Which nootropic drug is better than piracetam. Latest generation nootropics of good quality: list, price

Side effects of nootropics

S. Yu. Shtrygol, Dr. med. Sciences, Professor, T. V. Kortunova, Ph.D. pharm. Sciences, Associate Professor, D. V. Shtrygol, Ph.D. honey. Sciences, National Pharmaceutical University, Kharkov

The last 30 years have been marked by an increasingly widespread use of nootropic drugs. The term “nootropic drug” (from the Greek noos thinking, mind; tropos aspiration) was proposed in 1972 by S. Giurgea to designate drugs that have a specific activating effect on the integrative functions of the brain, stimulating learning, memory and mental activities that increase the brain’s resistance to damaging factors and improve cortico-subcortical connections. Nootropics are also called neurometabolic cerebroprotectors, and in the English literature the term cognitive enhancer is often used.

The prototype of this group is piracetam, synthesized by Strubbe (pharmaceutical company UCB, Belgium) in 1963 and initially studied as an antikinetic drug. Only a few years later it became clear that piracetam facilitates learning processes and improves memory, but, unlike classical psychostimulants, does not cause side effects such as speech and motor stimulation, depletion of the body's functional capabilities with long-term use, addiction and addiction. Based on these studies, S. Giurgea identified a new class of drugs – nootropics – in the classification of psychotropic drugs.

The nootropic concept has become the largest contribution to the development of psychopharmacology, both in applied and fundamental terms. In a short period of time, a significant number of drugs were created, which are used primarily to correct impaired mnestic functions, as well as to reduce the level of vital activity that occurs with many diseases and extreme exposures. Nootropics are also indicated for disorders of adaptation and mental activity during aging, including presenile and senile dementia. As M. Windish emphasizes, dementia occupies a special place in the list of indications, since in industrialized countries an increasingly important problem is the rapid increase in the elderly part of the population and the increase in the incidence of diseases associated with age.

In addition, nootropics are used for cerebrovascular disorders, intoxication (including alcohol), withdrawal syndrome, sleep deprivation, fatigue, asthenic and depressive states after traumatic brain injury and neuroinfections, as well as for the correction of side effects of psychopharmacotherapy (in treatment with antipsychotics, antidepressants, psychostimulants). In pediatric practice, nootropic drugs are used to treat cerebrastia, encephalopathy, intellectual disability, disorders that develop in premature infants as a result of intrauterine hypoxia and other damaging effects.

A special feature of nootropics is that they can be used not only by sick people, but also by healthy people in extreme situations to relieve mental fatigue and improve mental performance.

In general, nootropic drugs are characterized by relatively low toxicity and relatively infrequent development of undesirable effects. According to O. A. Gromova, the latter are observed in a little more than 5% of patients, but the widespread use of these drugs requires systematization of knowledge of their side effects. However, first it is necessary to dwell on the issues of classification of nootropic drugs.

Nootropics include numerous drugs with different chemical structures and mechanisms of action. This circumstance alone makes their classification difficult. In addition, for a number of drugs, memory improvement is the leading pharmacological effect (they are sometimes referred to as "true" nootropics, such as piracetam and its analogues). For most drugs, the nootropic effect is only one of the components of pharmacodynamics. Thus, many GABAergic drugs, along with nootropic drugs, have anxiolytic, sedative, anticonvulsant, muscle relaxant, antihypoxic effects (even terms such as “nootropic-like drug”, “tranquilonotropic” etc.). The nootropic effect may be associated with improved cerebral circulation (vinpocetine, nicergoline and other cerebrovasoactive drugs). Such polyvalent drugs are sometimes referred to as "neuroprotectors".

The most complete classification of drugs with nootropic activity (about 100 drugs) is given by T. A. Voronina and S. B. Seredenin (1998). Their main groups are presented in the table.

Table. Basic drugs with nootropic effects

Pyrrolidone derivatives

Let's begin our consideration of the side effects of nootropic drugs with the historically first group - pyrrolidone derivatives, or racetams. Today, more than 1,500 substances of a similar structure have been obtained, but only about 12 drugs are used in medical practice. The multicomponent mechanism of their action includes not only activation of energy metabolism, increased synthesis of RNA, protein, phospholipids, facilitation of cholinergic transmission, but also improvement of blood circulation in the brain.

