Old «nootropics» (local classification)
ATC code: N06BX-PIRACETAM (Piracetam (old «nootropic»))
Brand names
Nootropil
Cyclic GABA derivative without GABAergic activity. The manufacturer claims nootropic, neuroprotective, and rheological effects — improved membrane fluidity, neuronal metabolism, and microcirculation. Claimed effects are not confirmed in large independent RCTs. Piracetam is not -approved in the US; in 2010 the FDA prohibited piracetam as a dietary supplement. In the UK, EU, and Canada, it is used in limited niche indications (myoclonus, cortical myoclonus). In Russia it is historically used for a wide range of conditions without an evidence base.
Not recommended
A 2001 Cochrane Review of piracetam in dementia and cognitive impairment reported a weak positive effect with high risk of bias and methodological problems. No independent update has been published since. International dementia guidelines ( NG97, 2018) do not include piracetam. The drug is not registered as a medicine in the United States; issued warnings to supplement manufacturers using piracetam in 2004 and 2010.
Not recommended
International ADHD guidelines ( 2019, NG87) list psychostimulants (methylphenidate, lisdexamfetamine), atomoxetine, and behavioural therapy as first-line. Piracetam is not in these documents. Russian paediatric practice sometimes prescribes it 'to improve concentration' – this contradicts the guidelines.
Not recommended
— Cognitive enhancement in healthy adults: Piracetam is promoted in biohacker communities as the 'original nootropic' for cognitive enhancement in healthy adults. In RCTs in healthy adults, piracetam has not shown clinically meaningful improvement in memory, concentration, or mental speed. issued warnings in 2004 and 2010 to supplement manufacturers using unregistered piracetam.
Not recommended
In children with developmental delay, ADHD, or dyslexia, piracetam is not mentioned in international pediatric guidelines. and ESCAP do not include piracetam in standards. Evidence-based approaches — early behavioral intervention, speech and special education therapy, and stimulant pharmacotherapy on strict indication for confirmed ADHD.
Not recommended
2019 and 2021 stroke guidelines do not mention piracetam in acute ischemic stroke. The 2012 Cochrane review (Ricci et al., 9 RCTs, over 3,000 patients) did not confirm any effect on mortality or functional recovery. Proven therapies — tPA thrombolysis within 4.5 hours and mechanical thrombectomy within 6–24 hours in selected patients.
Not recommended
Piracetam is not included in international stroke rehabilitation guidelines ( 2023, 2022). Recovery relies on early mobilisation, physical, occupational, and speech therapy, and cardiovascular risk management.
Not recommended
— Subjective age-related memory complaints without objective cognitive impairment: Piracetam use for memory complaints in elderly without diagnosed dementia is not supported by international guidelines. 2018 updated mild cognitive impairment guidelines do not mention piracetam. In confirmed Alzheimer disease — acetylcholinesterase inhibitors and memantine. — Chronic cerebral ischaemia / dyscirculatory encephalopathy: «Dyscirculatory encephalopathy» is absent from international neurology and ICD-11. Piracetam for cognitive impairment or chronic cerebrovascular disease is not mentioned in AAN, , or guidelines. Evidence-based management — vascular risk factor control, physical activity, cognitive training.
Use in pregnancy is not recommended due to limited data and absence of demonstrated benefit.
Contraindicated during breastfeeding per manufacturer label.
piracetam is evaluated for the following indications with varying evidence strength: Cognitive impairment (evidence tier D), ADHD (evidence tier F), Post-stroke recovery (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of piracetam (≥ 1 in 100): Insomnia, nervousness, Agitation, Nausea, Weight gain. See the Safety section for uncommon and serious reactions.
Use in pregnancy is not recommended due to limited data and absence of demonstrated benefit.
Contraindicated during breastfeeding per manufacturer label.
piracetam is contraindicated in: Severe renal impairment; Acute hemorrhagic stroke; Huntington chorea; Age under 1 year; Hypersensitivity. Full list in the Safety section.