Piracetam

Piracetam (sold under many brand names) is a medication in the racetams group, with chemical name 2-oxo-1-pyrrolidine acetamide. It is approved in the United Kingdom but is not approved in the United States. In the UK, piracetam is prescribed mainly for myoclonus, but is used off-label for other conditions. Evidence to support its use for many conditions is unclear, although it is marketed as a nootropic (cognitive enhancer). Studies of piracetam's cognitive effects have had equivocal results, sometimes showing modest benefits in specific populations and sometimes showing minimal or no benefit. Piracetam (sold under many brand names) is a medication in the racetams group, with chemical name 2-oxo-1-pyrrolidine acetamide. It is approved in the United Kingdom but is not approved in the United States. In the UK, piracetam is prescribed mainly for myoclonus, but is used off-label for other conditions. Evidence to support its use for many conditions is unclear, although it is marketed as a nootropic (cognitive enhancer). Studies of piracetam's cognitive effects have had equivocal results, sometimes showing modest benefits in specific populations and sometimes showing minimal or no benefit. It shares the same 2-oxo-pyrrolidone base structure with pyroglutamic acid. Piracetam is a cyclic derivative of GABA (gamma-Aminobutyric acid). Related drugs include the anticonvulsants levetiracetam and brivaracetam, and the putative nootropics aniracetam and phenylpiracetam. A 2001 Cochrane review concluded that there was not enough evidence to support piracetam for dementia or cognitive problems. A 2002 review and 2005 review concluded that piracetam had some positive effects in older patients with these problems. In 2008, a working group of the British Academy of Medical Sciences noted that many of the trials of piracetam for dementia were flawed. Some sources suggest that piracetam's overall effect on lowering depression and anxiety is higher than on improving memory. However, depression is reported to be an occasional adverse effect of piracetam. Piracetam may facilitate the deformability of erythrocytes in capillary. Peripheral vascular effects of piracetam have suggested its use potential for vertigo, dyslexia, Raynaud's phenomenon and sickle cell anemia. There is no evidence to support piracetam's use in sickle cell crisis prevention or for fetal distress during childbirth. There is no evidence for benefit of piracetam with acute ischemic stroke, though there is debate as to its utility during stroke rehabilitation. Piracetam has been found to diminish erythrocyte adhesion to vascular wall endothelium, making any vasospasm in the capillary less severe. This contributes to its efficacy in promoting microcirculation, including to the brain and kidneys. Piracetam has been found to have very few side effects, and those it has are typically 'few, mild, and transient.' A large-scale, 12-week trial of high-dose piracetam found no adverse effects occurred in the group taking piracetam as compared to the placebo group. Many other studies have likewise found piracetam to be well tolerated. Symptoms of general excitability, including anxiety, insomnia, irritability, headache, agitation, nervousness, tremor, and hyperkinesia, are occasionally reported. Other reported side effects include somnolence, weight gain, clinical depression, weakness, increased libido, and hypersexuality.