Piracetam is a man-made substance, called a racetam, that was developed in the 1960s and originally used to treat motion sickness. It became the first drug to be labeled as a nootropic – which is a drug used to enhance memory, learning, and other cognitive functions. Piracetam was also found by serendipity to be an effective anticonvulsant in the 1980s.

Piracetam is not approved by the FDA for any medical or dietary use. In the UK, where it is available on prescription, it is mainly used for myoclonus. Proposed uses of piracetam include:

• Improving age-related conditions
• Improving memory
• Improving understanding and learning
• Helping with dyslexia
• Myoclonus particularly cortical reflex myoclonus
• Myoclonus epilepsy.

Piracetam has also been investigated for the following conditions, but more studies are needed to determine if it is beneficial for any of these conditions:

• Alcoholism
• Alzheimer’s disease (sometimes in combination with lecithin)
• Brain injury
• Breath-holding spells
• Deep vein thrombosis
• Dementia
• Dyslexia
• Fetal distress during labor
• Post-stroke
• Sickle cell disease
• Tardive dyskinesia
• Vertigo.

Animal studies have shown it can help reduce pain and inflammation by reducing the production of cytokines, and proinflammatory substances. It is not known if it has this effect in humans.

In general, evidence to support the use of piracetam for any condition is unclear. There possibly may be some cognitive benefits in older patients but not in those with dementia. In the United Kingdom, piracetam is available on prescription for myoclonus (involuntary spasmodic contraction of muscles), and may be used off-label for learning difficulties in children and cognitive deficits in the elderly.

How does piracetam work?

Piracetam is a racetam which is a man-made (chemically synthesized), derivative of gamma-aminobutyric acid (GABA). Experts are unsure exactly how piracetam works but research does suggest an effect on certain glutamate receptors, but not on GABA.

In addition, piracetam may influence membrane function and fluidity because it interacts with the polar heads in the phospholipid membrane, improving membrane stability and allowing the membrane to function normally with regards to transport of substances across the membrane, chemical secretion, and receptor binding and stimulation. This is thought to restore nerve transmission and provide neuroprotective and anticonvulsant effects.

Piracetam also improves the fluidity of platelet membranes and decreases the adhesion of red blood cells which improves blood flow through the brain and kidneys.

Is piracetam effective?

Most trials for piracetam were conducted years ago and did not use robust quality standards. Several Cochrane reviews have concluded that more evidence is needed. There may be some benefits for improving seizure or myoclonus frequency and also cognition in those who are aging, but not for those with dementia. There does not seem to be any benefit of piracetam for healthy people.

Results include:

• Piracetam for acute ischemic stroke ^{[Ricci S, 2012]}: Not enough evidence for a benefit of piracetam given to adults within 48 hours of an acute stroke, and possibly some suggestion of an unfavorable effect of piracetam on early death. The results of one large study that was conducted but interrupted early by the manufacturer were never made public.
• Piracetam for dementia or cognitive impairment ^{[Flicker L, 2001]}: Overall, the evidence is not consistent or positive enough to support the use of piracetam for dementia or cognitive impairment. Some benefit for global impression of change, but no benefit for more specific measures of cognitive function.
• Piracetam for fetal distress in labor ^{[Hofmeyr GJ, 2012]}: Piracetam is thought to promote the metabolism of brain cells when they are hypoxic but there was not enough evidence for this review to make a conclusion. One study of 96 pregnant women reported a trend of a reduced need for cesarean section in women taking piracetam compared to those taking placebo but there were no significant differences in neonatal respiratory distress or Apgar scores.
• Piracetam to reduce the incidence of painful sickle cell disease crises ^{[Al Hajeri A, 2016]}: Laboratory studies have shown that piracetam has the potential for blocking and reversing the process of sickling of erythrocytes but the three trials included in this review (n=169 people with sickle cell disease) were of poor quality and there was insufficient evidence to support the routine use of piracetam although unsubstantiated reports of a reduction in the number and severity of pain crises were reported in one trial.
• Piracetam for aphasia following stroke ^{[Greener J, 2001]}: Use of piracetam may be effective for improving language measures following a stroke as reported in one trial that met the criteria for inclusion; however, there were some concerns about safety and the possibility of an increased risk of death from piracetam could not be ruled out.
• No benefits on cognition or behavior were noted when piracetam was given to 25 children with down syndrome [Lobaugh NJ,2001]. Side effects included aggression, agitation, irritability, sexual arousal, poor sleep, and reduced appetite.
• Piracetam was not effective at reducing the frequency of breath-holding spells in 146 children ^{[Dai AI, 2020]}.

