Piracetam oral formulations
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of piracetam.
Drugs List
Therapeutic Indications
Uses
Myoclonus of cortical origin
Treatment of adult patients with myoclonus of cortical origin, in conjunction with other anti-myoclonic therapies, regardless of aetiology.
Dosage
Adults
Initial dose: 7.2g daily in 2 to 3 partial doses.
Dose can be increased by 4.8g per day every 3 to 4 days, depending on patient response.
Maximum dose is 24g daily.
Patients with Renal Impairment
Creatinine clearance 50-80ml/min: Use two thirds of the usual daily dose, in 2 to 3 sub-doses.
Creatinine clearance 30-50ml/min: Use one third of the usual daily dose, in 2 to 3 sub-doses.
Creatinine clearance 20-30ml/min: Use one sixth of the usual daily dose administered once daily.
Creatinine clearance less than 20ml/min: Contraindicated.
Additional Dosage Information
Continue treatment with piracetam for as long as the original cerebral disease persists. In patients with an acute episode, spontaneous evolution can occur in time, so every 6 months an attempt to decrease or discontinue treatment should be made. This should be done by reducing the dose of piracetam by 1.2g every 2 days.
(In the case of a Lance and Adams syndrome this should be reduced to every 3 or 4 days to prevent the possibility of sudden relapse or withdrawal symptoms.)
Other anti-myoclonic drugs should remain unchanged at their optimal dosage.
An attempt can be made to subsequently reduce the dosage of the other anti-myoclonic drugs, based on the individual clinical benefit.
Contraindications
Children under 18 years
Breastfeeding
Huntington's chorea
Pregnancy
Recent cerebral haemorrhage
Renal impairment - creatinine clearance below 20ml/minute
Precautions and Warnings
Elderly
Major surgery
Predisposition to haemorrhage
Severe haemorrhage
Gastrointestinal ulcer
History of haemorrhagic cerebrovascular accident
Impaired haemostasis
Renal impairment - creatinine clearance 20-79ml/min
Sodium content of formulation may be significant
Advise ability to drive/operate machinery may be affected by side effects
Oral liquid contains hydroxybenzoate: caution in hypersensitivity
Oral solution contains glycerol
Monitor renal function in elderly patients
Review treatment every 6 months
Avoid abrupt withdrawal
Pregnancy and Lactation
Pregnancy
Piracetam is contraindicated in pregnancy.
The manufacturer recommends that piracetam must be avoided during pregnancy unless the benefit for the mother exceeds the risks.
According to the manufacturer, piracetam crosses the placenta, with newborn levels being 70% to 90% of maternal levels.
Animal studies have shown no increased risk of teratogenic effects. There is no adequate information on the use of piracetam in pregnant women to date.
Lactation
Piracetam is contraindicated during breastfeeding.
The manufacturer does not recommend breastfeeding while taking piracetam. A decision to discontinue piracetam therapy or breastfeeding should be made, taking into account the benefits to the child and impact on the parent.
Piracetam is present in breast milk, but at the time of writing no reports of its use in nursing mothers have been located.
Side Effects
Abdominal pain
Agitation
Anaphylactoid reaction
Angioedema
Anxiety
Asthenia
Ataxia
Bleeding disorders
Confusion
Depression
Dermatitis
Diarrhoea
Exacerbation of epilepsy
Haemorrhage
Hallucinations
Headache
Hyperkinesia
Hypersensitivity reactions
Insomnia
Loss of balance
Nausea
Nervousness
Pruritus
Skin reactions
Somnolence
Urticaria
Vertigo
Vomiting
Weight gain
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( https://www.toxbase.org/ ) or if this is unavailable at the backup site ( https://www.TOXBASEbackup.org/ ).
Further Information
Last Full Review Date: July 2022.
Reference Sources
Summary of Product Characteristics: Nootropil 800mg & 1200mg film-coated tablets. UCB Pharma Ltd. Revised May 2022.
Summary of Product Characteristics: Nootropil 33% oral solution. UCB Pharma Ltd. Revised May 2022.
The Renal Drug Handbook. Fifth Edition (2019) ed. Ashley, C. and Dunleavy, A. Radcliffe Publishing Ltd, London.
NICE Evidence Services
Available at: www.nice.org.uk
Last accessed: 20 July 2022.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.