Piracetam - Generic Nootropil

What is Piracetam?
Piracetam is a member of the class of drugs known as nootropics. Nootropics are known commonly as cognitive enhances. Piracetam is similar in molecular structure to the amino acid pyroglutamate. Piracetam and pyroglutamate have the same base chemical structure, the 2-oxo-pyrrolidine, but they differ by a side chain. Pyroglutamate is 2-oxo-pyrrolidine carboxylic acid, and piracetam is 2-oxo-pyrrolidine acetamide.
Piracetam was created about 30 years ago by UCB laboratories. Other trade names include: Avigilen, Cerebroforte, Cerebrospan, Cetam, Dinagen, Encefalux, Encetrop, Euvifor, gabacet, Genogris, Memo-Puren, Nootron, Nootrop, Nootropil, Nootropyl, Normabrain,Norzetam, Pirroxil, Psycotron, Stimucortex, and UCB-6215.

Similar drugs
A number of drugs are related to Piracetam. These include oxiracetam, pramiracetam, etiracetam, nefiracetam, aniracetam and rolziracetam. These have additional structural analogues that behave in a similar manor. Unless otherwise indicated, the information contained in this FAQ is about Piracetam itself. In subsquent versions, I will expand this FAQ to cover these other drugs as well.

What are the reported benefits of Piracetam?
Piracetam is reported to enhance cognitive functions of the brain. It is said to enhanced memory, attention, intelligence, etc. It is commonly known as a smart drug for this reason. There is very little empirical evidence to support this claim in healthy individuals. Piracetam is believed to increase blood flow between the two hemispheres of the brain. It's also been reported to protect brain tissue from various physical and chemical abrasions such as alcohol damage.
One study described the benefits of piracetam in this way: "In animal models and in healthy volunteers, the drug improves the efficiency of the higher telencephalic functions of the brain involved in cognitive processes such as learning and memory. The pharmacology of piracetam is unusual because it protects against various physical and chemical insults applied to the brain. It facilitates learning and memory in healthy animals and in animals whose brain function has been compromised, and it enhances interhemispheric transfer of information via callosal transmission. At the same time, even in relatively high dosages it is devoid of any sedative, analeptic or autonomic activities."

Research and studies

What have medical studies found?
Alzheimer's disease
Abstract: Preclinical research suggests that piracetam (a nootropic drug) may improve cognitive functions, but previous studies have failed to demonstrate a clear benefit for the treatment of Alzheimer's disease (AD). We report a 1-year, double-blind, placebo-controlled, parallel-group study with a high dose of piracetam (8 g/d per os) in 33 ambulant patients with early probable AD. Thirty subjects completed the 1-year study. No improvement occurred in either group, but our results support the hypothesis that long-term administration of high doses of piracetam might slow the progression of cognitive deterioration in patients with AD. The most significant differences concerned the recall of pictures series and recent incident and remote memory. The drug was well-tolerated.

Elderly Drivers
Abstract: 101 elderly motorists with reduced reaction capacity were examined under real traffic conditions with regard to their driving ability. They were given a daily dose of 4.8 g piracetam or placebo over a six-week period in a randomized double-blind study. The percentage of correctly solved sign-observance items, which reflects orientation and perception in real traffic conditions, increased in the placebo-treated test-group from 79.86% in the pretest to 80.07% in the retest, whereas the test subjects of the piracetam-treated group improved their performance from 77.08% to 84.16%. After being treated with piracetam for 6 weeks, the drivers showed a significantly better performance than the placebo-group. Of particular interest is the finding that the test-subjects who had scored less than 80% in the pretest improved without exception in the retest after treatment with piracetam.

