unknown origin - caused by poisoning, trauma, internal diseases;
  • epilepsy, cortical myoclonia - sudden sharp jerking of large muscles with damage to the cerebral cortex;
  • neuromuscular disease;
  • impaired gait and motor functions of unknown origin;
  • speech disorders (aphasia, dysphasia);
  • coma, conditions before and after it against the background of severe intoxications that affect cerebral structures;
  • coma of unspecified origin;
  • nystagmus (uncontrolled movements of the eyeball);

In psychiatry, a pharmaceutical agent is prescribed in combination with other medications to patients:

  • with emotional and behavioral personality disorder;
  • with depressive anxiety, dysthymia (chronic depression), especially with the ineffectiveness of antidepressants;
  • with neurasthenia, psychosis of unknown origin;
  • receiving psychotropic medications - to eliminate the side antipsychotic syndrome.

In addiction medicine helps as a treatment tool:

  • persistent psycho-organic disorders in alcoholism (weakening of memory, muscle weakness, tremors, hallucinations, mental disorders);
  • withdrawal symptoms and psychosis in alcohol dependence;
  • severe poisoning with hallucinogens, barbiturates, ethanol, opiates, including morphine.

 

In pediatrics, Piracetam is prescribed for children:

  • to eliminate signs of brain damage resulting from infectious aggression, oxygen starvation, trauma during childbirth, other cerebral disorders in the newborn;
  • with a delay in intellectual and emotional development, low learning ability, speech disorders, impaired attention and memory;
  • with cerebrosthenic syndrome with the development of enuresis, fears, neurosis, tic, stuttering;
  • with oligophrenia, cerebral palsy;

The pronounced therapeutic effect of Piracetam is:

  • in combination with other drugs in the treatment of myocardial infarction - due to its property to enhance cell survival with oxygen deficiency;
  • with long-term anesthesia - to prevent brain damage in conditions of oxygen starvation.
  • to reduce the frequency of pain crises in patients with sickle cell anemia.

Instructions for use and dosage of Piracetam

Features of the treatment.

  1. Tablets and capsules are drunk with food or before it, drinking plenty of water, tea, compote - at least half a glass.
  2. The last dose of the medication should be taken no later than 15-17 hours of the day to prevent difficulties with falling asleep.
  3. The duration of the course is determined by the type and severity of the pathology - usually from 2 to 4 weeks to 2 to 6 months. The secondary course is carried out after 2 to 3 months.
  4. The indicated dosages are not the basis for self-administration of a pharmaceutical product. Only a specialist can calculate the exact doses, taking into account the severity of neuropsychiatric manifestations, the patient's age, and associated pathologies.

Piracetam tablets

The average daily dose for adults is calculated, taking into account the norm of 30 - 160 mg per kilogram of weight. The resulting amount is taken 2 to 4 times.

  1. Treatment of chronic brain disorders in age-related patients begins with a regimen of 400 mg three times a day, increasing the amount of medication per day to 2.4 g. The therapeutic effect appears after 14 to 20 days. As positive clinical changes, the dosage is reduced to the original. In the first 10-14 days of treatment of severe conditions, the dose has to be increased to 4.8 g. For ischemic stroke, the recommended daily amount of the drug is 12 g. The norm is to maintain a stable state of 3.2-4.8 g per day.
  2. Treatment of cortical myoclonia begins with a dose of 7.2 g per day, gradually increasing it by 4.8 g every 3 to 4 days, reaching a maximum daily amount of 24 grams. Every 5 to 6 months with myoclonia, attempts should be made to carefully adjust the dose in the direction of reduction. Usually it is reduced every 48 to 72 hours by 1.2 g.
  3. In case of withdrawal symptoms, after brain injuries, coma and ancestors, it is recommended to prescribe Piracetam for 3 to 4 weeks with an initial dosage of 9 to 12 g, which is slowly reduced to 2.4 g.
  4. To prevent pain crisis on the background of sickle cell anemia, it is recommended to take the medication in the calculated dose (160 mg per kilogram of weight) per day. Self-dose reduction or skipping a medication can cause an exacerbation of the disease.

In pediatrics, a medication is prescribed for babies from 3 years old, but when diagnosing serious pathologies, the medication is prescribed for the smallest children in combination with other medicines.


 

With speech disorders, reduced concentration of attention, memory, learning ability, nootropics are prescribed according to the following scheme:

  • babies 3 - 7 years old receive 200 mg 2 times a day, the highest dose - no more than 1000 mg per day;
  • schoolchildren of 8 - 12 years old are recommended a double dose of 800 mg or a triple dose of 400 mg, the maximum allowed daily amount of 2 g;
  • adolescents 13 to 15 years of age, the amount of the drug can be increased to 1.6 - 2.4 g per day.

To prevent pain attacks with sickle cell anemia, the volume of the therapeutic substance is calculated by the weight of the young patient at a rate of 160 mg per 1 kilogram of the baby’s weight. For example, a child weighing 35 kg per day will need 160 x 35 = 5600 mg. The calculated amount of the drug is divided into several doses.

In ampoules for injections

Piracetam injections are used in hospitals in severe conditions of patients with various cerebrovascular pathologies or when there is no possibility of taking the medicine in tablets and capsules.


 

When prescribing injections, the volume of the drug is determined by the severity of the pathological manifestations. The daily amount for intravenous or intramuscular administration is calculated by body weight (30-160 mg per kilogram of weight) or 3-12 g averaged, divided into 2-4 injections, are averaged.

