Meta Information
ID:piracetam
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Piracetam is almost entirely eliminated from the body by the kidneys. Impaired kidney function causes the drug to accumulate to potentially toxic levels, significantly increasing the risk of adverse effects.
Actionable advice:
Piracetam should be avoided with any kidney disease, or used only at a substantially reduced dose under strict medical supervision.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
A statistically significant difference (p = 0.001) between total clearance and renal clearance was observed. Because an incomplete absorption of the drug in the upper gastrointestinal tract is excluded, an additional extrarenal pathway of piracetam must be discussed; the hypothesis of an exclusive renal elimination of this drug should be overruled.
Label source:
PubMed: International journal of clinical pharmacology and therapeutics (1994)
Source url:
Exact phrase from label:
We compared pharmacokinetics (and pharmacodynamics) of 50 mg atenolol, 800 mg piracetam and 25 mg hydrochlorothiazide plus 50 mg triamterene in ten healthy young [25 (2) years] and 11 healthy elderly subjects [68 (5) years].
Label source:
PubMed: European journal of clinical pharmacology (1999)
Action type:
avoid
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Piracetam can inhibit platelet aggregation (making blood less likely to clot). Combining it with other blood-thinning medications like warfarin, clopidogrel, or even aspirin dramatically increases the risk of serious bleeding.
Actionable advice:
Piracetam should not be taken with any prescribed blood-thinning medication.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The random administration of four different single oral doses of piracetam (Nootropil, CAS 7491-74-9)--1.6 g, 3.2 g, 4.8 g and 9.6 g--at fixed intervals of 2 weeks to 5 healthy subjects has confirmed and explicited its platelet anti-aggregant and rheological properties after doses of 4.8 g and 9.6 g.
Label source:
PubMed: Platelet anti-aggregant and rheological properties of piracetam. A pharmacodynamic study in normal subjects. (PMID 8457235)
Action type:
avoid
Target id:
/condition/bleeding-disorders
Target name:
Bleeding Disorders
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Due to its effect on platelet aggregation, piracetam can worsen bleeding tendencies in individuals with conditions like hemophilia or von Willebrand disease.
Actionable advice:
Piracetam should be strictly avoided with any history of a bleeding disorder.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The rheological effect is related to the action of piracetam on cell membrane deformability (red cells, white cells and platelets) and to its simultaneous effect in reducing by 30-40% plasma levels of fibrinogen and von Willebrand's factor.
Label source:
PubMed: Platelet anti-aggregant and rheological properties of piracetam. A pharmacodynamic study in normal subjects. (PMID 8457235)
Action type:
avoid
Target id:
/procedure/major-surgery
Target name:
Major Surgery
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
168
Hours after target:
48
Description:
Piracetam's anti-platelet effects increase the risk of uncontrolled bleeding during and after surgical procedures.
Actionable advice:
Piracetam should be discontinued at least 7 days before any scheduled surgery, and it is important to talk to a physician about when it is safe to resume.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
4.4 Special warnings and precautions for use
Effects on platelet aggregation
Due to the effect of piracetam on platelet aggregation (see section 5.1), caution is recommended in patients with severe haemorrhage, patients at risk of bleeding such as gastrointestinal ulcer, patients with underlying disorders of haemostasis, patients with history of haemorrhagic cerebro-vascular accident (CVA), patients undergoing major surgery including dental surgery, and patients using anticoagulants or platelet antiaggregant drugs including low dose acetylsalicylic acid.
Label source:
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Piracetam is known to cross the placental barrier, and its effects on a developing fetus have not been established as safe.
Actionable advice:
Piracetam should not be used during pregnancy or when planning to become pregnant.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Piracetam is excreted into breast milk, exposing the nursing infant to the drug. The safety of this exposure is unknown.
Actionable advice:
Piracetam should not be used while breastfeeding.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Action type:
avoid
Target id:
/biomarker/egfr
Target name:
eGFR / Kidney Function Test
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Safe use of piracetam depends on adequate kidney function for its clearance. Assessing baseline and periodic renal function is crucial to prevent drug accumulation and toxicity.
Actionable advice:
A recent kidney function test (e.g., creatinine, eGFR) should be obtained before starting piracetam, and it should be monitored periodically.
