Indications for piracetam
Piracetam, the instructions for use indicate this, is in demand to combat many neurological, psychiatric and drug addiction problems. The wide scope of use is associated with the following properties:
- Positive effect on metabolic processes.
- The ability to improve blood circulation in the brain.
Indications for use are:
- Headaches and dizziness of various etiologies.
- The need to protect the brain from the effects of various damaging factors: intoxication, trauma, etc.
- The occurrence of cognitive impairment against the background of various diseases, which is manifested by memory deterioration.
The drug is used in the complex treatment of various mental illnesses and depressive conditions. It is also used in the treatment of chronic alcoholism, when persistent disorders of brain activity occur. When using the drug, it is possible to recover faster from brain injuries. This remedy improves the condition of patients with the development of dementia resulting from cerebral circulatory disorders. It is recommended for the prevention of Alzheimer's disease.
The drug is approved for the treatment of children in cases of confirmed dyslexia and other painful conditions, the symptoms of which are learning difficulties. The drug is indicated for perinatal brain damage. It is used for oligophrenia, cerebral palsy, and mental retardation.
Piracetam capsules 400 mg No. 30
Compound
Active substance: piracetam (in terms of 100% substance) - 400 mg.
Excipients: calcium stearate - 4.3 mg, magnesium hydroxycarbonate - up to the weight of the capsule contents 430 mg.
Composition of hard gelatin capsule: gelatin - 61.289 mg, glycerol - 0.193 mg, purified water - 10.585 mg, methyl parahydroxybenzoate - 0.268 mg, propyl parahydroxybenzoate - 0.067 mg, sodium lauryl sulfate - 0.049 mg, quinoline yellow dye E-104 - 0.042 mg, solar dye sunset yellow E-110 - 0.01 mg, titanium dioxide E-171 - 0.497 mg.
Pharmacokinetics
Absorption
After oral administration, piracetam is quickly and almost completely absorbed from the gastrointestinal tract. Bioavailability is approximately 100%.
After a single dose of piracetam in a dose of 2 g, the maximum concentration (Cmax) is reached in 30 minutes and is 40-60 mcg/ml, after 2-8 hours it is detected in the cerebrospinal fluid.
Distribution
The volume of distribution (Vd) is approximately 0.6 l/kg. Does not bind to plasma proteins. Piracetam penetrates the blood-brain and placental barriers, as well as hemodialysis membranes. An animal study found that piracetam selectively accumulates in the tissues of the cerebral cortex, mainly in the frontal, parietal and occipital lobes, in the cerebellum and basal ganglia.
Metabolism
Not metabolized.
Removal
The half-life from the blood (T½) is 4-5 hours and 8.5 hours from the cerebrospinal fluid. T½ is prolonged in renal failure. It is excreted unchanged by the kidneys. Renal excretion is almost complete (>95%) within 30 hours.
The total clearance of piracetam in healthy volunteers is 86 ml/min.
Indications for use
Symptomatic treatment of intellectual-mnestic disorders in the absence of an established diagnosis of dementia. Reducing the manifestations of cortical myoclonus in patients sensitive to piracetam, both as monotherapy and as part of complex therapy (in order to determine sensitivity to piracetam in a particular case, a trial course of treatment can be carried out).
Contraindications
- Individual intolerance to piracetam or pyrrolidone derivatives, as well as other components of the drug;
- Huntington's chorea;
- hemorrhagic stroke;
- end-stage chronic renal failure;
- pregnancy, breastfeeding period.
With caution:
Impaired hemostasis, extensive surgical interventions, severe bleeding, chronic renal failure (CC - 20-80 ml/min).
Directions for use and doses
Inside. The capsules are swallowed without chewing and washed down with water. During meals or on an empty stomach.
For memory disorders, intellectual impairments:
2.4-4.8 g/day in several doses during the first few weeks, then switch to maintenance therapy 2.4 g/day in 2-3 doses, 1.2 g/day is possible.
