Piracetam

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Piracetam.jpg

[edit] MECHANISM OF ACTION

Piracetam was one of the first drugs used for dementia and comes from the class of drugs called nootropics

Piracetam may enhance memory and other intellectual functions, but its usefulness in treating dementia is uncertain. It is, however, commonly prescribed for cognitive impairment and dementia in several countries of continental Europe.

Piracetam has been suggested to act by increasing oxygen and glucose utilization. At higher doses, it is also believed to enhance microcirculation and antithrombotic properties by affecting platelets and erythrocytes.

[edit] INDICATIONS

  • Adult patients suffering from myoclonus of cortical origin
  • Symptomatic treatment of cognitive and memory disorders caused by organic disorders except neurodegenerative dementias, such as Alzheimer’s disease
  • Treatment of vertigo
  • Treatment of dyslexia in children from 8 years old and adolescents in combination with appropriate measures, such as speech therapy (logopaedics).

[edit] DOSAGE

Symptomatic treatment of cognitive and memory disorders caused by organic disorders: The recommended daily dose ranges from 2.4 g up to 4.8 g, in two or three sub-doses. The therapy should be initiated with 4.8 g/day dose for the first few weeks. Subsequently the dose should be gradually lowered to 2.4 g/day in 1.2 g/day steps.

Treatment of vertigo : The recommended daily dose ranges from 2.4 g up to 4.8 g, in two or three sub-doses

Treatment of dyslexia in combination with speech therapy : In children from 8 years old and adolescents, the recommended daily dose is about 3.2 g, in two sub-doses.

Treatment of myoclonus of cortical origin : The daily dosage should begin at 7.2 g increasing by 4.8 g every three to four days up to a maximum of 24 g, in two or three sub-doses. Treatment with other anti-myoclonic medicinal products should be maintained at the same dosage. Depending on the clinical benefit obtained, the dosage of other such medicinal products should be reduced, if possible. Once started, treatment with piracetam should be continued for as long as the original cerebral disease persists. In patients with an acute episode, spontaneous evolution may occur over time and an attempt should be made every 6 months to decrease or discontinue the medicinal treatment. This should be done by reducing the dose of piracetam by 1.2 g every two days (every three or four days in the case of a Lance and Adams syndrome, in order to prevent the possibility of sudden relapse or withdrawal seizures).


Piracetam should be administered orally, and may be taken with or without food. The tablet(s) should be swallowed with liquid. It is recommended to take the daily dose in two to four sub-doses.

[edit] CONTRAINDICATIONS

  • Hypersensitivity to piracetam or other pyrrolidone derivatives
  • Cerebral haemorrhage
  • End stage renal disease
  • Huntington's Chorea.
  • Haemorrhagic stroke.

[edit] WARNINGS AND PRECAUTIONS

Effects on platelet aggregation
Due to the effect of piracetam on platelet aggregation, caution is recommended in patients with severe haemorrhage, patients at risk of bleeding such as gastrointestinal ulcer, patients with underlying disorders of haemostasis, patients with history of haemorrhagic CVA, patients undergoing major surgery including dental surgery, and patients using anticoagulants or platelet antiaggregant drugs including low dose aspirin.


Renal insufficiency
Piracetam is eliminated via the kidneys and care should thus be taken in cases of renal insufficiency.


Elderly
For long-term treatment in the elderly, regular evaluation of the creatinine clearance is required to allow dosage adaptation, if needed.


Discontinuation
Abrupt discontinuation of treatment should be avoided in myoclonic patients as this may induce sudden relapse or withdrawal seizures


Effects on ability to drive and use machines
In clinical studies, at dosages between 1.6 - 15 grams per day, hyperkinesia, somnolence, nervousness and depression were reported more frequently in patients on piracetam than on placebo. There is no experience on driving ability in dosages between 15 and 20 grams daily. Given the adverse events observed with the drug, an influence on driving and using machines is possible and should be taken into account. Caution should therefore be exercised by patients intending to drive or use machinery whilst taking piracetam.

[edit] INTERACTIONS

Thyroid hormones : Confusion, irritability and sleep disorder have been reported during concomitant treatment with thyroid extract (T3 + T4).

[edit] PREGNANCY AND LACTATION

Pregnancy
There are no adequate data from the use of piracetam in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal / foetal development, parturition or post-natal development.

Piracetam crosses the placental barrier. Drug levels in the newborn are approximately 70% to 90% of maternal levels. Piracetam should not be used during pregnancy unless clearly necessary, when benefit exceeds the risks and the clinical condition of the pregnant mother requires treatment with piracetam.


Breast-feeding
Piracetam is excreted in human breast milk. Therefore, piracetam should not be used during breast-feeding or breast-feeding should be discontinued, while receiving treatment with piracetam. A decision must be made whether to discontinue breast-feeding or to discontinue piracetam therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.

[edit] SIDE EFFECTS

The following adverse experiences were reported for piracetam with a statistically significantly higher incidence than placebo:

  • Common (≥1/100 to <1/10) : Hyperkinesia (increase in muscular activity), weight increased and nervousness
  • Uncommon (≥1/1,000 to <1/100): Somnolence and astenia


Post-marketing experience:
From the post-marketing experience, the following additional adverse drug reactions have been reported (sorted according to MedDRA System Organ Classes). Data are insufficient to support an estimate of their incidence in the population to be treated.

  • Blood and Lymphatic disorders: haemorrhagic disorder
  • Ear and labyrinth disorders: vertigo
  • Gastrointestinal disorders: abdominal pain, abdominal pain upper, diarrhoea, nausea, vomiting
  • Immune system disorders: anaphylactoid reaction, hypersensitivity
  • Nervous system disorders: ataxia, balance impaired, epilepsy aggravated, headache, insomnia
  • Psychiatric disorders: agitation, anxiety, confusion, hallucination
  • Skin and subcutaneous tissue disorders: angioneurotic oedema, dermatitis, pruritus, urticaria
  • Rare cases of injection site pain, thrombophlebitis, pyrexia or hypotension have been reported after intravenous administration.

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES

Alzheimer/Dementia
Anticholinesterases Donepezil (Aricept, Memac)   Galantamine (Reminyl)   Rivastigmine (Oral) (Exelon)   Rivastigmine (Transdermal) (Exelon Patch)
Glutamatergic NMDA receptor antagonists Memantine (Ebixa)
Psychostimulants and nootropics Aniracetam   Choline   Citicoline   Ginkgo biloba   Piracetam