CNS Drug Rev. 2005 Summer;11(2):169-82.

Piracetam: a review of pharmacological properties and clinical

uses.
http://www.ncbi.nlm.nih.gov/pubmed/16007238
Winblad B.
Author information
Abstract
Piracetam, a derivative of the neurotransmitter gamma-aminobutyric acid (GABA), has a
variety of physiological effects that may result, at least in part, from the restoration of
cell membrane fluidity. At a neuronal level, piracetam modulates neurotransmission in a
range of transmitter systems (including cholinergic and glutamatergic), has
neuroprotective and anticonvulsant properties, and improves neuroplasticity. At a
vascular level, it appears to reduce erythrocyte adhesion to vascular endothelium,
hinder vasospasm, and facilitate microcirculation. This diverse range of physiological
effects is consistent with its use in a range of clinical indications. Its efficacy is
documented in cognitive disorders and dementia, vertigo, cortical myoclonus, dyslexia,
and sickle cell anemia. While high doses are sometimes necessary, piracetam is well
tolerated.

Brain Lang. 2011 Apr;117(1):23-7. doi: 10.1016/j.bandl.2010.11.003. Epub 2011 Jan 11.
Does long term use of piracetam improve speech disturbances
due to ischemic cerebrovascular diseases?
http://www.ncbi.nlm.nih.gov/pubmed/21227483
Gngr L
1
, Terzi M, Onar MK.
Author information
Abstract
Aphasia causes significant disability and handicap among stroke survivors. Language
therapy is recommended for aphasic patients, but not always available. Piracetam, an
old drug with novel properties, has been shown to have mild beneficial effects on post-
stroke aphasia. In the current study, we investigated the effects of 6 months treatment
with piracetam on aphasia following stroke. Thirty patients with first-ever ischemic
strokes and related aphasia were enrolled in the study. The scores for the National
Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale
(mRS), and Glhane Aphasia Test were recorded. The patients were scheduled
randomly to receive either 4.8 g piracetam daily or placebo treatment for 6 months. At
the end of 24 weeks, clinical assessments and aphasia tests were repeated. The level
of improvement in the clinical parameters and aphasia scores was compared between
the two groups. All patients had large lesions and severe aphasia. No significant
difference was observed between the piracetam and placebo groups regarding the
improvements in the NIHSS, BI and mRS scores at the end of the treatment. The
improvements observed in spontaneous speech, reading fluency, auditory
comprehension, reading comprehension, repetition, and naming were not significantly
different in the piracetam and placebo groups, the difference reached significance only
for auditory comprehension in favor of piracetam at the end of the treatment. Piracetam
is well-tolerated in patients with post-stroke aphasia. Piracetam taken orally in a daily
dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language
disorders.
Copyright 2010 Elsevier Inc. All rights reserved.


Piracetam
From Wikipedia, the free encyclopedia


Systematic (IUPAC) name
2-oxo-1-pyrrolidineacetamide
Clinical data
Trade names Breinox, Dinagen, Lucetam,
Nootropil, Nootropyl, Oikamid,
Piracetam and many others
AHFS/Drugs.com International Drug Names
Legal status Prescription Only (S4) (AU)POM (UK)
Not FDA approved (US)
Routes Oral, parenteral and vaporized
Pharmacokinetic data
Bioavailability ~100%
Half-life 45 hr
Excretion Urinary
Identifiers
CAS number 7491-74-9


ATC code N06BX03
PubChem CID 4843
ChemSpider 4677


UNII ZH516LNZ10


KEGG D01914


ChEMBL CHEMBL36715


Chemical data
Formula C
6
H
10
N
2
O
2


Mol. mass 142.16 g/mol
SMILES[show]
InChI[show]
(what is this?) (verify)
Piracetam (sold under many brand names) is a nootropic in the racetams group, with chemical
name 2-oxo-1-pyrrolidine acetamide. It shares the same 2-oxo-pyrrolidone base structure with 2-
oxo-pyrrolidine carboxylic acid(pyroglutamate). Piracetam is a cyclic derivative of GABA. Piracetam
is prescribed by doctors for some conditions, mainly myoclonus,
[1]
but is used off-label for a much
wider range of applications.
Piracetam's mechanism of action, as with racetams in general, is not fully
understood. The drug influences neuronal and vascular functions and influences
cognitive function without acting as a sedative or stimulant.
[3]
Piracetam is a
positiveallosteric modulator of the AMPA receptor.
[16]
It is hypothesized to act on
ion channels or ion carriers; thus leading to increased neuron
excitability.
[17]
GABA brain metabolism and GABA receptors are not affected by
piracetam.
[citation needed]
It has been found to increase blood flow and oxygen
consumption in parts of the brain but this may be a side effect of increased brain
activity rather than a primary effect or mechanism of action for the drug.
[18]

Piracetam improves the function of
the neurotransmitter acetylcholine via muscarinic cholinergic (ACh) receptors,
which are implicated in memory processes.
[19]
Furthermore, piracetam may have
an effect on NMDA glutamate receptors, which are involved
with learning and memory processes. Piracetam is thought to increase cell
membrane permeability.
[19][20]
Piracetam may exert its global effect on brain
neurotransmission via modulation of ion channels (i.e., Na
+
, K
+
).
[17]
It has been
found to increase oxygen consumption in the brain, apparently in connection
to ATP metabolism, and increases the activity of adenylate kinase in rat
brains.
[21][22]
Piracetam, while in the brain, appears to increase the synthesis
of cytochrome b5,
[23]
which is a part of the electron transport mechanism
in mitochondria. But in the brain, it also increases the permeability of the
mitochondria of some intermediaries of the Krebs cycle.
[21]