Cerebrovascular accidents and cerebral insufficiency: Ischaemic or haemorrhagic acute events, and chronic manifestations of these conditions or cerebral atherosclerosis.

Mental retardation in children: Improvement in social interaction, sociability, learning ability, intellectual performance, and school results.

Behavioural and psychotic problems in old age: Memory impairment (especially fixation and recall), asthenia, adaptation disorders, and disturbed psychomotor responses.

Piracetam is a nootropic agent, a psychotropic drug that acts directly on the brain to improve the efficiency of the telencephalon in both normal individuals and those with functional deficits. This brain region is involved in cognition, learning, memory, alertness, and consciousness. Piracetam does not produce sedation or stimulation. It acts on the central nervous system through multiple mechanisms, including modulation of neurotransmission and improvement of the metabolic environment necessary for neuronal function. It also acts as a haemorrheological agent, improving microcirculation without causing vasodilation. In patients with CNS dysfunction, acute or long-term use enhances alertness and cognitive performance, with EEG changes showing increased alpha and beta activity and reduced delta activity. It helps protect and restore cognitive function in conditions such as cerebral trauma, hypoxia, intoxication, and after electroshock therapy. Piracetam may be used alone or with other drugs in the treatment of myoclonus due to anoxia. It reduces the duration of vestibular nystagmus. It also improves cerebral oxygen and glucose utilization in dementia due to multiple infarcts or cerebral ischaemia. Additionally, it inhibits increased platelet aggregation and improves red blood cell deformability, helping them pass through microvasculature in conditions of increased rigidity.

Adults:

• In cerebrocortical insufficiency disorders: the usual dose is 800 mg 3 times a day.
• In myoclonic seizures: a dose of 7.2 gm daily, increasing by 4.8 gm per day every 3 to 4 days up to a maximum of 20 gm daily, given in 2 or 3 divided doses.

Children: The daily dosage depends on the weight of the child, 50 mg/kg of body weight in 3 divided doses. Once the desired results have been obtained, reduce the initial dose by half.

In a single reported case, confusion, irritability, and sleep disturbances occurred when Piracetam was used concomitantly with thyroid extract. However, no interactions have been observed with anti-epileptic drugs such as clonazepam, carbamazepine, phenytoin, phenobarbitone, and sodium valproate based on limited clinical studies.

Piracetam is contraindicated in patients with severe renal impairment (creatinine clearance < 20 ml/min) and hepatic impairment. Since it is primarily eliminated through the kidneys, caution is required in patients with renal dysfunction. Renal function monitoring is recommended. Dose adjustment is necessary based on creatinine clearance:

• CrCl 60–40 ml/min: 1/2 of normal dose
• CrCl 40–20 ml/min: 1/4 of normal dose

Reported side effects include nervousness, agitation, irritability, anxiety, and sleep disturbances (approximately 5%), more commonly in elderly patients receiving doses above 2.4 g daily. Dose reduction usually resolves these symptoms. Other less common effects include fatigue, drowsiness, gastrointestinal disturbances (nausea, vomiting, diarrhea, stomach pain), vertigo, headache, tremor, and occasional sexual stimulation.

Piracetam should not be used during pregnancy or breastfeeding unless absolutely necessary. It can cross the placenta barrier.

Adjunct anti-epileptic drugs, drugs used in tremor, tics & related disorders

Store in a cool, dry place below 30°C. Protect from sunlight. Keep out of reach of children.