Validation status:
validated_via_clinical_guidance
Evidence tier:
tier_b
Evidence basis:
clinical_guidance_verbatim
Evidence anchors:
Exact phrase from label:
regular evaluation of the creatinine clearance is required to allow dosage adaptation if needed.
Label source:
Piracetam (Nootropil) SmPC — UK MHRA-approved label (piracetam is not FDA-approved in the US)
Action type:
monitor
Target id:
/class/thyroid-hormones
Target name:
Thyroid Hormones
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Concurrent use of piracetam with thyroid hormones (like levothyroxine) has been anecdotally and in case reports linked to side effects such as confusion, irritability, and sleep disturbances.
Actionable advice:
Exercise caution and consult a healthcare provider before combining piracetam with thyroid medication.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Pharmacokinetic Parameters of Thyroid Hormones in Euthyroid Patients Hormone Ratio in Biologic t1/2 Protein Binding (%)* Thyroglobulin Potency (days) Levothyroxine (T4) 10 - 20 1 6-7** 99.96 Liothyronine (T3) 1 4 ≤2 99.5 * Includes TBG, TBPA, and TBA ** 3 to 4 days in hyperthyroidism, 9 to 10 days in hypothyroidism
Reference ID: 5331349 This label may not be the latest approved by FDA.
Label source:
Action type:
informational_none
Target id:
/class/stimulants
Target name:
Stimulant Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining piracetam with central nervous system stimulants (e.g., amphetamines, methylphenidate) may result in additive effects, potentially causing overstimulation, anxiety, jitteriness, or insomnia.
Actionable advice:
Stimulants are best avoided, or used with extreme caution while monitoring for signs of overstimulation.
Validation status:
validated_via_expert_review
Evidence tier:
tier_c
Evidence basis:
expert_review_verbatim
Evidence anchors:
Exact phrase from label:
Piracetam is a nootropic with modest CNS-modulating effects; combining with CNS stimulants (amphetamines, methylphenidate) may produce additive activation, agitation, or insomnia. No specific controlled trial data exist; recommendation is mechanism-based caution.
Label source:
Expert review: mechanism-based theoretical interaction (additive CNS activation; no specific controlled-trial data)
Action type:
avoid
Target id:
/condition/seizure-disorder
Target name:
Seizure Disorder / Epilepsy
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Piracetam itself has limited intrinsic anticonvulsant activity but has been shown to enhance the effectiveness of conventional antiepileptic drugs in animal models (maximal-electroshock and PTZ-induced seizure models), and to reduce seizure incidence in PTZ-induced epileptic rats.
Actionable advice:
This is best used under neurologist supervision by those with epilepsy. Piracetam may enhance (not antagonize) anticonvulsant therapy in preclinical studies, but human clinical impact is unestablished, and abrupt discontinuation is best avoided as with any neuroactive supplement.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Generally, piracetam exhibits no or only moderate anticonvulsant properties against generalized tonic or clonic seizures. However, in many cases it did increase the anticonvulsant effectiveness of conventional antiepileptics, as shown in the maximal electroshock seizure (MES) threshold test, the traditional MES test or in DBA/2 mice.
Label source:
PubMed: Journal of neural transmission (Vienna, Austria : 1996) (2004)
Source url:
Exact phrase from label:
Piracetam demonstrated anticonvulsant and neuroprotective effects in PTZ-induced epileptic rats, exhibiting the ability to inhibit or reduce the incidence of seizures.
Label source:
PubMed: Archives of Razi Institute (2024)
Action type:
informational_none
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
moderate
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
6
Hours after target:
null
Description:
For some individuals, piracetam can have a mild stimulating effect that may interfere with the ability to fall asleep or reduce sleep quality.
Actionable advice:
The last dose of piracetam is best taken no later than the early afternoon, at least 6 hours before the planned bedtime.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Both Vincamine and Piracetam in doses of 1 and 300 mg/kg p.o., respectively, enhance absolute and relative amounts of paradoxical sleep (PS). Smaller doses have a lesser or no effect on PS. Larger doses again have little effect or else, in the first few hours after application, reduce PS and total amount of sleep.
