Piracetam Investigational [ Comments ] [ Indications ] [ Product Information ] Indications: •ischemic stroke† •myoclonus† •sickle cell disease† Comments: Description: Piracetam is a cyclic derivative of gamma-amino butyrate. It is classified as a nootropic agent and has been studied in vascular and neurologic disorders. Piracetam-like nootropics were first identified in the mid-1960s. Actions: has been shown to improve learning and memory, however, the cognition-enhancing properties of piracetam-like nootropics have never been identified; the mechanism is postulated to be related to modulations in ion flux (e.g., potentiation of calcium influx through non-L-type calcium channels, potentiation of sodium influx, or decreases in potassium efflux); also possesses neuroprotective properties; has been reported to increase compromised regional cerebral blood flow in patients with acute ischemic stroke. Uses: has been studied in acute ischemic stroke, myclonus due to various etiologies, Down's syndrome, Alzheimer's disease, and in sickle cell disease. Distinguishing Features: in one study which initiated therapy within 12 hours of onset of acute ischemic stroke, benefit of piracetam was not demonstrated (De Deyn PP et al. Stroke 1997); these investigators are exploring whether initiation of therapy within 7 hours may be beneficial; elimination half-life is 4.3 hours. Major Adverse Reactions: unclear at this time; Usual Adult Dosage: unclear at this time; in one randomized clinical trial, patients received a 12 g IV bolus within 12 hours of the onset of an acute ischemic stroke, followed by 12 g/day for 4 weeks, then 4.8 g/day for 8 weeks (De Deyn PP et al. Stroke 1997); in the treatment of sickle cell disease, IV infusion was employed during acute crises, followed by oral therapy for up to 12 months. Status: this is not a new compound, however its status regarding licensure in the US is unclear at this time. Manufacturer: References: •clinical trial: Enderby P et al. Clin Neuropharmacol 1994;17:320—31. •clinical trial: El-Hazmi MA et al. Acta Haematol 1996;96:221—6. •clinical trial: De Deyn PP et al. Stroke 1997;28:2347—52. •pharmacokinetics: Saletu B et al. Int J Clin Pharmacol Ther 1995;33:249—62. •review: Van Vleymen B et al. Acta Neurol Belg 1996;96:270—80.