Piracetam

How it works

Its mechanism is not fully established; it is thought to modulate neuronal membrane fluidity and neurotransmission and to influence cortical excitability, but the precise mode of action is uncertain.

Prescribing in practice

• It is mainly renally excreted, so the dose must be reduced in renal impairment and it should be avoided in severe renal failure.
• Avoid abrupt withdrawal in myoclonus, as this may precipitate seizures or a rebound in myoclonic jerks.
• It is usually added to existing antimyoclonic therapy rather than used alone, and is taken in divided doses through the day.

Monitoring

Monitor renal function and seizure or myoclonus control, and review for adverse effects such as weight gain, nervousness or hyperkinesia.

Counselling the patient

• Do not stop this medicine suddenly, as your myoclonus could worsen.
• Report any unusual restlessness, agitation, or significant weight change to your team.

Evidence & guidelines

Its use in cortical myoclonus is supported by clinical trial and long-standing practice as an add-on agent, as reflected in current prescribing references.