Treatment of cortical myoclonus:
Treatment begins with 7.2 g per day, increasing it by 4.8 g every 3-4 days up to 24 g, divided into 2-3 injections. The dose of other drugs for the treatment of myoclonus is not changed. In the future, based on the results of treatment, it is necessary, if possible, to reduce the dose of other drugs for the treatment of myoclonus. After starting treatment with piracetam, treatment is continued as long as symptoms of the disease persist. In patients with an acute episode, the course of the disease may change over time, so attempts should be made to reduce the dose or discontinue the drug every 6 months. To avoid a sudden relapse, the dose is reduced by 1.2 g every 2 days (in order to prevent the possibility of a sudden relapse of seizures in Lance-Adams syndrome - every 3-4 days).
If oral administration is not possible, the drug is administered intravenously in the same dose.
Elderly patients
Elderly patients with renal insufficiency should undergo dose adjustment (see "Renal insufficiency" below). During long-term treatment, creatinine clearance should be regularly assessed to determine the need for dose adjustment.
Kidney failure
Piracetam is excreted almost exclusively by the kidneys; caution should be used when treating patients with renal failure or requiring monitoring of renal function.
The half-life increases in direct proportion to the deterioration of renal function and creatinine clearance; this is also true in the elderly, in whom creatinine excretion varies with age.
The dose should be adjusted depending on creatinine clearance (CC).
Creatinine clearance for men can be calculated from the serum creatinine concentration (CSC) using the following formula:
CC (ml/min) = [140 - age (years) x body weight (kg)]/[72 x serum CC (mg/ml)]
Creatinine clearance for women can be calculated by multiplying the resulting value by a factor of 0.85.
Liver failure
Patients with isolated liver dysfunction do not require dose adjustment. For patients with impaired function of both the kidneys and liver, dosing is carried out according to the scheme (see above “Renal failure”).
Storage conditions
Store in a dry place, protected from light, at a temperature not exceeding 25 °C. Keep out of the reach of children.
Best before date
3 years. Do not use after the expiration date stated on the packaging.
special instructions
Effect on platelet aggregation
Due to the antiplatelet effect (see section "Pharmacodynamics"), patients should be prescribed with caution to patients with severe hemorrhagic disorders, risk of bleeding (for example, gastric ulcers), hemostasis disorders, in patients with surgical procedures, including dental procedures, in patients taking anticoagulants and antiplatelet agents, incl. low doses of acetylsalicylic acid.
Kidney failure
Since piracetam is excreted by the kidneys, caution should be exercised when prescribing the drug to patients with renal failure (see section "Dosage and Administration").
Elderly patients
During long-term treatment of elderly patients, regular monitoring of creatinine clearance is necessary, as dose adjustment may be required.
Cancellation of therapy
When treating cortical myoclonus, abrupt interruption of treatment should be avoided, as this may cause resumption of attacks.
Penetrates through the filter membranes of hemodialysis machines.
Description
Nootropic drug.
Pharmacodynamics
Piracetam is a nootropic drug that affects the central nervous system in various ways: it modifies neurotransmission in the brain;
improves conditions conducive to neuronal plasticity; improves microcirculation, affecting the rheological characteristics of the blood and without causing vasodilation. The use of piracetam in patients with cerebral dysfunction increases concentration and improves cognitive function, which is accompanied by changes in the electroencephalogram (increased α and β activity, decreased δ activity). Promotes the restoration of cognitive functions due to various disorders, such as hypoxia, intoxication or electroconvulsive therapy. Piracetam is indicated for the treatment of cortical myoclonus both as monotherapy and as part of complex therapy.
Reduces the duration of induced vestibular neuronitis. Piracetam inhibits increased aggregation of activated platelets and, in the case of pathological rigidity of red blood cells, improves their deformability and filtration ability.
Side effects
The adverse drug reactions listed below were identified in clinical studies and based on the results of post-registration surveillance and are grouped by system-organ classes. Frequency gradation is determined as follows: very often (≥1/10), often (≥1/100 to <1/10), infrequently (≥1/1000 to <1/100), rarely (≥1/10000 to <1 /1000), very rare (<1/10000) and frequency unknown (cannot be estimated from available clinical trial data).