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Who should not take piracetam?

Piracetam may not be suitable for people with severe kidney or liver disease, Huntington’s disease, or with bleeding conditions. It should not be taken by women who are pregnant or breastfeeding or by children unless under a doctor’s advice.

What are the side effects of piracetam?

Common side effects of piracetam include:

• Agitation
• Anxiety or nervousness
• Depression
• Diarrhea
• Drowsiness
• Hyperactivity
• Muscle spasm
• Rash
• Sleeplessness
• Weight gain.

Piracetam may affect your ability to drive or operate machinery. Abrupt withdrawal of piracetam should be avoided.

What is the dosage of piracetam?

The standard dosage of piracetam for adults is 1.2grams to 4.8 grams per day depending on the condition:

• Cognition and memory: 1.2–4.8 grams daily
• Myoclonus epilepsy: 3.2 (initial) to up to 20 grams daily.

When given for breath-holding spells in children, a dosage of 40-100mg per kilogram of body weight was used but you should always consult with a health professional before giving piracetam to children as it is not effective for many conditions.

Does piracetam interact with any other medications?

Piracetam may interact with anticoagulants, other medications that thin the blood, and thyroid supplements. Examples of medications it may interact with include:

• acetaminophen
• aspirin
• clopidogrel
• dipyridamole
• levothyroxine and thyroid derivatives
• prasugrel
• ticlopidine
• tirofiban
• warfarin.

Are there similar drugs to piracetam?

Since piracetam was developed in the 1960s, more than 20 piracetam-like substances have been developed for the purpose of improving cognitive function, treating cognitive impairment, or treating other nervous system disorders, although some are no longer available. These racetams are all man-made (chemically synthesized), derivatives of gamma-aminobutyric acid (GABA), and share a common structural feature, that of a 2-pyrrolidone nucleus. Experts are unsure how these substances work but research does suggest an effect on certain glutamate receptors, but not on GABA.

Levetiracetam is structurally like piracetam (it is also a racetam) but it is much more potent than piracetam as an anticonvulsant although its antidystonic effect (ability to control random muscle contractions) is similar to piracetam. It is marketed under the brand names Elepsia XR, Keppra, Keppra XR, Roweepra, Spritam, Roweepra XR in the U.S. as a treatment partial onset seizures, myoclonic seizures, and tonic-clonic seizures.

What are some brand names for piracetam?

Piracetam may also be known as:

• Dinagen
• Lääkelait
• Lucetam
• Memoril
• Memotropil
• Myocalm
• Nooropyl
• Nootropil
• Qropi.

Is piracetam illegal?

Piracetam is not illegal in the United States but because it is not regulated or approved by the FDA as a dietary supplement, it can technically only be sold for research purposes. However, despite the FDA rejecting piracetam as a dietary supplement, it can be still found as a dietary supplement, and remains available for purchase, despite warning letters from the FDA asking companies to stop marketing it. One study ^{[Cohen PA, 2019]} investigated 10 different over-the-counter piracetam supplements and found:

• Two did not contain any piracetam at all
• For those that did contain piracetam, the quantity contained varied from 85% to 118% of the labeled amount
• Labeling on some product labels could expose the user to dosages of more than 11,000 mg per day (the recommended dosage for cognitive disorders is 2400-4800 mg/day).
• If you are buying piracetam, choose one that has been tested by a third party to ensure its quality.

