Piracetam is a synthetic nootropic agent of the racetam class, chemically a derivative of the neurotransmitter GABA. It is a cyclic derivative of GABA (gamma-aminobutyric acid) but does not bind to GABA receptors. It is primarily used for its cognitive-enhancing and neuroprotective effects, improving neuronal and cognitive functions without acting as a sedative or stimulant. In India, it is widely prescribed for cognitive deficits, cortical myoclonus, and as an adjunct in dyslexia.
Adult: Cognitive impairment: 1.2-2.4 g/day in 2-3 divided doses, may increase to 4.8 g/day. Cortical myoclonus: Start at 7.2 g/day in 2-3 divided doses, increase by 4.8 g/day every 3-4 days to max 24 g/day. Maintenance: 12-24 g/day. Vertigo: 2.4-4.8 g/day in divided doses.
Note: Oral: Can be taken with or without food. Tablets should be swallowed whole with a glass of water. For the 400mg strength, multiple tablets are typically required to achieve therapeutic doses. Therapy for cognitive disorders is long-term; abrupt discontinuation should be avoided, especially in myoclonus.
The exact mechanism is not fully elucidated. Piracetam is believed to act on neuronal and vascular functions. It modulates neurotransmission, enhances neuroplasticity, and improves cerebral microcirculation. It facilitates interhemispheric transfer of information via the corpus callosum and has protective effects against hypoxia and physical brain trauma.
Pregnancy: Category B: Animal studies show no risk, but adequate human studies lacking. Use only if potential benefit justifies potential risk to the fetus. Not recommended during pregnancy unless clearly needed.
Driving: May cause dizziness, drowsiness, or visual disturbances. Patients should not drive or operate machinery until their individual response is known.
| Anticoagulants (Warfarin, Acenocoumarol) | Piracetam may inhibit platelet aggregation and increase bleeding risk. Increased risk of hemorrhage. | Major |
| Antiplatelet drugs (Aspirin, Clopidogrel) | Additive antiplatelet effect, increasing bleeding risk. | Major |
| NSAIDs (Ibuprofen, Diclofenac) | Increased risk of gastrointestinal bleeding due to combined effects on platelets and gastric mucosa. | Moderate |
| Thyroid hormones (Levothyroxine) | Piracetam may increase T4 levels and decrease T3 levels; monitor thyroid function. | Moderate |
| Antipsychotics (Haloperidol) | May reduce efficacy of haloperidol in Huntington's chorea; may increase extrapyramidal symptoms. | Moderate |
| Other CNS stimulants (Modafinil, Methylphenidate) | Additive stimulant effects, may increase nervousness and insomnia. | Moderate |