Piracetam is a first-generation nootropic agent (racetam family) with neuroprotective and neuroenhancing properties. It is a cyclic derivative of GABA (gamma-aminobutyric acid) but does not act directly on GABA receptors. It is widely used in India for cognitive disorders, cortical myoclonus, and as an adjunct in dyslexia. It improves neuronal membrane fluidity, enhances microcirculation in the brain, and facilitates interhemispheric communication.
Adult: **Myoclonus:** Start 7.2 g/day in 2-3 divided doses, increase by 4.8 g/day every 3-4 days to max 24 g/day. **Cognitive Disorders/Vertigo:** 2.4 - 4.8 g/day in 2-3 divided doses. Maintenance often 1.2 - 2.4 g/day. The 800mg tablet is a common strength for maintenance or initiation in divided doses.
Note: Oral. Can be taken with or without food. Tablets should be swallowed whole with a glass of water. For myoclonus, abrupt discontinuation should be avoided; taper gradually.
The exact mechanism is not fully elucidated. Piracetam improves neuronal and cognitive function without acting as a sedative or stimulant. Key actions include: 1) Modulating neurotransmission (particularly cholinergic and glutamatergic), 2) Enhancing neuronal membrane fluidity and function, 3) Improving cerebral microcirculation and oxygen utilization, 4) Potentiating neuroplasticity.
Pregnancy: Category B (Animal studies show no risk, but no adequate human studies). Use only if clearly needed and benefit outweighs risk. Crosses the placenta.
Driving: May cause drowsiness, dizziness, or visual disturbances. Patients should not drive or operate machinery until their individual response is known.
| Anticoagulants (Warfarin, Acenocoumarol) & Antiplatelets (Clopidogrel, Aspirin) | Increased risk of bleeding due to additive anti-thrombotic effect of Piracetam. | Major |
| Thyroid Hormones (Levothyroxine) | Piracetam may increase T4 levels and potentiate CNS effects like irritability, insomnia, and tremor. | Moderate |
| Antihypertensives | Additive hypotensive effect possible. | Moderate |
| Central Nervous System Depressants (Alcohol, Benzodiazepines) | May potentiate drowsiness and sedation. | Moderate |