„Cognitive Enhancement' or non-evidence-based nootropic abuse? – Use of Piracetam in Hungary

Piracetam has been available on the market since 1971. Its primary indication is the age-related memory decline. The objective of this review is to highlight the controversies surrounding in the use of piracetam. Piracetam modulates membrane fluidity, which is decreased in the elderly, and this explains its effects on the vascular and nervous system. The scientific literature on piracetam is extensive; nevertheless, Cochrane systematic reviews raised serios concerns about the efficacy of this pharmacon in the treatment of dementia, cognitive decline, aphasia in post-stroke, and the prophylaxis of vasoocclusive sickle cell disease crises. However, in the treatment of acute vertigo and cortical myoclonus, its efficacy appears to be supported by several studies. The indications for drugs containing piracetam in Hungary are diverse. Furthermore, in the SPC, memory deterioration is mentioned as an indicator; nevertheless, the package leaflet emphasizes the improvement of brain functions (e.g. learning). Despite these facts, the use of piracetam in Hungary is still significant, approximately 10,000 inhabitants used this active substance every day in 2022, in the defined daily dose (DDD – 2400 mg). Based on European medicine databases, the availability, indications and daily dose of piracetam in cognitive decline vary by country to country in Europe. In the United States, no piracetam-containing drugs have been approved, and the FDA did not support the use of piracetam in food supplements. Dementia and cognitive decline are more prevalent in elderly; nonetheless, international and Hungarian guidelines do not support the use of piracetam in dementia or cognitive decline indications, nor do lists and screening tools (PIM lists). In Hungary, piracetam is commonly used to treat dementia and cognitive decline; however, its efficacy is questioned due to a lack of data. As a result, the use of this pharmacon in this indication lacks evidence-based support.