Children with dyslexia
Abstract: Sixty children with dyslexia (41 boys, 19 girls; ages 9 to 13) were enrolled in a 10-week summer tutoring program that emphasized word-building skills. They were randomly and blindly assigned to receive either placebo or piracetam, a purportedly memory-enhancing drug that has been reported to facilitate reading skill acquisition. The children were subtyped as "dysphonetic" or "phonetic" on the basis of scores from tests of phonological sensitivity and phoneme-grapheme correspondence skills. Of the 53 children who completed the program, 37 were classified as dysphonetic and 16 as phonetic. The phonetic group improved significantly more in word-recognition ability than the dysphonetic group. Overall, the children on medication did not improve more than the nonmedicated ones in any aspect of reading.
The phonetic subgroup on piracetam gained more in word recognition than any subgroup but did not improve significantly more than the phonetic subgroup on placebo. Results are discussed in relation to findings from previous studies of piracetam in children with dyslexia.

Parkinson's disease
Abstract: Twenty patients with Parkinson's disease and marked intellectual impairment or dementia participated in a double-blind placebo controlled trial of the nootropic, piracetam. A standardized neurological examination, a neuropsychological test battery, and a functional scale, The Sickness Impact Profile, were completed for all patients. They were then assigned by blind randomization to drug or placebo conditions receiving 3.2 g of piracetam or an identical amount of placebo for 12 weeks. The dose was increased to 4.8 g for an additional 12 weeks. Neurological, psychological, and functional measures were rated as improved, unchanged, or worsened in comparison to baseline performance. Twenty-five percent of the patients did not complete the trial for reasons unrelated to the medication. Although there was a significant improvement on one subtest of the functional scale, no significant effects were demonstrated in cognitive or neurological measures.

How does Piracetam work?

Theories

This continues to be somewhat of a mystery. No definitive mechanism of action has been found. A study conducted in 1994 reviewed previously published literature from 1965-1992 (407 references). An excerpt:
"We believe that the effect of the racetams is due to a potentiation of already present neurotransmission and that much evidence points in the direction of a modulated ion flux by, e.g., potentiated calcium influx through non-L-type voltage-dependent calcium channels, potentiated sodium influx through alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor gated channels or voltage-dependent channels or decreases in potassium efflux. Effects on carrier mediated ion transport are also possible." "How piracetam exerts its effects on memory disorders is still under investigation, although among other proposed mechanisms of action it is thought to facilitate central nervous system efficiency of cholinergic neurotransmission. Results from trials involving elderly patients with senile cognitive disorders have been equivocal, as have the results obtained when piracetam has been combined with acetylcholine precursors."

How it doesn't work

It has been determined the Piracetam does not work though many common metabolic pathways.
"No affinity for the alpha 1-, alpha 2-, beta-, muscarinic, 5-hydroxytryptamine-, dopamine, adenosine-A1-, mu-opiate, gamma-aminobutyric acid (GABA) (except for nefiracetam (GABAA)), benzodiazepine and glutamate receptors has been found."

Are there side effects?
No significant side effects of been observed. Piracetam is remarkably well tolerated in humans through a wide range of doses. Women who are breast feeding or pregnant should not use this drug. Piracetam may cause stomach upset as well. The effects of this drug are largely subjective. Some of the effects may be undesirable.

Usage Guidelines

What is a typical dose?
Dosages form 400mg to 4800mg are considered safe. Some literature recommend an 'attack dose' in the range of 1600mg to 2400mg for the first few days to initiate a response in people seeking cognitive enhancing effects. Start with a normal dose like 800mg. It is likely that you will feel the affects at this level. Then try and attack dose if you feel it necessary.
Some individuals report that they could feel strong effects at 800mg on the first day. On subsequent days at the same dosage the effects were not as noticeable. It is unclear whether maximum benefits are obtained from daily use over time or if occasional use has benefits. If possible work your doctor.

Does piracetam interact with other drugs?
Piracetam is said to increases the effects of alcohol and amphetamines. No other drug interactions have been noted. It is recommended that alcohol be avoided as one of the reported effects of Piracetam is increased flow of blood to the brain which would increase damage and intoxication.