The main and most frequently used representative of this group is piracetam. Its side effects are observed rarely and mainly in mentally ill people. Such effects include dizziness, tremors, nervousness, and increased irritability. Possible sleep disturbances: mainly insomnia, less often drowsiness. Due to the risk of sleep disturbances, piracetam should not be taken at night. In isolated cases, sexual arousal is noted when using piracetam. Sometimes dyspeptic symptoms occur: nausea, vomiting, diarrhea, abdominal pain. In elderly patients, exacerbation of coronary insufficiency is occasionally possible. In such cases, it is recommended to reduce the dose or stop taking the drug.

Piracetam is contraindicated in acute renal failure, pregnancy (especially in the first trimester), breastfeeding (stop treatment during treatment), and in infancy (up to 1 year). According to data summarized by A.P. Kiryushchenkov and M.L. Tarakhovsky, G.V. Kovalev, the effect of piracetam and many other nootropic drugs on the fetus has not been sufficiently studied, although experimental data indicate the absence of embryotoxicity and teratogenicity. Obviously, in-depth studies are needed, including elucidation of the possible long-term effects of long-term effects of piracetam on the fetus. At the same time, there are indications of the positive effect of high doses of piracetam (up to 3-10 g) for distress syndrome in newborns (the drug was administered intravenously to women in labor).

Relative contraindications associated with the side effects of piracetam are states of psychomotor agitation (manic, hebephrenic, catatonic, hallucinatory-paranoid, psychopathic). Particular caution is required when deciding whether to prescribe piracetam to patients with increased convulsive readiness, as well as in severe diseases of the cardiovascular system with severe arterial hypotension. There are indications that it is inappropriate to prescribe the drug to children suffering from diabetes mellitus if there is a history of allergic reactions to the consumption of fruit juices, essences, etc. When treating with piracetam granules, it is recommended to exclude sweets from the diet.

Drugs that enhance cholinergic processes

Currently, this group of nootropics is developing most rapidly, since it is with it that progress in the treatment of Alzheimer's disease is associated. The use of classical drugs of the pyrrolidone series for this disease usually brings only a temporary effect, which can be followed by a rapidly progressive decline in memory and intelligence. Since the mechanisms of mnestic disorders in Alzheimer's disease are associated mainly with a deficiency of cholinergic transmission in the brain, the use of drugs that enhance it brings the greatest positive effect. The leading place today is occupied by anticholinesterase drugs, namely amiridine and tacrine. They promote the accumulation of acetylcholine due to the inhibition of the enzyme cholinesterase that destroys it.

Amiridine has not only central, but also peripheral choline-positive effects. Therefore, its relatively infrequent side effects include hypersalivation, nausea, vomiting, increased peristalsis, diarrhea, and bradycardia. In addition, the drug may cause dizziness.

Amiridine is contraindicated in case of patient hypersensitivity, as well as in diseases where increased cholinergic transmission is associated with a risk of worsening the condition: epilepsy, extrapyramidal and vestibular disorders, angina pectoris, bradycardia, peptic ulcer. In addition, amiridine should not be prescribed during pregnancy and breastfeeding.

Tacrine has more known side effects. The frequency is dominated by ataxia (discoordination of movements, instability), anorexia (loss of appetite), cramping abdominal pain, diarrhea, nausea, vomiting, as well as hepatotoxic effects. Less common are side effects from the cardiovascular system (bradycardia or tachycardia, heart rhythm disturbances, arterial hyper- or hypotension), hypersalivation, rhinitis, sweating, skin rash, swelling of the feet and ankles, fainting. In isolated cases, bronchial obstruction (difficulty breathing, a feeling of constriction in the chest, cough), changes in mood and psyche (aggression, irritability), extrapyramidal disorders (stiffness and trembling of the limbs), and urinary tract obstruction (difficulty urinating) are noted.

The list of contraindications to the use of tacrine is quite long. Along with hypersensitivity to this drug or other acridine derivatives, it includes bronchial asthma, arterial hypotension, bradycardia, sick sinus syndrome, epilepsy, head injuries with loss of consciousness, increased intracranial pressure (in this case, the development of convulsive syndrome is facilitated), gastrointestinal obstruction. intestinal or urinary tract, liver dysfunction (even in history), Parkinson's disease and symptomatic parkinsonism, gastric and duodenal ulcers.

