Piracetam

General characteristics. Structure:

Active ingredient: 200 mg of piracetam.

Excipients: sodium acetate, acetic acid divorced - to рН 5,8, water for injections.

Drug improves an integrative deyayotelnost of a brain, promotes memory improvement, facilitates training process.

Pharmacological properties:

Pharmacodynamics. Piracetam is nootropic means, exerts positive impact on exchange processes of a brain, increases concentration of ATP in brain fabric, strengthens biosynthesis of RNA and phospholipids, stimulates glycoclastic processes, strengthens glucose utilization.

Improves the course of metabolic processes, without having at the same time vasodilating effect, suppresses aggregation of thrombocytes. Drug improves bonds between cerebral hemispheres and a synoptic provodiyomost in neocortical structures, recovers and stabilizes cerebral functions, especially consciousness, memory and the speech, increases intellectual working capacity, improves a brain blood stream. Piracetam inhibits an agyoregation of thrombocytes and recovers elasticity of a membrane of erythrocytes, reduces adhesion of erythrocytes. In a dose of 9.6 g reduces the level of fibrinogen and Villibrand's factors, for 30%-40% and extends a bleeding time. The alpha - and a beta - activity strengthens, the delta - activity on electroencephalograms reduces, reduces a vyrayozhennost of a vestibular nystagmus.

Piracetam has the tire-tread and recovering effect at dysfunction of a brain vsledyostvy hypoxias and intoxications. The effect develops gradually.

Pharmacokinetics. Bioavailability, irrespective of a dosage form, makes about 95%. Tsmakh is 0.5-1 h. Easily gets through gistogematichesky barriers, including a blood-brain barrier. Collects in a spinal zhidyokost (Smakh is defined by 2-8 h), breast milk. Out of SMZh it is brought much more slowly, than out of other fabrics. Practically it is not metabolized. Т½ - 4.5 h (7.7 h - from a brain). During 24 - 30 h it is completely removed (in an invariable look) by kidneys.

Indications to use:

Neurology: chronic cerebrovascular insufficiency (disturbance of memory, attention, the speech, a golovokruyozheniye, a headache), the residual phenomena of disturbances of cerebral circulation (on ischemic type); komayotozny states (including after injuries and intoxications of a brain); reconvalescence (for increase in dvigayotelny and mental activity); the diseases of a nervous system which are followed by decrease intellectual мнестических functions and disturbances of the emotional and strong-willed sphere (including Alzheimer's disease).

Psychiatry: a neurotic syndrome, an astheno-depressive syndrome (various genesis, with dominance in a kliyonichesky picture of an adynamia, asthenic and senesto-hypochiondrial disturbances, ideatorny block); vyaloapatichesky defective states (schizophrenia, psychoorganic syndrome); in complex therapy: the psikhiyochesky diseases proceeding on "integrally defective soil"; depressions, resistant to antidepressants; bad portability of antipsychotic means (neuroleptics), for elimination or a preyodotvrashcheniye of the somatovegetativny, neurologic and mental complications caused by them.

Narcology: abstinence alcoholic syndrome, pre-and delirious states, abstinent morphine sindyory, acute poisoning with ethanol, morphine, barbiturates, psychoses and astheno-depressive states (komplekyosny therapy). Drepanocytic anemia (as a part of a combination therapy).

In pediatric practice: if necessary to accelerate process of training and to liquidate effects of the periyonatalny injuries of a brain caused by pre-natal infections, a hypoxia, a birth trauma at an oliyogofreniya, a delay of intellectual development.

Route of administration and doses:

Intravenously, intramusculary. Parenterally - in/in, in an initial dose of 10 g; at serious conditions - in/in kapelno, within 20-30 min. - to 12 g/days; after improvement the dose is gradually reduced and passed to oral administration. At long therapy of a psychoorganic syndrome at elderly - on 4,8 g/days (24 ml), within several days with the subsequent reduction to a maintenance dose - 1.2-2.4g/days (6-12 ml) within several weeks.