From the blood and lymphatic system:
Frequency unknown: bleeding.
From the immune system:
Frequency unknown: anaphylactoid reactions, hypersensitivity.
From the mental side:
Often: nervousness. Uncommon: depression.
Frequency unknown: agitation, anxiety, confusion, hallucinations.
From the nervous system:
Common: hyperactivity. Uncommon: drowsiness. Frequency unknown: ataxia, balance disorders, exacerbation of epilepsy, headache, insomnia, tremor.
From the organ of hearing and labyrinth:
Frequency unknown: vertigo.
From the side of blood vessels:
Rarely: thrombophlebitis, arterial hypotension (only with parenteral administration).
From the digestive system:
Frequency unknown: abdominal pain (including in the upper parts), nausea, vomiting, diarrhea.
For the skin and subcutaneous tissues:
Frequency unknown: angioedema, dermatitis, itching, urticaria.
From the reproductive system:
Frequency unknown: increased sexual desire.
General disorders and disorders at the injection site:
Uncommon: asthenia.
Rarely: pain at the injection site, fever (only with parenteral administration).
Laboratory and instrumental data:
Common: weight gain.
Use during pregnancy and breastfeeding
Pregnancy
There are no sufficient data on the use of piracetam during pregnancy. Animal studies have not shown direct or indirect effects on pregnancy, embryo/fetal development, childbirth or postnatal development.
Piracetam penetrates the placental barrier. The plasma concentration of piracetam in newborns reaches 70-90% of that in the mother. Piracetam should be prescribed during pregnancy only in exceptional cases, if the benefit to the mother outweighs the potential risk to the fetus, and the clinical condition of the pregnant woman requires treatment with piracetam.
Lactation
Piracetam passes into breast milk. Piracetam should not be used during breastfeeding or breastfeeding should be discontinued while being treated with piracetam. When deciding whether to stop breastfeeding or refuse treatment with piracetam, the benefits of breastfeeding for the child should be weighed against the benefits of therapy for the woman.
Interaction
Thyroid hormones
Confusion, irritability and sleep disturbances were observed with simultaneous use of piracetam and thyroid extract (triiodothyronine + thyroxine).
Acenocoumarol
In a published blinded clinical trial in patients with recurrent venous thrombosis, piracetam 9.6 g/day had no effect on the dose of acenocoumarol required to achieve an international normalized ratio of 2.5 to 3.5, but compared with the effects of piracetam alone. acenocoumarol, the addition of piracetam at a dose of 9.6 g/day significantly reduces platelet aggregation, the release of P-thromboglobin, the concentration of fibrinogen and von Willebrand factor (VIII: C; VIII: vW: Ag; VIII: vW: RCo), as well as the viscosity of whole blood and plasma.
Pharmacokinetic interactions
The possibility of changes in the pharmacokinetics of piracetam under the influence of other drugs is low, since 90% of piracetam is excreted unchanged in the urine.
At concentrations of 142, 426 and 1422 mg/ml, piracetam does not inhibit cytochrome P450 isoenzymes (CYP 1A2, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1 and 4A9/11) in vitro.
At a concentration of 1422 mg/ml, minimal inhibition of the CYP2A6 isoenzyme (21%) and ZA4/5 (11%) was observed. However, the values of the inhibition constant (K;) probably go well beyond the concentration of 1422 mg/ml. Thus, metabolic interactions of piracetam with other drugs are unlikely.
Anticonvulsants
Taking piracetam at a dose of 20 g/day for 4 weeks in patients with epilepsy taking constant doses of antiepileptic drugs (carbamazepine, phenytoin, phenobarbital and valproic acid) did not change their maximum and minimum concentrations. Alcohol Concomitant use with alcohol did not affect the plasma concentration of piracetam; When taking 1.6 g of piracetam, the concentration of ethanol in plasma did not change.
Pharmaceutical Compatibility
There is no information on pharmaceutical compatibility.
Overdose
Symptoms: abdominal pain, bloody diarrhea.
