Piracetam

Piracetam is a cyclic derivative of GABA. It is the first member of the pyrrolidone family, a class that later produced the antiepileptic levetiracetam [1]. What originally set the class apart was cognitive activity without the sedation, analgesia or behavioural changes of other psychoactive drug classes [1].

Its licensed uses are cognitive disorders and dementia, vertigo, cortical myoclonus, dyslexia and sickle cell anaemia [2]. In the nootropics community it is usually the first racetam people try, and it is often combined with a choline source such as Citicoline or alpha-GPC.

How piracetam works has never been pinned down. The review literature says the mechanism is not fully established, and that different pyrrolidones may act in different ways [1]. The leading explanation is restoration of cell membrane fluidity. From that, downstream effects on cholinergic and glutamatergic transmission, neuroplasticity and neuroprotection would follow [2].

It also has vascular effects that are unusual for a cognitive drug. It reduces red blood cell adhesion to the vessel wall, hinders vasospasm and improves microcirculation. Those effects underlie some of its non-cognitive licensed uses [2].

Piracetam is well tolerated, even at the high doses sometimes needed clinically [2]. The class was defined in part by what it lacked: sedation, analgesia and motor or behavioural effects [1].

In healthy people the bigger question is efficacy rather than safety. Reviews of "smart drug" use conclude that benefits in unimpaired brains are uncertain and at most temporary [5].