Combination nootropic (local classification)
ATC code: N06BX-FEZAM (Fezam (piracetam + cinnarizine, combination local code))
A combination of 400 mg piracetam (a cyclic GABA derivative with unclear nootropic mechanism) and 25 mg cinnarizine (an H1-antagonist-class calcium channel blocker with vestibular blocking properties). The manufacturer claims combined nootropic and 'vasoactive' effects. The piracetam-cinnarizine combination originated in the USSR and is not registered outside CIS countries. Individual components – piracetam and cinnarizine – are also absent from current international neurology guidelines.
Not recommended
'Chronic cerebral ischaemia', 'dyscirculatory encephalopathy', and 'vegetative-vascular dystonia' are absent from ICD-11 and international neurology. Fezam is a piracetam-cinnarizine combination assembled under diagnoses that do not exist outside Russia. AAN, ESO, AHA/ASA, and NICE do not mention the drug or its components.
Not recommended
For cognitive impairment, international guidelines (NICE NG97, AAN 2018) list cholinesterase inhibitors and memantine for Alzheimer dementia and workup for reversible causes in mild cognitive impairment. Combination nootropics with piracetam are not included.
Not recommended
For age-related memory complaints without objective cognitive impairment, international sources do not recommend nootropics. The reasonable approach is sleep, physical activity, cognitive training, and correction of reversible causes.
Not recommended
AAO-HNS 2014 and NICE NG214 note the absence of evidence-based pharmacotherapy for tinnitus. Fezam is not in these recommendations. Russian practice of prescribing it 'for ear ringing' is not considered substantiated.
Not recommended
In Russian practice, Fezam and Omaron are popular for 'dizziness', but AAN 2024 and Barany Society guidelines require a specific diagnosis – BPPV, Meniere's, vestibular neuritis, vestibular migraine – and condition-specific treatment. The fixed piracetam-cinnarizine combination is not in these documents. Cinnarizine in older adults, especially with prolonged use, can cause drug-induced parkinsonism.
Contraindicated in pregnancy.
Contraindicated during breastfeeding.
Piracetam + cinnarizine is evaluated for the following indications with varying evidence strength: Chronic cerebral ischaemia / dyscirculatory encephalopathy (marketed indication) (evidence tier F), Cognitive impairment (evidence tier F), Subjective age-related memory complaints (marketed indication) (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Piracetam + cinnarizine (≥ 1 in 100): Drowsiness, fatigue, Dyspepsia, Dry mouth, Weight gain. See the Safety section for uncommon and serious reactions.
Contraindicated in pregnancy.
Contraindicated during breastfeeding.
Piracetam + cinnarizine is contraindicated in: Hypersensitivity to piracetam or cinnarizine; Severe renal failure (CrCl < 20 mL/min); Severe hepatic impairment; Haemorrhagic stroke; Parkinson's disease and drug-induced parkinsonism. Full list in the Safety section.