A case is described in which, after taking piracetam at a dose of 75 g/day, a patient developed bloody diarrhea accompanied by abdominal pain, which was explained by the effect of a significant amount of sorbitol.
Treatment: induction of vomiting, gastric lavage, symptomatic therapy, hemodialysis (effectiveness 50-60%). There is no specific antidote.
Impact on the ability to drive vehicles and operate machinery
Considering the profile of adverse reactions, during the treatment period it is necessary to be careful when driving vehicles, operating machinery and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Contraindications and side effects
Since piracetam is used in the treatment of various pathologies, the instructions focus on this, only a doctor should prescribe its use, based on the patient’s condition and the presence of contraindications. Do not use the drug if you are hypersensitive to the active substance or other components included in its composition. The medicine is not used to treat children under one year of age, as well as during pregnancy and lactation.
Piracetam tablets, the instructions indicate this, are not used in the presence of the following pathologies:
- Huntington's chorea, which is a genetic disease and is characterized at the initial stage of development by impaired coordination of movements.
- Chronic renal failure in severe form.
- Hemorrhagic stroke.
- Psychomotor agitation.
The decision to take piracetam should be made with extreme caution in case of hemostasis disorders, severe bleeding, or after major surgical operations.
Various side effects were observed when taking the drug. Patients most often experienced the following body reactions:
- Nausea and vomiting.
- Headache.
- Hives.
- Diarrhea.
As a rule, such side effects disappear on their own during therapy. More dangerous symptoms while taking the drug are decreased blood pressure, abdominal pain, depression, hallucinations, dermatitis, and confusion. Sometimes during treatment with the drug, motor disinhibition, increased libido, drowsiness or insomnia, and a constant feeling of internal anxiety occur. Overdose may increase side effects.
Buy Piracetam solution intravenously and intramuscularly 20% 5ml No. 10 in pharmacies
Pharmacological action The active component is piracetam, a cyclic derivative of gamma-aminobutyric acid (GABA). Piracetam is a nootropic that directly affects the brain, improving cognitive processes such as learning, memory, attention, and mental performance. Piracetam affects the central nervous system in various ways: by changing the speed of propagation of excitation in the brain, it improves metabolic processes in nerve cells, improves microcirculation, and affects the rheological characteristics of the blood without having a vasodilating effect. Improves communication between the cerebral hemispheres and synaptic conduction in neocortical structures, improves cerebral blood flow. Piracetam inhibits platelet aggregation and restores the configurational properties of the outer membrane of rigid erythrocytes, as well as the ability of the latter to pass through microcircular vessels. At a dose of 9.6 g, it reduces the concentration of fibrinogen and von Willebrand factors by 30-40% and prolongs bleeding time. Piracetam has a protective and restorative effect in cases of impaired brain function due to hypoxia and intoxication. Piracetam reduces the severity and duration of vestibular nystagmus.
Indications In adults: - symptomatic treatment of psychoorganic syndrome, accompanied by memory loss, decreased concentration and activity, mood changes, behavior disorder, gait disturbance; - treatment of dizziness (vertigo) and related balance disorders (with the exception of dizziness of vasomotor and psychogenic origin); — treatment of cortical myoclonus (monotherapy or as part of complex therapy); — relief of sickle cell vaso-occlusive crisis. In children: - treatment of dyslexia in children from 8 years of age in combination with other methods; — relief of sickle cell vaso-occlusive crisis.
Contraindications - severe chronic renal failure (creatinine clearance (CK) less than 20 ml/min); - hemorrhagic stroke; - psychomotor agitation; - Huntington's chorea; - pregnancy; - lactation period. With caution: impaired hemostasis; extensive surgical interventions; heavy bleeding; chronic renal failure (KK 20-80 ml/min).
Use during pregnancy and lactation Contraindicated during pregnancy and lactation.
