FCognitive impairment
Not recommended
Cognitive impairment
Not recommended
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.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Not recommended
Phezam is a combination of piracetam and cinnarizine developed for the Russian diagnoses chronic cerebral ischemia, dyscirculatory encephalopathy, and vegetative-vascular dystonia, none of which exist in ICD-11 or international neurology. International clinical guidelines (, , , ) do not mention either the combination or its components for cognitive impairment. In elderly patients, cinnarizine can cause parkinsonian symptoms: tremor, rigidity, slowed movement, which sometimes persist after the drug is stopped. For memory complaints or dizziness attributed to blood pressure, it is more useful to check blood pressure, hemoglobin, B12, thyroid function, and screen for depression. If Phezam was prescribed for memory improvement or dyscirculatory encephalopathy, consider seeking a second opinion.
Not recommended
-HNS 2014 and 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.
Sources
ICD-10: H93.1 · ICD-11: MC41
Not recommended
In Russian practice, Fezam and Omaron are popular for 'dizziness', but 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.
Sources
ICD-10: H81.9 · ICD-11: MB48.0
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Direct links to regulator labels. Open in a new tab.
Contraindicated in pregnancy.
Contraindicated during breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Piracetam + cinnarizine is evaluated for the following indications with varying evidence strength: Cognitive impairment (evidence tier F), Tinnitus (evidence tier F), Vertigo (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.
FDA category N. 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.