Antagonists of anticholinesterase drugs are m-anticholinergic blockers. However, the use of the latter to correct side effects cannot be considered justified, since blockade of cholinergic receptors in the brain aggravates mnestic disturbances in Alzheimer's disease. It is advisable to select doses of anticholinesterase drugs that are well tolerated by patients.

Another approach to enhancing cholinergic transmission is associated with increasing the synthesis of the neurotransmitter acetylcholine. This mechanism of action has gliatilin (choline alfoscerate). In the body it is broken down into choline and glycerophosphate. Choline is used for the synthesis of acetylcholine, and glycerophosphate for the synthesis of phosphatidylcholine in neuronal membranes. Unlike anticholinesterase drugs, gliatilin is almost free of side effects. May cause nausea, apparently associated with activation of dopaminergic transmission and, if necessary, eliminated by antiemetic drugs (metoclopramide, etc.). Allergic reactions to gliatilin are extremely rare. It is contraindicated in case of individual hypersensitivity; it is not recommended for use during pregnancy and lactation.

GABAergic drugs

The mechanisms of the nootropic effect exerted by GABAergic substances are associated both with an increase in energy processes in the brain (activation of Krebs cycle enzymes, increased glucose utilization by brain cells) and with an improvement in cerebral blood flow and its autoregulation. The GABAergic component is also inherent in the mechanism of action of piracetam, which can be considered as a cyclic analogue of GABA.

Gamma-aminobutyric acid (aminalone, gammalon) usually well tolerated. Only sometimes side effects such as a feeling of heat, insomnia, nausea, vomiting, dyspeptic disorders, fluctuations in blood pressure (in the first days of treatment, associated with the vasoactive properties of GABA), and increased body temperature are possible. When the dose is reduced, these effects usually disappear quickly. This drug is contraindicated in case of hypersensitivity to it.

Using pantogam (hopantenic acid) allergic reactions are possible (rhinitis, conjunctivitis, skin rash), which disappear with discontinuation of the drug. Pantogam is contraindicated in severe acute kidney disease, as well as in the first trimester of pregnancy.

When prescribing picamilon, which predominantly intensifies the GABA metabolic shunt, irritability, agitation, anxiety, dizziness, headache, and mild nausea are possible. In these cases, you need to reduce the dose. Occasionally, an allergic rash and itching of the skin occur, requiring discontinuation of the drug. Contraindications, along with individual intolerance, are acute and chronic kidney diseases.

Phenibut, due to the enhancement of inhibitory GABAergic processes, can cause such a side effect as drowsiness during the first doses. Allergic reactions are sometimes observed. Contraindicated in case of individual intolerance, liver failure.

Sodium hydroxybutyrate, combining nootropic, antihypoxic, hypothermic, sedative, hypnotic, anesthetic effects, it produces side effects most often with rapid intravenous administration. The drug is capable of causing motor agitation, convulsive twitching of the limbs and tongue, and even cases of respiratory arrest are known. Therefore, it is necessary to slowly inject sodium hydroxybutyrate into a vein. During recovery from anesthesia, motor and speech excitation is possible. When used in high doses, it sometimes causes nausea and vomiting. Some patients experience daytime drowsiness. With long-term use of large doses of the drug, hypokalemia may develop (potassium chloride, asparkam, panangin are correctors for this side effect).

Contraindications to the use of sodium hydroxybutyrate are hypokalemia, myasthenia gravis (due to its muscle relaxant properties), epilepsy, severe arterial hypertension, eclampsia, and delirium tremens. It should not be prescribed for glaucoma. Due to the hypnosedative effect, sodium hydroxybutyrate should not be used during the daytime by persons whose work requires a quick physical or mental reaction.

Glutamatergic drugs

The glutamatergic system plays an important role in the implementation of synaptic plasticity and higher integrative functions of the brain, including the processes of learning and memory. Therefore, it is being intensively studied as a target for pharmacological intervention. Glutamate is an excitatory neurotransmitter; glutamate receptors (in particular, NMDA receptors), as evidenced by accumulating evidence, are involved in the mechanisms of memory impairment in various diseases of the central nervous system.

Glycine, which is a nonessential amino acid that acts at the glycine site of the NMDA receptor, is well tolerated and has virtually no side effects. This drug can be considered contraindicated only in case of individual intolerance.

