Pyracetam - instructions for use, dose, side effects, contraindications

Nootropic agent. Has a positive effect on the metabolic processes and blood circulation of the brain. Increases the utilization of glucose, improves the flow of metabolic processes, improves microcirculation in ischemic zones, inhibits the aggregation of activated platelets. Has a protective effect in brain damage caused by hypoxia, intoxication, injuries, electric shock. Improves the integrative activity of the brain.

Activates associative processes in the central nervous system, improves memory, mood and mentality in healthy and sick people. Stimulates the integrative activity of the brain and intellectual activity,improves synaptic conductivity in the cortex and the connection between the cerebral hemispheres, facilitates the learning process, restores and stabilizes the impaired brain functions (consciousness, memory, speech), increases mental performance.

Does not have sedative and psychostimulating effects.

In connection with the antihypoxic effect is effective in the complex therapy of myocardial infarction.

Pharmacokinetics:

When ingestion quickly and almost completely absorbed from the digestive tract. Maximum concentrationin plasma is reached after about 30 minutes, in cerebrospinal fluid after 2-8 hours. The apparent volume of distribution is 0.6 l / kg. Does not bind to blood plasma proteins.

It is distributed in all organs and tissues, penetrates through the blood-brain and placental barriers. Selectively accumulates in the tissues of the cerebral cortex, mainly in the frontal, parietal and occipital lobes, in the cerebellum and basal ganglia.

Half-lifefrom the plasma is 4-5 hours, from the cerebrospinal fluid - 6-8 hours. It is excreted by the kidneys in unchanged form. With renal failure, the elimination half-life increases.

Indications:

Psychoorganic disorders, chronic cerebrovascular insufficiency (atherosclerosis, hypertension, vascular parkinsonism), accompanied by memory, attention, speech, dizziness and headache; dementia (vascular dementia, Alzheimer's disease, senile dementia); ischemic stroke and its consequences, craniocerebral trauma, intoxication (coma and subcomatose state, recovery period); acute viral neuroinfection; diseases of the nervous system, accompanied by a decrease in intellectual-mnestic functions, wakefulness level, a violation of the emotional-volitional sphere and behavior; vestibular nystagmus, dizziness, cortical myoclonus, aphasia; epilepsy (as an adjuvant); neurotic depression with prevalence in the clinical picture of adynamia, asthenic and senesto-hypochondriacal disorders, phenomena of ideomotor inhibition; sluggish-apathic condition; senile and atrophic processes; Depressive states resistant to antidepressants; elimination or prevention of somatovegetative,neurological or psychiatric complications of therapy with neuroleptics and other psychotropic drugs; relief of abstinent, pre- and delirious states with alcoholism and drug addiction, acute intoxication with ethanol, morphine, barbiturates, amphetamine; psycho-organic syndrome in chronic alcoholism; children - the effects of perinatal CNS injury, infantile cerebral palsy, poor learning ability with psycho-organic syndrome, mental retardation, oligophrenia, speech disorder, memory impairment, intellectual insufficiency, cerebral disorders; sickle-cell anemia (complex therapy).

ICD-10

III.D55-D59.D57 Sickle-cell disorders

V.F00-F09.F03 Dementia, unspecified

V.F00-F09.F01 Vascular dementia

V.F00-F09.F07.2 Postcontasia syndrome

V.F00-F09.F07.1 Postencephalitis syndrome

V.F00-F09.F04 Organic amnestic syndrome not caused by alcohol or other psychoactive substances

V.F10-F19.F10.4 Mental and behavioral disorders caused by alcohol use - abstinent state with delirium

V.F10-F19.F10.3 Mental and behavioral disorders caused by alcohol use - withdrawal symptoms

V.F60-F69.F63 Disorders of habits and drives

V.F40-F48.F48.0 Neurasthenia

VI.G30-G32.G30 Alzheimer's disease

VI.G20-G26.G25.3 Myoclonus

VI.G80-G83.G80 Cerebral palsy

VII.H55-H59.H55 Nystagmus and other involuntary eye movements

IX.I60-I69.I63 Cerebral infarction

IX.I60-I69.I61.3 Intracerebral haemorrhage in the brain stem

XVI.P90-P96.P91 Other violations of cerebral status of the newborn

IX.I60-I69.I69 Effects of cerebrovascular disease

IX.I60-I69.I67.2 Cerebral atherosclerosis

XVIII.R40-R46.R45.1 Anxiety and Excitement

Contraindications:

Hypersensitivity to piracetam and pyrrolidone derivatives; hemorrhagic stroke, marked renal failure (creatinine clearance less than 20 ml / min), agitated depression, Huntington's disease, pregnancy, breast-feeding, children under 1 year.

