Piracetam

The foundational nootropic with the largest racetam evidence base. Benefits are modest and most reliable in elderly or impaired populations. Healthy young adults may notice little.

A rough internal score reflecting quantity, quality, and consistency of human evidence. Not a clinical recommendation.

A Cochrane review of 24 trials in dementia found some evidence of global cognitive improvement but recommended more research. Best-supported use is for cortical myoclonus (high-dose). Mechanism involves AMPA receptor modulation, enhanced membrane fluidity, and improved cerebral microcirculation.

• Largest evidence base of any racetam
• Approved for cortical myoclonus in Europe
• May improve cognitive function in age-related decline
• Enhances interhemispheric communication

Cognitive use: 2400–4800 mg/day in 2–3 divided doses. Myoclonus: up to 20g/day under medical supervision.

• Headache (common, often from choline depletion)
• Insomnia
• GI discomfort
• Weight gain (rare)

Prescription-only in many European countries. May worsen agitation in dementia with Lewy bodies. Theoretically increases bleeding risk.

Effect sizes in healthy adults are small to negligible. Works best in populations with some degree of cognitive impairment.

• Memory45
• Focus40
• Mood25