Treatment of adult patients usually begins with 2–4 g per day, increasing the dose daily to reach 4–6 g. Acute severe diseases require an increase in the daily initial dose to 10–15 g, especially in coma.

With precursors of a pain attack in patients with sickle cell anemia, daily dosages with intravenous infusion can be increased based on the norm of 200-300 mg per kilogram of body weight.

Injections, as a rule, do at least 10 to 20 days. When the patient becomes better, the amount of the drug is gradually reduced, and the patient begins to take pills.

Piracetam capsules

The medicine in capsules is prescribed when the patient reaches 5 years.


 

Dosages, treatment regimen, dosage and duration of the course are the same as in the treatment of tablets.

Features of therapy for renal impairment

In case of impaired renal function, the dose of the medication should be adjusted downward in accordance with the parameter QC - creatinine clearance:

  1. With CC in the range of 50 - 79 ml / min - it is recommended to prescribe 2/3 of the usual daily dose for a specific type of pathology
  2. When diagnosing an average degree of organ failure (CC = 30 - 49), the dosage is reduced to 1/3 of the daily dose (divided by 2 times).
  3. Severe renal impairment (CC less than 30 ml / min) the amount of the drug per day cannot exceed 1/6 of the usually prescribed dose, and the frequency of administration is reduced to 1 time per day.

Given the complexity of the selection of dosages, you should not independently engage in treatment, since only the doctor will accurately calculate the amount of the drug for each particular patient.

During pregnancy and lactation

It is forbidden to take Piracetam to nursing mothers and women awaiting delivery, since the active substance easily penetrates both breast milk and fetal tissue, and full studies on the effect of the nootropic on the embryo and the fetus have not been conducted.

A medication can be used only in case of a serious threat to the health and life of the mother.

Drug interaction

Piracetam is allowed to combine with antipsychotic, tranquilizing, anti-inflammatory and cardiovascular drugs, drugs for hypertension.

Piracetam enhances:

  • the effect of blood-thinning drugs (Warfarin, Acenokumarol, Sinkumar), which must be taken into account when it is used simultaneously with anticoagulants;
  • effects of psychostimulants, antipsychotics, but reduces the risk of extrapyramidal disorders (slow movement, convulsive effects, trembling of the extremities, inhibited perception, emotional instability, speech disorders);
  • the effect on the brain of thyroid hormones, in connection with which sleep disturbance, nervousness, tremor, confusion are possible.

Piracetam Compatibility with Alcohol

Despite the fact that Piracetam is used in the combined treatment of alcoholism, it is forbidden to combine ethanol and Piracetam. Therapy is carried out only after removal of all toxins from the body (not earlier than 48 to 72 hours after the last dose of alcohol taken) in order to avoid the occurrence of negative consequences.

The simultaneous use of alcohol and Piracetam will not only slow down the therapeutic effect, but can enhance all manifestations of intoxication. The following are noted:

  • overexcitation, impaired perception of the environment;
  • headache;
  • dizziness;
  • depressed state, acute allergic manifestations;
  • vomiting, loose stools.

Contraindications, side effects and overdose

The medicine is contraindicated:

  • infants up to 12 months of age (in isolated cases exclusively as prescribed by a pediatric neurologist);
  • lactating and pregnant patients;
  • with special sensitivity to a medicinal substance, pyrrolidone derivatives and any other components of a medication;
  • with hemorrhagic form of stroke (cerebral hemorrhage);
  • if the patient suffers from severe renal impairment (CC below 20 ml / min);
  • with psychomotor overexcitation, anxious neurotic conditions, agitated depression (at the time of prescribing the drug);
  • with Huntington's chorea;
  • during heavy bleeding.

 

Due to the fact that piracetam inhibits the process of platelet aggregation (sticking), it should be prescribed with extreme caution to patients:

  • receiving antiplatelet agents and anticoagulants (including acetylsalicylic acid);
  • with chronic renal failure (CC 20 - 80 ml / min);
  • with reduced blood viscosity, hemorrhages, a tendency to bleeding;
  • with extensive surgical interventions, including dental.

Adverse reactions during treatment with Piracetam occur in rare cases - in 1 - 2 patients out of a hundred, more often in older people who receive more than 2,400 mg of the drug per day.

  • The following side effects are sometimes noted:
  • sleep disorder (the drug should be taken before 3 p.m.);
  • increased arousal, irritability;
  • drowsiness during the day, muscle weakness, dizziness, headache, trembling fingers, increased sexual desire;
  • nausea, diarrhea, weight gain;
  • jumps in blood pressure;
  • in children - hyperactivity, poor sleep, nervousness.

Usually, side effects disappear when the dose is reduced.

Given the possibility of developing adverse reactions, caution should be exercised when working with vehicles, equipment, and precise and dangerous machinery.

If the patient does not adhere to the recommended doses, an overdose of the drug may occur. This is manifested by the occurrence or intensification of adverse reactions. Immediately cancel therapy with Piracetam, take absorbents (optimally - Polysorb). In severe cases, gastric lavage, hemodialysis, and extrarenal blood purification are necessary (the degree of effectiveness is up to 60%).

Analogues of the drug in tablets and injections

Synonyms of piracetam, that is, pharmacological agents with the same therapeutic substance and identical therapeutic effect: Nootropil, Lucetam in tablets and injection.

Analogues of the drug, that is, drugs with a similar therapeutic effect, but with a different composition and therapeutic component: Noopept, Pantogam, FezamTanakan.

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