Memantine is a non-competitive antagonist of NMDA receptors, along with a nootropic effect, it has a neuroprotective effect and is capable of correcting motor disorders in various lesions of the brain and spinal cord. The drug can cause a number of side effects from the central nervous system. These include dizziness, anxiety, including motor anxiety, a feeling of fatigue, and heaviness in the head. In addition, nausea is sometimes possible. Contraindications to the use of memantine include confusion and severe renal impairment, as this slows down the excretion of the drug.

Neuropeptides and their analogues

The peptidergic direction of memory correction is also promising. A significant number of drugs in this group are being developed, many of which will apparently soon appear on the pharmaceutical market. Let's focus on two drugs: Semax and Cerebrolysin.

Semax is a synthetic analogue of adrenocorticotropic hormone, but lacks hormonal activity. This drug, used intranasally, exhibits nootropic and adaptogenic effects. The drug is well tolerated, there is no information about its side effects. Semax is contraindicated during pregnancy, breastfeeding, and acute psychotic conditions.

Cerebrolysin is a complex of neuropeptides (15%) with a molecular weight of no more than 10,000 daltons, free amino acids (85%) and trace elements (O. A. Gromova, 2000), obtained from the brain of young pigs. For more than 20 years it has been used as a neuroprotector and nootropic. Recently, it has been proven that the neuroprotective activity of Cerebrolysin is associated mainly with the peptide fraction. The drug has a multimodal effect: it increases the intensity of energy metabolism, protein synthesis in the brain, exhibits antiradical, membrane protective and neurotrophic activity, inhibits the release of excitatory amino acids (glutamate), and improves cerebral blood flow.

Cerebrolysin demonstrates good tolerability. Its side effects are infrequent and include an increase in body temperature (pyrogenic reaction), which is observed mainly with rapid intravenous administration. Therefore, the drug must be administered intravenously by drip.

Cerebrolysin is contraindicated in acute renal failure, in the first trimester of pregnancy, in convulsive conditions, including epilepsy, and allergic diathesis. It should be noted that this drug is one of the few highly effective neuroprotectors that can be used in neuropediatric practice and even prescribed to newborns.

When considering Cerebrolysin, one should also focus on a brain hydrolyzate containing neuropeptides, such as Cerebrolysate. The latter cannot be considered an analogue of Cerebrolysin either in composition or in pharmacotherapeutic effectiveness and safety. Cerebrolysate, obtained from the brain of adult cows, contains high molecular weight neuropeptide fractions. It carries a potential danger due to the possibility of transmitting the bovine spongiform transmissible encephalopathy virus (“rabies” in cows), which causes an incurable neurodegenerative disease in humans, Jakob-Creutzfeldt disease. Cerebrolysate cannot be injected into a vein, and when administered intramuscularly it often causes severe irritation. Prescribing Cerebrolysate to children is unacceptable.

Antioxidants and membrane protectors

Free radical processes that damage the neuronal membrane are involved in the basic mechanisms of disorders of synaptic plasticity, memory and learning processes. Many nootropics have a multicomponent mechanism of action, including antiradical properties. However, drugs such as Mexidol, meclofenoxate, and pyritinol have a particularly pronounced antioxidant effect.

Since 1993, the clinic has been using Mexidol, which contains a residue of succinic acid and has pronounced nootropic and neuroprotective activity. Along with antioxidant and membrane protective effects (inhibition of free radical oxidation processes, activation of superoxide dismutase, lipid-regulating properties), it increases the intensity of cerebral blood flow, inhibits platelet aggregation, modulates GABA, benzodiazepine and cholinergic transmission. The drug is characterized by good tolerability and rare side effects, which include nausea, dry mouth, drowsiness (the latter mainly when using high doses). Mexidol is contraindicated in acute disorders of liver and kidney function. The experiment did not reveal embryotoxic, teratogenic or mutagenic effects of the drug.

Meclofenoxate (cerutil) is also well tolerated, only occasionally causing sleep disturbances (therefore it is not recommended to take the drug later than 16 hours), anxiety, minor pain in the stomach, heartburn, and increased appetite. In isolated cases, allergic skin reactions are possible. A feature of meclofenoxate is its ability to exacerbate psychotic symptoms (delusions, hallucinations, for which the drug is contraindicated), as well as contribute to the emergence of fear and anxiety. It is not recommended to prescribe the drug in cases of severe anxiety and agitation. As for pregnancy, if there are strict indications, meclofenoxate can be used.

