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Piracetam: Difference between revisions
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Piracetam was first synthesized in 1964 by Corneliu E. Giurgea and other scientists at the Belgian pharmaceutical company UCB.{{citation needed}} | Piracetam was first synthesized in 1964 by Corneliu E. Giurgea and other scientists at the Belgian pharmaceutical company UCB.{{citation needed}} | ||
In the United Kingdom, piracetam is prescribed mainly for myoclonus (spasmodic jerky contraction of groups of muscles),<ref>Nootropil (piracetam) | In the United Kingdom, piracetam is prescribed mainly for myoclonus (spasmodic jerky contraction of groups of muscles),<ref>{{Citation | vauthors=((Henderson, D. R.)) | year=2012 | title=Nootropil (piracetam) | url=http://www.netdoctor.co.uk/medicines/brain-and-nervous-system/news/a7226/nootropil-piracetam/}}</ref> but is used off-label for other conditions. In the United States, it is not approved by the Food and Drug Administration for any medical use and it is not permitted to be sold as a dietary supplement. However, it is still readily available and sold through online vendors. As a "smart drug", it is reported to enhance cognitive functions including memory, intelligence, and attention.<ref>{{Citation | title=Erowid Piracetam Vault : FAQ : Frequently Asked Questions v0.7 | url=https://www.erowid.org/smarts/piracetam/piracetam_faq.shtml}}</ref> | ||
The active dose of piracetam is 100 times than that of [[noopept]],{{citation needed}} making it both the earliest and least potent [[racetam]]. The standard piracetam dose for adults is between 1,200-4,800mg a day. The largest effective dose is 1,600mg taken three times a day for a total of 4,800mg. | The active dose of piracetam is 100 times than that of [[noopept]],{{citation needed}} making it both the earliest and least potent [[racetam]]. The standard piracetam dose for adults is between 1,200-4,800mg a day. The largest effective dose is 1,600mg taken three times a day for a total of 4,800mg. | ||
==Chemistry== | ==Chemistry== | ||
Piracetam, or 2-oxo-1-pyrrolidine-acetamide, is a synthetic compound of the [[racetam]] family. Racetams share a [[pyrrolidine]] nucleus, a five member nitrogenous ring with a ketone bonded oxygen at R<sub>2</sub>.<ref>Piracetam and piracetam-like drugs: from basic science to novel clinical applications to CNS disorders | Piracetam, or 2-oxo-1-pyrrolidine-acetamide, is a synthetic compound of the [[racetam]] family. Racetams share a [[pyrrolidine]] nucleus, a five member nitrogenous ring with a ketone bonded oxygen at R<sub>2</sub>.<ref>{{cite journal | vauthors=((Malykh, A. G.)), ((Sadaie, M. R.)) | journal=Drugs | title=Piracetam and piracetam-like drugs: from basic science to novel clinical applications to CNS disorders | volume=70 | issue=3 | pages=287–312 | date=12 February 2010 | issn=1179-1950 | doi=10.2165/11319230-000000000-00000}}</ref> This 2-pyrrolidone ring is bound to the terminal carbon of an acetamide group, an ethyl amide chain with a ketone bond (C=O) at the alpha carbon. | ||
Piracetam shares structural similarity to the neurotransmitter [[GABA]], its pyrrolidine core is the cyclic counterpart of [[GABA]] and could theoretically be converted into an acetamide chain through a hydrolysis reaction into [[GABA]]. | Piracetam shares structural similarity to the neurotransmitter [[GABA]], its pyrrolidine core is the cyclic counterpart of [[GABA]] and could theoretically be converted into an acetamide chain through a hydrolysis reaction into [[GABA]]. | ||
==Pharmacology== | ==Pharmacology== | ||
Piracetam's mechanism of action, as with [[racetam]]s in general, is not fully understood. The drug influences neuronal and vascular functions and influences cognitive function without acting as a [[sedative]] or [[stimulant]].<ref>Piracetam: a review of pharmacological properties and clinical uses | Piracetam's mechanism of action, as with [[racetam]]s in general, is not fully understood. The drug influences neuronal and vascular functions and influences cognitive function without acting as a [[sedative]] or [[stimulant]].<ref>{{cite journal | vauthors=((Winblad, B.)) | journal=CNS drug reviews | title=Piracetam: a review of pharmacological properties and clinical uses | volume=11 | issue=2 | pages=169–182 | date= 2005 | issn=1080-563X | doi=10.1111/j.1527-3458.2005.tb00268.x}}</ref> Piracetam is a positive allosteric modulator of the AMPA receptor.<ref>{{cite journal | vauthors=((Ahmed, A. H.)), ((Oswald, R. E.)) | journal=Journal of Medicinal Chemistry | title=Piracetam defines a new binding site for allosteric modulators of alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptors | volume=53 | issue=5 | pages=2197–2203 | date=11 March 2010 | issn=1520-4804 | doi=10.1021/jm901905j}}</ref> It is hypothesized to act on ion channels or ion carriers, thus leading to increased neuron excitability.<ref>{{cite journal | vauthors=((Gouliaev, A. H.)), ((Senning, A.)) | journal=Brain Research. Brain Research Reviews | title=Piracetam and other structurally related nootropics | volume=19 | issue=2 | pages=180–222 | date= May 1994 | doi=10.1016/0165-0173(94)90011-6}}</ref> [[GABA]] brain metabolism and GABA receptors are not affected by piracetam.<ref>{{cite journal | vauthors=((Giurgea, C. E.)) | journal=Drug Development Research | title=The nootropic concept and its prospective implications | volume=2 | issue=5 | pages=441–446 | date= 1982 | url=https://onlinelibrary.wiley.com/doi/10.1002/ddr.430020505 | issn=0272-4391 | doi=10.1002/ddr.430020505}}</ref> | ||