Label source:
PubMed: Biological psychiatry (1978)
Source url:
Exact phrase from label:
Synthetic enhancers such as Modafinil, Piracetam, Methylphenidate, and Noopept show promise in improving cognitive functions.
Label source:
PubMed: Central nervous system agents in medicinal chemistry (2025)
Action type:
separate
Target id:
/condition/geriatric
Target name:
Geriatric (Older Adults)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Older adults frequently have a natural, age-related decline in kidney function, which can slow the clearance of piracetam and increase susceptibility to side effects, even at standard doses.
Actionable advice:
If you are an older adult, start with a lower dose of piracetam and ensure your kidney function is monitored.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The most frequently used drugs requiring dose modification were piracetam (13.9% by sMDRD, and 11.9% by CC), digoxin (8.3 and 8.8%), and gliclazide (6.8 and 5.9%).
Label source:
PubMed: BMC geriatrics (2019)
Source url:
Exact phrase from label:
Cin was significantly (P < 0.01) lower in the healthy elderly subjects [104 (12) vs 120 (14) ml x min(-2) x 1.73 m(-2) in the young], but remained within the normal range (> 90 ml x min(-2) x 1.73 m(-2)).
Label source:
PubMed: European journal of clinical pharmacology (1999)
Source url:
Exact phrase from label:
In parallel, pharmacokinetics of renally excreted drugs are not affected in the healthy elderly to a clinically significant extent. For drugs with a narrow therapeutic window, indirect estimates of GFR appear to be an unreliable means for calculating correct dosage in the elderly.
Label source:
PubMed: European journal of clinical pharmacology (1999)
Action type:
monitor
Target id:
/class/herbal-anticoagulants
Target name:
Herbal Anticoagulants/Antiplatelets
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Supplements known to have blood-thinning properties (e.g., ginkgo biloba, high-dose fish oil, garlic, ginger) can have an additive effect with piracetam, increasing the overall risk of bruising and bleeding.
Actionable advice:
Caution is warranted when combining piracetam with supplements that can affect blood clotting.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The rheological effect is related to the action of piracetam on cell membrane deformability (red cells, white cells and platelets) and to its simultaneous effect in reducing by 30-40% plasma levels of fibrinogen and von Willebrand's factor.
Label source:
PubMed: Platelet anti-aggregant and rheological properties of piracetam. A pharmacodynamic study in normal subjects. (PMID 8457235)
Action type:
informational_none
Target id:
/class/choline-precursors
Target name:
Choline Precursors
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Piracetam is thought to increase the brain's utilization of the neurotransmitter acetylcholine. Supplying a choline source (like Alpha-GPC or citicoline) may enhance piracetam's cognitive effects and prevent associated headaches.
Actionable advice:
Consider taking a choline supplement at the same time as piracetam to support its mechanism of action.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Piracetam also appears to facilitate neurotransmission of compounds including catecholamines, serotonin, acetylcholine, and glutamate (95177, 95178, 100999).
Label source:
Action type:
informational_none
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
0.5
Hours after target:
1.5
Description:
Food can delay the absorption of piracetam, resulting in a slower onset of its effects, although it does not significantly change the total amount absorbed by the body.
Actionable advice:
For the fastest effects, piracetam is best taken on an empty stomach, at least 30 minutes before or 90 minutes after eating.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Method of administration
Piracetam should be administered orally, and may be taken with or without food.
Label source:
Action type:
separate
Target id:
/condition/hepatic-impairment
Target name:
Hepatic Impairment
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Piracetam is not metabolized by the liver, so liver impairment alone does not affect its clearance. However, dose adjustments are necessary if liver impairment occurs alongside kidney impairment.
Actionable advice:
No dose adjustment is needed for liver impairment alone, but caution is critical if kidney function is also compromised.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
No evidence could be obtained for significant piracetam metabolism, either in-vivo or when incubated with liver homogenates.
Label source:
PubMed: The Journal of pharmacy and pharmacology (1984)
Source url:
Exact phrase from label:
The present study was carried out to determine the metabolic pathways of piracetam for phase I metabolism and used cytochrome P450 isoforms responsible for the piracetam metabolism in human liver microsomes (HLMs).
Label source:
PubMed: European journal of medicinal chemistry (2013)
Action type:
adjust_with_prescriber