Pyritinol (pyriditol, encephabol), being a pyridoxine molecule (vitamin B6, which has an antihypoxic effect) doubled with a disulfide bridge, it lacks vitamin activity. It exhibits pronounced nootropic properties in combination with antidepressant and sedative effects, being a low-toxic drug. Relatively infrequent side effects include nausea, headache, insomnia, irritability, and in children, psychomotor agitation, sleep disturbance. In such cases, the dose of the drug is reduced and it is not prescribed in the evening. In addition, in some cases, decreased appetite, changes in taste, cholestasis, increased levels of transaminases, dizziness, fatigue, leukopenia, joint pain, lichen planus, allergic skin reactions, and hair loss are possible.

Pyriditol is contraindicated in cases of severe psychomotor agitation, convulsive conditions, including epilepsy, severe liver and kidney dysfunction. Contraindications also include changes in blood composition (leukopenia), autoimmune diseases, fructose intolerance (for oral suspension).

Ginkgo biloba preparations

Standardized extracts of the relict gymnosperm plant Ginkgo biloba ( bilobil, memoplant, tanakan and others) contain a composition of flavonoids, in particular amentoflavone and ginkgetin, flavone glycosides, diterpene lactones and alkaloids. Along with these components, in the studies of O. A. Gromova et al. Neuroactive elements such as magnesium, copper, manganese, selenium were found in the ginkgo extract (bilobil), and high activity of superoxide dismutase was detected.

These drugs have a complex of valuable pharmacological properties, providing an antioxidant effect, enhancing energy metabolism in the brain, increasing the sensitivity of m-cholinergic receptors to acetylcholine, weakening the activation of NMDA receptors, reducing cerebral edema, improving the rheological properties of blood and microcirculation. Typically, ginkgo extracts approved for over-the-counter release are well tolerated; the frequency of side effects, as reported by O. A. Gromova, is about 1.7%. These isolated cases manifest themselves in the form of self-limiting dyspepsia, and even less often in the form of headache and allergic skin rash.

However, such a side effect of ginkgo preparations as hemorrhages is little known and is not included in reference books. The review by A. V. Astakhova, summarizing clinical observation data, provides cases of intracranial hemorrhage and postoperative bleeding after laparoscopic cholecystectomy. Apparently, these complications are associated with the effect of ginkgolides, which inhibit platelet activating factor and reduce platelet aggregation. The risk of bleeding increases in surgical patients, who are advised to stop taking ginkgo preparations at least 36 hours before surgery. Obviously, the combination of these drugs with various antithrombotic agents (antiplatelet agents, anticoagulants, fibrinolytics) should be avoided, since they can increase the risk of hemorrhages. It is also inappropriate to use ginkgo preparations, including as part of various nutritional supplements, in patients with thrombocytopenia and thrombocytopathies.

Ginkgo preparations are contraindicated in case of individual hypersensitivity. Their use is not recommended during pregnancy and lactation, as well as in childhood.

Calcium channel blockers

An increase in intracellular calcium concentration plays an important role in the mechanisms of memory impairment, ischemic damage and neuronal apoptosis. In this regard, calcium channel blockers, which primarily improve cerebral blood flow and are used for cerebral ischemia, also have a nootropic effect, the mechanism of which remains not fully understood. Among the numerous “anti-calcium” drugs, the greatest affinity for cerebral vessels and the nootropic component of pharmacodynamics are demonstrated by nimodipine and cinnarizine. The relatively good tolerability of calcium channel blockers is explained by the wide breadth of their therapeutic action.

The effectiveness of nimodipine in patients with dementia has been confirmed in at least 15 controlled clinical trials. Unlike acute cerebral ischemia and subarachnoid hemorrhages, when nimodipine is used by injection, for dementia the drug is used in tablets. The range of its side effects is quite wide. The most common symptoms are decreased blood pressure (due to systemic vasodilation) and dizziness. In addition, the drug can cause dyspepsia, headache, attention and sleep disturbances, psychomotor agitation, a feeling of heat and redness of the face, sweating, and less commonly, tachycardia, thrombocytopenia, angioedema and skin rash.