Among other things, it has also 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.<ref>Cerebral blood flow effects of piracetam, pentifylline, and nicotinic acid in the baboon model compared with the known effect of acetazolamide | Among other things, it has also 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.<ref>{{cite journal | vauthors=((Jordaan, B.)), ((Oliver, D. W.)), ((Dormehl, I. C.)), ((Hugo, N.)) | journal=Arzneimittel-Forschung | title=Cerebral blood flow effects of piracetam, pentifylline, and nicotinic acid in the baboon model compared with the known effect of acetazolamide | volume=46 | issue=9 | pages=844–847 | date= September 1996 | issn=0004-4172}}</ref> Piracetam also improves the function of the neurotransmitter [[acetylcholine]] via muscarinic cholinergic (ACh) receptors, which are implicated in memory processes.<ref>{{cite journal | vauthors=((Winnicka, K.)), ((Tomasiak, M.)), ((Bielawska, A.)) | journal=Acta Poloniae Pharmaceutica | title=Piracetam--an old drug with novel properties? | volume=62 | issue=5 | pages=405–409 | date= October 2005 | issn=0001-6837}}</ref> | ||
Although it is not fully understood how, it's these multiple complex mechanisms of action which result in piracetams [[nootropic]] effects. | Although it is not fully understood how, it's these multiple complex mechanisms of action which result in piracetams [[nootropic]] effects. | ||
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==Toxicity and harm potential== | ==Toxicity and harm potential== | ||
Adverse effects, although rare and of short duration are limited to [[anxiety]], [[wakefulness|insomnia]], [[sedation|drowsiness]], [[headaches]] and [[irritability|agitation]]. It may be safe for up to 18 months in humans at doses of 3.2g daily with one year-long study in ambulatory patients with Alzheimer's using 8g daily reporting no side effects.<ref>Long-term efficacy and safety of piracetam in the treatment of progressive myoclonus epilepsy. | Adverse effects, although rare and of short duration are limited to [[anxiety]], [[wakefulness|insomnia]], [[sedation|drowsiness]], [[headaches]] and [[irritability|agitation]]. It may be safe for up to 18 months in humans at doses of 3.2g daily with one year-long study in ambulatory patients with Alzheimer's using 8g daily reporting no side effects.<ref>{{cite journal | vauthors=((Fedi, M.)), ((Reutens, D.)), ((Dubeau, F.)), ((Andermann, E.)), ((D’Agostino, D.)), ((Andermann, F.)) | journal=Archives of Neurology | title=Long-term efficacy and safety of piracetam in the treatment of progressive myoclonus epilepsy | volume=58 | issue=5 | pages=781–786 | date= May 2001 | issn=0003-9942 | doi=10.1001/archneur.58.5.781}}</ref> However, a possibility for adverse drug-drug interactions persists for piracetam due to it interacting with blood in an anti-clotting manner. Therefore, caution should be taken when pairing piracetam with pharmaceutical blood thinning agents such as Warfarin or potent nutraceutical options and individuals prone to brain hemorrhaging are discouraged from using piracetam. | ||
Patients with renal insufficiency should also not use piracetam. | Patients with renal insufficiency should also not use piracetam. | ||
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===Dangerous interactions=== | ===Dangerous interactions=== | ||
Piracetam showed nonselective MAO activity in a rat study.<ref> | Piracetam showed nonselective MAO activity in a rat study.<ref>{{cite journal | vauthors=((Stancheva, S. L.)), ((Alova, L. G.)) | journal=Farmakologiia I Toksikologiia | title=[Effect of centrophenoxine, piracetam and aniracetam on the monoamine oxidase activity in different brain structures of rats] | volume=51 | issue=3 | pages=16–18 | date= June 1988 | issn=0014-8318}}</ref><ref>{{cite journal | vauthors=((Trabucchi, M.)), ((Govoni, S.)), ((Battaini, F.)) | journal=Il Farmaco; Edizione Scientifica | title=Changes in the interaction between CNS cholinergic and dopaminergic neurons induced by L-alpha-glycerylphosphorylcholine, a cholinomimetic drug | volume=41 | issue=4 | pages=325–334 | date= April 1986 | issn=0430-0920}}</ref> Piracetam and [[MAOIs]] are a potentially dangerous combination. It is likely that MAOIs could increase the effects of piracetam unpredictably. Taking this chemical while on prescription MAOIs is strongly discouraged. | ||
==Legal status== | ==Legal status== | ||
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Piracetam, being a member of the [[racetam]] family, currently is legally available to buy and sell in most countries, but may still vary by region. | Piracetam, being a member of the [[racetam]] family, currently is legally available to buy and sell in most countries, but may still vary by region. | ||
*'''Germany:''' Piracetam is a prescription medicine, according to Anlage 1 AMVV.<ref>https://www.gesetze-im-internet.de/amvv/anlage_1.html</ref> | *'''Germany:''' Piracetam is a prescription medicine, according to Anlage 1 AMVV.<ref>{{Citation | title=Anlage 1 AMVV - Einzelnorm | url=https://www.gesetze-im-internet.de/amvv/anlage_1.html}}</ref> | ||
*'''Switzerland:''' Piracetam is listed as a "Abgabekategorie B" pharmaceutical, which requires a prescription.{{citation needed}} | *'''Switzerland:''' Piracetam is listed as a "Abgabekategorie B" pharmaceutical, which requires a prescription.{{citation needed}} | ||
*'''United Kingdom:''' Piracetam and other racetams are prescription only drugs; however, there is no penalty for possession or importing them. | *'''United Kingdom:''' Piracetam and other racetams are prescription only drugs; however, there is no penalty for possession or importing them. | ||