At least one law group ^{[Kazerouni Law]} is attempting to gather support for potential litigation against the manufacturers of piracetam, in an effort to get piracetam supplements off the street.

Is piracetam illegal in other countries?

Outside of the U.S., regulation of piracetam varies.

In Australia, piracetam requires a prescription to buy however up to 3 months can be imported from suppliers outside of Australia under a “Personal Importation Scheme”.

In Europe, the legal status of piracetam varies depending on the country. Some, such as the Czech Republic and Ukraine, do not require a prescription to buy piracetam. Others, such as Italy, Norway, and Spain do require a prescription.

In Canada, piracetam has no drug identification number (DIN) which means it cannot be sold but can be imported for personal use.

In Brazil, piracetam is readily available over the counter.

References

 

• Piracetam - Uses, Side Effects, and More. Web MD. https://www.webmd.com/vitamins/ai/ingredientmono-1597/piracetam#:~:text=Piracetam%20is%20most%20commonly%20used,antipsychotic%20drugs%20(tardive%20dyskinesia).
• Aronson JK. Piracetam. Meyler’s Side Effects of Drugs 2016. Science Direct. https://www.sciencedirect.com/topics/neuroscience/piracetam
• Cohen PA, Zakharevich I, Gerona R. Presence of Piracetam in Cognitive Enhancement Dietary Supplements. JAMA Intern Med. 2020;180(3):458–459. doi:10.1001/jamainternmed.2019.5507
• Löscher, W., & Richter, A. (2000). Piracetam and levetiracetam, two pyrrolidone derivatives, exert antidystonic activity in a hamster model of paroxysmal dystonia. European journal of pharmacology, 391(3), 251–254. https://doi.org/10.1016/s0014-2999(00)00105-9
• Piracetam Cognitive Vitality Reports. Alzheimer’s Drug Discovery Foundation. April 20, 2018. https://www.alzdiscovery.org/uploads/cognitive_vitality_media/Piracetam-Cognitive-Vitality-For-Researchers.pdf
• Ricci S, Celani MG, Cantisani TA, Righetti E. Piracetam for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000419. DOI: 10.1002/14651858.CD000419.pub3
• Flicker L, Grimley Evans J. Piracetam for dementia or cognitive impairment. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD001011. DOI: 10.1002/14651858.CD001011
• Hofmeyr GJ, Kulier R. Piracetam for fetal distress in labour. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD001064. DOI: 10.1002/14651858.CD001064.pub2. Accessed 22 September 2022.
• Al Hajeri A, Fedorowicz Z. Piracetam for reducing the incidence of painful sickle cell disease crises. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD006111. DOI: 10.1002/14651858.CD006111.pub3. Accessed 22 September 2022.
• Greener J, Enderby P, Whurr R. Pharmacological treatment for aphasia following stroke. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000424. DOI: 10.1002/14651858.CD000424. Accessed 22 September 2022.
• Dai AI, Demiryürek AT. Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children With Simple Breath-Holding Spells. Journal of Child Neurology. 2020;35(1):25-30. doi:10.1177/0883073819871854
• Lobaugh, N. J., Karaskov, V., Rombough, V., Rovet, J., Bryson, S., Greenbaum, R., Haslam, R. H., & Koren, G. (2001). Piracetam therapy does not enhance cognitive functioning in children with down syndrome. Archives of pediatrics & adolescent medicine, 155(4), 442–448. https://doi.org/10.1001/archpedi.155.4.442
• Piracetam: Illegal & Ineffective. Kazerouni Law Group. APC. https://www.kazlg.com/piracetam/
• Piracetam. Drugbank Online. https://go.drugbank.com/drugs/DB09210
• Fedi M, Reutens D, Dubeau F, Andermann E, D'Agostino D, Andermann F. Long-term Efficacy and Safety of Piracetam in the Treatment of Progressive Myoclonus Epilepsy. Arch Neurol. 2001;58(5):781–786. doi:10.1001/archneur.58.5.781
• Patel K. Piracetam. Jan 22, 2022. Examine database.https://examine.com/supplements/piracetam

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