Special instructions Prescribe with caution to patients with impaired hemostasis, before upcoming major surgical interventions or in patients with symptoms of severe bleeding. When treating cortical myoclonus, abrupt cessation of treatment should be avoided, as this may cause a recurrence of attacks. During long-term therapy in elderly patients, regular monitoring of renal function is recommended; if necessary, dose adjustment is carried out depending on QC. Penetrates through the filter membranes of hemodialysis machines. Impact on the ability to drive vehicles and operate machinery During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Method of administration and dose: IV stream or drip, IM. The daily dose is divided into 2-4 doses. Symptomatic treatment of psychoorganic syndrome: 4.8 g/day during the first week, then switch to a maintenance dose of 1.2-2.4 g/day. Treatment of dizziness and related balance disorders: 2.4-4.8 g/day. Treatment of cortical myoclonus: start with a dose of 7.2 g/day, every 3-4 days the dose is increased by 4.8 g/day until a maximum dose of 24 g/day is reached. Treatment is continued throughout the entire period of the disease. Every 6 months you should try to reduce the dose or discontinue the drug, gradually reducing the dose by 1.2 g/day every 2 days. If there is little or no therapeutic effect, treatment is stopped. For sickle cell vaso-occlusive crisis (in adults and children): IV 300 mg/kg/day, divided into 4 equal doses. Treatment of dyslexia in children over 8 years of age (in combination with other treatment methods) - 3.2 g, divided into 2 equal doses. For mild chronic renal failure (KK 50-79 ml/min) - 2/3 of the dose divided into 2-3 doses; moderate degree (KK 30-49 ml/min) - 1/3 of the dose, divided into 2 doses; severe (KK 20-30 ml/min) -1/6 dose once.
Side effects From the central nervous system: motor disinhibition, irritability, drowsiness, depression, asthenia, headache, insomnia, mental agitation, imbalance, ataxia, exacerbation of epilepsy, anxiety, hallucinations, confusion. From the digestive system: nausea, vomiting, diarrhea, abdominal pain. Metabolism: increased body weight. From the senses: vertigo. From the skin: dermatitis, itching, rashes. Allergic reactions: hypersensitivity, anaphylactic reactions, angioedema. Local reactions: pain at the injection site, thrombophlebitis. Other: fever, decreased blood pressure. Drug interactions When used simultaneously with iodine-containing thyroid hormones, confusion, irritability and sleep disturbance may occur. In high doses (9.6 g/day) in patients with venous thrombosis, it increases the anticoagulant effect of indirect anticoagulants (a more pronounced decrease in platelet aggregation, fibrinogen content, von Willebrand factor, blood and plasma viscosity). Pharmaceutically compatible with solutions of dextrose (5%, 10%, 20%), fructose (5%, 10%, 20%), 0.9% sodium chloride solution, Ringer's solution, 20% mannitol solution, hydroxyethyl starch (6%, 10%) .
Overdose Symptoms: abdominal pain, diarrhea mixed with blood. Treatment: induction of vomiting, gastric lavage, symptomatic therapy, hemodialysis (effectiveness 50-60%). There is no specific antidote.
Storage conditions Store in a place protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children.
Shelf life: 5 years.
Instructions for use, price, reviews analogues
Piracetam must be taken in accordance with the instructions for use, as tablets and capsules are intended for internal use. The daily dosage is calculated depending on the patient’s weight and is 30-160 mg per kilogram of weight. The drug is taken 2-4 times a day, but to prevent the occurrence of insomnia, the last dose should be no later than 17 hours before bedtime.
The dosage regimen is developed by the doctor. It may vary depending on the pathology. Thus, the drug is used in complex methods of rehabilitation therapy in the treatment of serious brain damage. For recovery from complex psychotic disorders, it is used in combination with psychotropic drugs.
The price of pirocetam may vary depending on the manufacturer. But in any case, it is accessible. Today you can buy analogues of the drug in pharmacies. They are presented as single drugs and complex drugs. When prescribing such drugs, the doctor must take into account their interaction with other medications.
All nootropic drugs are highly effective, as evidenced by numerous patient reviews. First of all, they note the cumulative effect of the drug. Many note the ability to withstand heavy loads without losing concentration. You can also often find positive reviews about the treatment of children.