Nimodipine is contraindicated during pregnancy and lactation, severe liver dysfunction, and cerebral edema. Great care must be taken when deciding on prescribing the drug to patients with low blood pressure or increased intracranial pressure. Nimodipine should not be used during work by persons whose profession requires high concentration of attention (drivers, etc.)

It must be taken into account that various antihypertensive drugs enhance the hypotensive effect of nimodipine, and beta-blockers, in addition, potentiate the negative inotropic effect and, in combination with nimodipine, can decompensate heart function.

Cinnarizine (stugeron) is a popular drug that improves cerebral circulation and has nootropic and vestibuloprotective properties, as well as antihistamine activity. If well tolerated, it can sometimes cause side effects such as dry mouth, drowsiness, headache, extrapyramidal disorders, weight gain, dyspepsia, cholestatic jaundice, allergic reactions (despite the antihistamine effect). Some women experience polymenorrhea during long-term treatment with cinnarizine, so in such cases it is advisable to discontinue it on menstrual days.

Contraindications, with the exception of individual intolerance, have not been established. Drowsiness, dry mouth and gastrointestinal disorders do not require discontinuation of cinnarizine; it is usually sufficient to reduce the dose of the drug. Since cinnarizine predominantly dilates the blood vessels of the brain and has little effect on other vascular systems, in therapeutic doses it practically does not reduce blood pressure, but in patients with severe hypotension it is recommended to take the drug in a reduced dose. Apparently, one should be careful when prescribing cinnarizine to patients with parkinsonism, since there is a risk of increased extrapyramidal disorders. When using the drug, it is advisable to avoid driving a car, as drowsiness with decreased attention is possible.

Cerebral vasodilators

Drugs in this group have different mechanisms and multifaceted neuro- and psychopharmacological effects. Their nootropic effect, as already noted, is largely a consequence of improved cerebral circulation, although other ways of its implementation are also possible. Thus, vinpocetine (Cavinton) is able to block NMDA receptors, inhibit calcium and sodium channels, inhibit cAMP phosphodiesterase, and increase the neurophysiological parameter long-term potentiation, which indicates an increase in the plasticity of neuronal transmission.

Vinpocetine (Cavinton), obtained from the small periwinkle, has been used for about 30 years. It causes almost no side effects. Unlike the vinca alkaloid devincan, vinpocetine does not have a sedative effect. Typically, its use maintains the level of wakefulness and systemic hemodynamic parameters. Sometimes there is a temporary decrease in blood pressure due to vasodilation and baroreflex tachycardia. Therefore, parenteral administration of the drug is contraindicated in severe coronary heart disease and heart rhythm disturbances. In addition, Cavinton is contraindicated during pregnancy. Its combination with heparin is undesirable, since the risk of bleeding increases.

The use of the α-blocker nicergoline may be accompanied by a variety of side effects, but their frequency is low. It should be noted that with increasing duration of treatment they occur less frequently. The most common symptoms are erythema, a feeling of heat with redness of the facial skin, fatigue, sleep disturbances, decreased appetite, nausea, increased acidity of gastric juice and abdominal pain (relieved by antacids), diarrhea. Orthostatic hypotension is less common (due to the risk of which, after the injection of nicergoline, the patient must lie down for some time). The effects of antihypertensive drugs, anticoagulants, antiplatelet agents and alcohol may be enhanced.

Contraindications to the use of nicergoline are bleeding, recent myocardial infarction, arterial hypotension, severe bradycardia, pregnancy and breastfeeding. This drug should not be combined with other α-blockers, as well as with β-blockers, to avoid increased adverse effects on the circulatory system.

Instenon, which is a combination of three components: hexobendine, etamivan and etophylline, has recently attracted attention not only as a corrector of cerebral circulation, but also as a drug with nootropic properties. Compared with previous cerebrovascular drugs, it exhibits slightly more side effects, especially when administered intravenously. The frequency of their occurrence is about 4%. A pronounced decrease in blood pressure, tachycardia, headaches due to increased intracranial pressure, discomfort in the heart, and facial flushing are possible. Therefore, intravenous administration should only be drip and very slow (over 3 hours), and the appearance of these symptoms requires stopping the infusion. With intramuscular injections, and especially when using tablets, side effects occur less frequently. It is necessary to take into account the ability of instenon to enhance the antiplatelet effect of acetylsalicylic acid, which is fraught with hemorrhagic complications.

