Piracetam

Oral
Vertigo
Adult: Dose range: 2.4-4.8 g daily in 2-3 divided doses.
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<20 or ESRD	Contraindicated.
20-29	1/6 of the usual daily dose once daily.
30-49	1/3 of the usual daily dose in 2 divided doses.
50-79	2/3 of the usual daily dose in 2-3 divided doses.

Oral
Cognitive impairment
Adult: Dose range: 1.2-4.8 g daily in 2-4 divided doses. Treatment may be initiated at 4.8 g daily depending on the severity of symptoms. Dosage recommendations may vary among countries and individual products (refer to specific product guideline).
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<20 or ESRD	Contraindicated.
20-29	1/6 of the usual daily dose once daily.
30-49	1/3 of the usual daily dose in 2 divided doses.
50-79	2/3 of the usual daily dose in 2-3 divided doses.

Oral
Cortical myoclonus
Adult: As monotherapy or in combination with other anti-myoclonic drugs: Initially, 7.2 g daily in 2 or 3 divided doses, then increased by 4.8 g every 3-4 days. Max: 24 g daily in 2-3 divided doses. Continue treatment for as long as the original cerebral disease persists. Once symptoms are controlled, consider dosage reduction or gradual discontinuation of therapy every 6 months. Dose reduction may be done by 1.2 g every 2 days (every 3-4 days for Lance-Adams syndrome). Treatment recommendations may vary among countries and individual products (refer to specific product guideline).
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<20 or ESRD	Contraindicated.
20-29	1/6 of the usual daily dose once daily.
30-49	1/3 of the usual daily dose in 2 divided doses.
50-79	2/3 of the usual daily dose in 2-3 divided doses.

Oral
Dyslexia
Child: ≥8-13 years In combination with appropriate measures (e.g. speech therapy): As 200 mg/mL oral solution or 800 mg tab: 3.2 g daily in 2 divided doses. Treatment recommendations may vary among countries and individual products (refer to specific product guideline).
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<20 or ESRD	Contraindicated.
20-29	1/6 of the usual daily dose once daily.
30-49	1/3 of the usual daily dose in 2 divided doses.
50-79	2/3 of the usual daily dose in 2-3 divided doses.

Intravenous
Vertigo
Adult: In cases when oral administration is not possible (e.g. difficulty swallowing, unconsciousness): 2.4-4.8 g daily in 2-3 divided doses via inj over several minutes or continuous infusion over 24-hour period.
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<20 or ESRD	Contraindicated.
20-29	1/6 of the usual daily dose once daily.
30-49	1/3 of the usual daily dose in 2 divided doses.
50-79	2/3 of the usual daily dose in 2-3 divided doses.

Intravenous
Cognitive impairment
Adult: In cases when oral administration is not possible (e.g. difficulty swallowing, unconsciousness): Dose range: 1.2-4.8 g daily in 2-4 divided doses via inj over several minutes or continuous infusion over 24-hour period. Treatment may be initiated at 4.8 g daily depending on the severity of symptoms. Dosage recommendations may vary among countries and individual products (refer to specific product guideline).
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<20 or ESRD	Contraindicated.
20-29	1/6 of the usual daily dose once daily.
30-49	1/3 of the usual daily dose in 2 divided doses.
50-79	2/3 of the usual daily dose in 2-3 divided doses.

Intravenous
Cortical myoclonus
Adult: In cases when oral administration is not possible (e.g. difficulty swallowing, unconsciousness): As monotherapy or in combination with other anti-myoclonic drugs: Initially, 7.2 g daily in 2 or 3 divided doses, then increased by 4.8 g every 3-4 days. Max: 24 g daily in 2-3 divided doses. Doses are given via inj over several minutes or continuous infusion over 24-hour period. Continue treatment for as long as the original cerebral disease persists. May consider dosage reduction or gradual discontinuation of therapy every 6 months if symptoms are controlled. Reduce dose by 1.2 g every 2 days (every 3-4 days for Lance-Adams syndrome). Treatment recommendations may vary among countries and individual products (refer to specific product guideline).
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<20 or ESRD	Contraindicated.
20-29	1/6 of the usual daily dose once daily.
30-49	1/3 of the usual daily dose in 2 divided doses.
50-79	2/3 of the usual daily dose in 2-3 divided doses.

Oral soln: May be taken with or without food. Take w/ a glass of water or soft drink to mask bitter taste.

Cerebral haemorrhage, Huntington's chorea. ESRD or severe renal impairment (CrCl <20 mL/min).

Patient with severe haemorrhage, increased risk of bleeding (e.g. gastrointestinal ulcer), underlying haemostatic disorder, history of haemorrhagic cerebrovascular accident (CVA). Patient undergoing major surgery including dental surgery or receiving anticoagulants or antiplatelet drugs (including low dose aspirin). Avoid abrupt withdrawal. Renal impairment. Children and elderly. Pregnancy and lactation. Patient CounsellingThis drug may cause drowsiness, weakness and impaired coordination, if affected, do not drive or operate machinery. Monitoring Parameters Monitor renal function.

Significant: Bleeding disorder, CNS effects (e.g. impaired coordination, weakness, drowsiness). General disorders and administration site conditions: Rarely, pyrexia, inj site pain (IV). Investigations: Weight gain. Nervous system disorders: Hyperkinesia. Psychiatric disorders: Nervousness, depression. Vascular disorders: Rarely, thrombophlebitis, hypotension (IV).

Concomitant use with thyroid hormones may cause confusion, irritability and sleep disorder. May increase the effects of anticoagulants (e.g. acenocoumarol) or antiplatelet agents (e.g. aspirin).

Piracetam is a nootropic that acts on the CNS. Its exact mechanism in reducing symptoms of cortical myoclonus is not yet fully elucidated however, it is suggested to be due to its GABA-mimetic effects. It is believed to exert neuronal effect by protecting the cerebral cortex and restoring cognitive abilities after various cerebral trauma (e.g. hypoxia, intoxications, electroconvulsive therapy). Additionally, it has vascular effects on thrombocytes, erythrocytes and blood vessel walls by enhancing the erythrocyte deformability, decreasing the aggregability of thrombocytes, and reducing capillary vasospasm and erythrocyte adhesion to the blood vessel walls.
Absorption: Rapidly and almost completely absorbed from the gastrointestinal tract. Bioavailability: Approx 100% (oral). Time to peak plasma concentration: 1-1.5 hours (oral).
Distribution: Distributed to all tissues except adipose tissues; penetrates the membranes of isolated RBCs. Crosses the placenta and blood brain barrier; enters breast milk. Volume of distribution: Approx 0.7 L/kg.
Metabolism: Not significantly metabolised.
Excretion: Via urine (80-100% as unchanged drug). Plasma elimination half-life: Approx 5 hours.

Intravenous: Store between 15-30°C. Oral: Store between 15-30°C.

Nootropics & Neurotonics/Neurotrophics

N06BX03 - piracetam ; Belongs to the class of other psychostimulants and nootropics.