FCognitive impairment
Not recommended
Cognitive impairment
Not recommended
Piracetam + cinnarizine
Combination nootropic (local classification)
ATC code: N06BX-FEZAM(Fezam (piracetam + cinnarizine, combination local code))
Updated · Methodology
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
F
FMemory and concentration enhancement
Not recommended
Memory and concentration enhancement
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.
FTinnitus
Not recommended
Tinnitus
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
FVertigo
Not recommended
Vertigo
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
How to read tiers A–F
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit
Mechanism of action
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.
Safety
Contraindications
- Hypersensitivity to piracetam or cinnarizine
- Severe renal failure (CrCl < 20 mL/min)
- Severe hepatic impairment
- Haemorrhagic stroke
- Parkinson's disease and drug-induced parkinsonism
- Pregnancy and breastfeeding
- Age under 18 years
Serious adverse effects
- Drug-induced parkinsonism in the elderly (cinnarizine component)
- Increased bleeding tendency (piracetam)
- Lowered seizure threshold
Common adverse effects
- Drowsiness, fatigue
- Dyspepsia
- Dry mouth
- Weight gain
Pregnancy: can you take Piracetam + cinnarizine?
Contraindicated in pregnancy.
Breastfeeding: can you take Piracetam + cinnarizine?
Contraindicated during breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Practical notes
Russian practice note
Fezam and Omaron are a fixed-combination product very popular in Russian neurology and general practice. They are prescribed to people over 50 complaining of dizziness, tinnitus, and memory decline. In Western medicine such complaints trigger workup for specific conditions – BPPV, depression, sleep apnoea, Meniere's disease, migraine. A universal drug for an umbrella diagnosis delays real diagnostic work.
Safety concerns
In older patients, cinnarizine can cause drug-induced parkinsonism with prolonged use. This is a known adverse effect of D2-antagonist compounds (including cinnarizine). In patients with longstanding memory complaints who take Fezam or Omaron for years, the emergence of bradykinesia and tremor should prompt discontinuation and workup for drug-induced parkinsonism.
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Frequently asked
What is Piracetam + cinnarizine used for?
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.
What are the side effects of Piracetam + cinnarizine?
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.
Is Piracetam + cinnarizine safe during pregnancy?
Contraindicated in pregnancy.
Is Piracetam + cinnarizine compatible with breastfeeding?
Contraindicated during breastfeeding.
Who should not take Piracetam + cinnarizine?
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.
Official sources
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