At a cortical myoclonia treatment is begun at the beginning of 4,8 g/days (24 ml of solution for infection), further, in case of need the dose can be increased by 4,8 g/days (24 ml of solution for infection) in 3-4 days - before achievement maksimalyyony - 20 g/days (6 ampoules on 15 ml and 2 ampoules on 5 ml). At a sickemia a daily dose - 160 mg/kg, in 4 receptions. During crisis - to 300 mg/kg.

At alcoholism - 12 g/days in the period of manifestation of a syndrome of "cancellation" of ethanol; a maintenance dose - 2.4 g, a course of treatment of 2-3 weeks.

At treatment of comas, in the posttraumatic period an initial dose - 9-12 g/days, podderzhivayoyushchy - 2.4 g, a course of treatment - 3 weeks. Children are 1-5 years old - 1 g/days, 5-16 years - 2 g/days. It is necessary to continue treatment not less than 3 weeks. Duration of therapy is defined individually.

At a chronic renal failure with clearance of creatinine of 50-79 ml/min. appoint 2/3 usual doses in 2-3 receptions, with KK of 30-49 ml/min. - 1/3 doses in 2 receptions, less than 30 ml/min. - 1/6 usual doses, once.

Features of use:

Constant control behind indicators of function of kidneys (especially at patients with chronic pochechyony insufficiency) - residual nitrogen and creatinine is recommended, and patients with diseases of a liver have a functional sosyotoyaniye of a liver.

Treatment by piracetam if necessary can be combined using psychoactive, cordial сосудис­тых, etc. medicines.

At treatment of acute damages of a brain appoint in a complex with other methods of disintoxication and recovery therapy, and at treatment of psychiatric diseases - with the appropriate psychotropic medicines.

At treatment of patients with a cortical myoclonia it is necessary to avoid sharp drug withdrawal (risk of resuming of attacks).

Gets through the filtering membranes of devices for a hemodialysis.

During treatment it is necessary to abstain from driving of motor transport and occupations potentially dangerous types of activity demanding the increased concentration of attention and speed of psychomotor reactions.

Side effects:

Hyperphrenia, motive disinhibition, irritability, disbalance, decline in the ability to concentration of attention, uneasiness, sleep disorders, a gastralgia, nausea, vomiting, locks or диа­рея, a loss of appetite, dizziness, a headache, extrapyramidal disturbances, spasms, a tremor, povysheyony sexual activity, deterioration in a course of stenocardia. Side effects are most often noted at doses higher than 5 g/days.

Interaction with other medicines:

Increases efficiency of hormones of a thyroid gland, antipsychotic medicines (neyrolepyotik), indirect anticoagulants (against the background of high doses of piracetam), psychostimulants.

At appointment from neyroyoleptika reduces danger of emergence of extrapyramidal disturbances.

Contraindications:

Hypersensitivity, heavy renal failure (KK less than 20 ml/min.), hemorrhagic stroke. Detyosky age (till 1 year), pregnancy, feeding by a breast.

With care. Disturbance of a hemostasis, extensive surgical interventions, heavy bleeding.

Storage conditions:

In the dry, protected from light place at a temperature not above 25 °C. In the place, unavailable to children, the Period of validity of 5 years. Not to use after the expiry date specified on packaging.

Issue conditions:

According to the recipe

Packaging:

Solution for intravenous and intramuscular administration. 5 ml in ampoules of neutral glass. 5 ampoules in a blister strip packaging from a PVC film. 2 planimetric packagings place in a pack from a cardboard. 10 ampoules place in a pack from a cardboard with partitions or lattices, or a separator from a cardboard or paper bag. 10 ampoules place in a box from a cardboard. Put the application instruction and a knife in each pack or a box ampoule or the scarificator ampoule. When using ampoules with notches, rings of a break or points of a break the knife ampoule or the scarificator ampulyyony is not put.