Carefully:

Due to the antiaggregant effect, piracetam should be administered with caution to patients with severe hemorrhagic disorders, the risk of bleeding (eg, gastric ulcer), hemostasis disorders, hemorrhagic cerebrovascular disorders in the anamnesis, in patients with surgical interventions, including dental interventions, in patients taking anticoagulants and antiplatelet agents, including low doses of acetylsalicylic acid.

Patients with impaired renal function need constant monitoring of the level of residual nitrogen and creatinine in the blood. Elderly patients are adjusted the dose in the presence of renal failure, with prolonged therapy, it is necessary to monitor the functional state of the kidneys.

Piracetam lowers the threshold of convulsive readiness for epilepsy, which requires correction of the dose of anticonvulsants.

In the treatment of cortical myoclonia, abrupt withdrawal of piracetam can cause a resumption of seizures.

When treating patients on a hyponatrial diet, it is recommended that piracetam tablets in a dose of 24 g contain 46 mg of sodium.

Pregnancy and lactation:

Category of recommendations FDA not defined. Adequate and well-controlled studies in humans and animals have not been conducted. Use is only possible when the intended benefit to the mother exceeds the possible risk to the fetus.

There is no information on the penetration into breast milk. Do not apply!

Dosing and Administration:

Inside (during meals or on an empty stomach, squeezed with liquid).

Adults inside - 30-160 mg / kg per day in 2-4 admission. Duration of treatment is 6-8 weeks.

If necessary, use intramuscularly or intravenously at an initial dose of 10 g per day. When intravenously administered to patients in serious condition, the daily dose can be 12 g. After clinical improvement, the dose is gradually reduced and switched to oral administration.

Children inside - 30-50 mg / kg per day in 2-3 hours. Treatment should be continued for at least 3 weeks.

Side effects:

Most often occur when administered in doses exceeding 5 g per day.

Children (especially with mental retardation): fussiness, anxiety, restlessness, motor disinhibition, decreased ability to concentrate, unbalanced, irritable, increased conflict.

From the side digestive system: rarely - dyspeptic symptoms, abdominal pain, nausea, vomiting, diarrhea, constipation, anorexia, weight gain.

From the side CNS: rarely - nervousness, irritation, irritability, restlessness, sleep disorders, dizziness, headache, tremor, in some cases - weakness, drowsiness, extrapyramidal disorders, tremor, convulsions.

From the side Hearing organs: Vertigo.

From the side skin integument: dermatitis, itching, hives, angioedema.

Other: increased sexual activity.

Overdose:

Symptoms: increased potential side effects.

Treatment: gastric lavage, Activated carbon, symptomatic therapy, hemodialysis possible (efficacy 50-60%); there is no specific antidote.

Interaction:

A case of interaction of piracetam with simultaneous application with a thyroid extract containing triiodothyronine and tetraiodothyronine is described when anxiety, irritability and sleep disorders were noted in the patient.

With simultaneous use with drugs of thyroid hormones, it is possible to develop central effects - tremor, anxiety, irritability, sleep disorders, confusion.

With the simultaneous use of stimulants of the central nervous system, it is possible to intensify the psychostimulating effect.

With simultaneous use with neuroleptics, there is an increase in extrapyramidal disorders.

Cinnarizine with simultaneous application enhances the effect of pyracetam. Ethylthiobenzimidazole enhances the effects of pyracetam.

Special instructions:

It is recommended that the kidney function is monitored continuously.

In case of occurrence of disturbances of a dream it is recommended to cancel the evening reception of piracetam, having added this dose to a day reception.

With caution apply during work drivers of vehicles and people whose profession is associated with increased concentration of attention.

It penetrates the hemodialysis apparatus through the filter membranes.

Instructions

Pyracetam (Piracetamum)