Piracetam

A 2001 Cochrane Review of piracetam in dementia and cognitive impairment reported a weak positive effect with high risk of bias and methodological problems. No independent update has been published since. International dementia guidelines (NICE NG97, AAN 2018) do not include piracetam. The drug is not registered as a medicine in the United States; FDA issued warnings to supplement manufacturers using piracetam in 2004 and 2010.

ICD-10: F06.7 · ICD-11: 6D71

In children with developmental delay, ADHD, or dyslexia, piracetam is not mentioned in international pediatric guidelines, and AAP and ESCAP do not include it in standards of care. Convincing benefit for these uses has not been shown. Proven help comes from early behavioral intervention, speech and special-education therapy, and, for confirmed ADHD, psychotherapy and stimulants on strict indication. Piracetam should not replace these approaches, since it costs a child time during the early window when intervention works best.

ICD-10: F80-F89 · ICD-11: 6A0Z

International ADHD guidelines (AAP 2019, NICE NG87) list psychostimulants (methylphenidate, lisdexamfetamine), atomoxetine, and behavioural therapy as first-line. Piracetam is not in these documents. Russian paediatric practice sometimes prescribes it 'to improve concentration' – this contradicts the guidelines.

ICD-10: F90.0 · ICD-11: 6A05

Piracetam is the original nootropic drug, developed in the 1960s. In biohacker communities, piracetam is promoted as the original nootropic for cognitive enhancement in healthy adults. International clinical guidelines (AAN, ESO, NICE) do not mention piracetam, and the FDA has not approved it. No clinical studies in healthy adults with endpoints on productivity, working memory, or attention exist. International anti-aging guidelines do not include piracetam. The drug is relatively safe but can cause nervousness, insomnia, and GI disturbances. If piracetam is being taken for anti-aging, concentration, or productivity, consider seeking a second opinion.

AHA/ASA 2019 and ESO 2021 stroke guidelines do not mention piracetam in acute ischemic stroke. The 2012 Cochrane review (Ricci et al., 3 RCTs, 1,002 patients; 93 % of the data from the PASS trial) confirmed no effect on mortality or functional recovery, and PASS showed a trend toward higher early mortality. Proven therapies are tPA thrombolysis within 4.5 hours and mechanical thrombectomy within 6–24 hours in selected patients.

ICD-10: I63 · ICD-11: 8B11

Piracetam is the original nootropic drug, developed in the 1960s. International clinical guidelines (AAN, ESO, NICE) do not include piracetam for age-related memory decline, dementia, or chronic cerebral ischemia. The diagnosis of dyscirculatory encephalopathy, which is the most common reason piracetam is prescribed in Russia, does not exist in international neurology or in ICD-11. For memory complaints without diagnosed dementia, piracetam does not work: there are no convincing clinical studies. For confirmed Alzheimer's dementia, other drugs are used: acetylcholinesterase inhibitors (donepezil, rivastigmine) and memantine. For prevention of vascular cognitive impairment: blood-pressure control, lipid management, smoking cessation, physical activity, cognitive training. If piracetam was prescribed for memory improvement, for dyscirculatory encephalopathy, or after stress, consider seeking a second opinion.

Piracetam is not included in international stroke rehabilitation guidelines (AHA/ASA 2023, ESO 2022). Recovery relies on early mobilisation, physical, occupational, and speech therapy, and cardiovascular risk management.

ICD-10: I69 · ICD-11: 8B25