Piracetam for use in amnestic condition s/p aspiration

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Anasazi23

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Anyone have much experience with this? I'm strongly considering having a patient with profound memory disturbance and global cognitive deficits (former engineering student) s/p aspiration and anoxia due to opiate overdose, started on this. A so-called nootropic. I've read only some of the literature, and it will take a while for me to assimilate it all. A couple of attendings have mentioned it as well.

Can start with wikipedia and work from there.
http://en.wikipedia.org/wiki/Piracetam
 
I don't have specific experience with this particular one but a number of prominent psychiatrists are now advocating the use of neuroprotection in the use of psychiatric disorders because of the long term neurodegeneration in those disorders.

Henry A. Nasrallah, M.D. (editor in chief of Current Psychiatry) wrote a good (though somewhat superficial) article on such agents. Jeff Lieberman, M.D. of Columbia wrote some excellent articles on neuroprotection.

I however haven't seen piracetam use, but this seems to follow several parallels with neuroprotection.

For this reason, I have often advised several of my own patients to use fish oil 1 g a day because of the possible links with neuroprotection. There's evidence it may also prevent dementia, though more studies are needed. (Actually Columbia is doing a big study on this from what I understand). I figure even if it didn't accomplish the goals the patient & I want, it wouldn't hurt them. It might even help out their other issues such as cholesterol.

I'm very intrigued with anything anyone can offer on this. I know little on this one.
 
I wonder if this drug could be used peri-ECT, or if the very least that would make a good research topic.

Also, I wonder if I can find this at GNC...
 
Probably, if not maybe Vitamin Shoppe.

Problem with places like that though is they sell a lot of stuff with only the manufacturer's or some other advertiser's data. Lots of herbal & alternative treatments though worthy of further research, or even treatment have a lot of people trying to push them on the consumer.
 
We had a very good grand rounds speaker that spoke to us this week on the topic of interesting and unusual presentations of dementia. During the question session I brought this up, since we were discussing treatment options. He basically said that this was a popular thing around 20 years ago, and that he saw no results from it. I spoke to another European attending who stated that she saw very robust results from it, and was puzzled as to why it wasn't more used here in the U.S. She explained that dosing must be aggressive to achieve a good response.

There are a good number of studies on pubmed and other places, where they claim to improve symptoms of TD, and even have performance improvement with dyslexic kids. It seems particulary good for hypoxic and hypometabolic conditions, however...if it would work at all.
 
Hey, Sazi

Disclaimer: I have never read any literature on Piracetam. All the following information is derived from personal experience and must be treated as such (ie, anectodal evidence🙂)

I come from a country where Piracetam use is very widespread. It is used for everything and anything, from head injury to epilepsy to "perinatal encephalopathy" (which, for the uninitiated, is the state of a baby who was born as a result of a prolonged labour, esp if s/he needed resus at birth, however minimal). My 4 yo niece was put on it as the doctor was concerned that she was "withdrawn" (she is not exactly a gregarious person, but I would not dream of treating her with anything, much less piracetam. Her social development is completely normal and appropriate for her age). When I was practising medicine in that country, I saw it being used in epileptics, in people who have suffered strokes, in the depressed, in those with head injury... I cannot comment how effective the treatment was, as EVERYONE was on it, so there was no comparison group as such. My attengings were never able to give me a good reason for its use (such as an RCT citation, for example), other than the fact that "they know it works". Needless to say, I was not very impressed with the reason. I also do not quite understand Piracetam's mechanism of action on cell/molecular level. I have never seen it used in the UK. I know docs in my country of origin and Eastern European countries in general are very much prone to polypharmacy, hand-waving, etc. My opinion: if there were good evidence that Piracetam works beyond placebo effect (and there should be by now, considering the drug is 30 year old), the UK medics (who are very much EBM-oriented) would have been using it. I am slightly embarrassed to say that I did not go out of my way to investigate whether there have been any good studies assessing Piracetam's efficacy in treatment of various conditions.

Sorry, this is not very helpful. As a side note: more than half of my class in medical school were taking piracetam for a good half year before the finals, "to improve memory". I have always been very careful about my brain, and as i did not understand its mechanism of action, I decided against taking any piracetam (I have a good thing going already, thank you - why risk screwing it up?). The result? I graduated at the top of my class. :idea:
 
Thanks for teh response, BPD. Indeed, the attending that had mentioned it to me was Russian-trained, and closely follows an eastern European model of psychiatry.

There are lots of studies out there, though I admit that I have not scrutinized them beyond perusing the abstracts. These so-called nootropics (others besides piracetam as well) have claimed to improve a wide variety of conditions, and as you mention, have been used in colleges and universities for brain boosts. Considering also the amount of supplements here in the U.S. which are at best, not harmful, I'm surprised there isn't more of it around.

This study in the Journal of Neurology suggests no significant difference in stroke outcome in an RCT, while the British Medical Journal showed the oxygenation provided a benefit in treating sickle cell crisis.

There are lots more. I'll keep reviewing.
 
I am not sure why Piracetam is not as widely used in the US as it is in other countries. It is one of the most commonly used drugs in neurology (and psychiatry) in countries like Russia and other countries of former Soviet Union. At least about 6 years ago, any patient who would complain on any memory problems or feeling dizzy would be started on Piracetam automatically. So, it was considered as being type of a "vitamin" that improved cerebram blood circulation.
I am not aware of any studies, though, done in these countries to show the efficacy of piracetam and other nootrops.
 
As I said, sorry for not being more helpful. It will be good to find out whether there is actually any evidence out there that would support use of Piracetam in neurology/psychiatry. Thanks for posting the links - I guess, eventually we will come up with the SDN consensus on nootrops! 🙂
 
I am not sure why Piracetam is not as widely used in the US as it is in other countries. It is one of the most commonly used drugs in neurology (and psychiatry) in countries like Russia and other countries of former Soviet Union. At least about 6 years ago, any patient who would complain on any memory problems or feeling dizzy would be started on Piracetam automatically.

I assure you, it is still the case, based on reports from friends and family back in the post-Soviet zone. I hope, people will understand my reluctance to use it and my kind of dismissive attitude if I tell you this: last month my Mother had Actovegin IV prescribed to treat her non-existent varicose veins (she has intervertebral disc prolapse, alright, but the doc she saw decided they should treat varicose veins first, and "if it does not work, then it is definitely the prolapse that causes the pain"). I mean, come on... First, he prescribes some sort of magic cocktail that I do not think even has any pharmaceutical value full-stop. (Well, other than a CJD vehicle, maybe...) Second, it is not even marketed for varicose veins. Third, she does not have varicosities.

And here is the link to the manufacturer's info on actovegin:
http://www.nycomed.com.cn/english/wmdcp/awz/biaoti.html
 
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