The drug is contraindicated for epilepsy, increased intracranial pressure, and cerebral hemorrhage. During pregnancy and lactation, it is permissible to use it only according to strict indications.

At the end of the review of the side effects of the most commonly used nootropic drugs, it is necessary to emphasize that their prevention and correction, taking into account contraindications and adverse drug interactions by doctors and pharmacists are an important reserve for increasing the safety of pharmacotherapy.

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Nootropics are drugs designed to speed up metabolism in the cells of the nervous system and increase mental performance. First of all, they are intended for people suffering from neurological diseases (stroke, epilepsy, Alzheimer's disease and others). In such cases, the drugs prevent the destruction of diseased cells and stimulate them to work at the level of healthy ones.
A side effect of nootropics is stimulation of mental activity. People taking nootropic substances perceive and remember information better, think more effectively and are less susceptible to stress and mental stress. Thanks to this property, medications are popular not only among patients, but also among people who want to improve their thinking ability.

Pramiracetam is the most powerful representative of the racetam class of drugs. It has a beneficial effect on human cognitive functions:

• improves short-term and long-term memory;
• accelerates thought processes and internal dialogue inside a person’s head;
• increases the level of motivation and also helps to bring thoughts and goals to completion;

• nausea and abdominal pain;
• headaches.

9. Sulbutiamin

Sulbutiamine - vitamin B1, soluble in fat, has a wide range of positive characteristics:

• the drug accelerates oxygen in the body;
• copes well with depression;
• improves coordination and fine motor skills;
• enhances attentiveness and concentration.

Hydrafinil is a substance of the eugorica class, which has a strong invigorating effect.

The main purpose of the drug is to increase energy and general level of vigor. It also has a number of other effects:

• enhances attention and learning;
• increases the intensity of mental activity;
• speeds up reflexes.

• skin rashes;
• headaches;
• sleep problems.

7.5-htp

The full name is 5-hydroxytryptophan. The drug, due to its ability to naturally increase the level of serotonin in the body, is the most effective and safe alternative to classic antidepressants. 5-hydroxytryptophan, unlike antidepressants, acts specifically on serotonin levels, and not on melatonin and neurotrophic factors.
The medicine also has a beneficial effect on a person's sleep and fights insomnia. It is suitable for people who want to overcome stress and anxiety and depression without the use of potent antidepressants.

The drug has only 2 side effects - excessive drowsiness and nausea that occur when the conditions for taking the drug are violated.

6. DMAE

DMAE (stands for dimethylethanolamine) is a drug consisting of organic compounds present in fish. Characteristics of the drug:

• increases life expectancy;
• improves liver performance;
• has a positive effect on the psycho-emotional mood;
• used in the prevention of intellectual and mental disorders.

A course of taking the drug is recommended for people who want to increase their overall level of health, psycho-emotional state, attentiveness and memory. The drug is also suitable for people who practice lucid dreams.
If the dosage is too high, the following consequences may occur:

• confusion of thinking;
• hyperactivity and difficulty falling asleep.

5.Aniracetam

Aniracetam stands out among other representatives of the racetam class due to its features, including:

• stimulation of the overall performance of the body;
• beneficial effect on human emotions and creative thinking;
• effective fight against stress and depression.

After completing the course, a person experiences a long-term improvement in social adaptability. A person thinks more clearly and can remember more information. Aniracetam is an excellent choice for creative, socially active people who work with a lot of information and are prone to mood swings. There are only two negative effects - abdominal pain and skin rashes.

Fasoracetam is a medicine originally developed to combat Alzheimer's disease. Subsequently, it also began to be used as an effective prevention of dementia, an antidepressant and a tranquilizer.

Nootropic properties include:

• significant effect on receptors responsible for long-term memory;
• increased attentiveness and learning;
• maintaining mental clarity and orderly thoughts.

Fasoracetam acts for a long time and does not lose its effectiveness. The list of side effects contains:

• the possibility of allergies;
• headaches;
• nausea and vomiting in case of overdose.

Imagine the situation: there is an important task ahead that requires maximum concentration of mental abilities, and your brain, as luck would have it, refuses to work. Thoughts are in the clouds, your head seems wobbly, and your memory seems “full of holes.” But there is a whole group of drugs that improve cognitive function!

Norm and pathology

First of all, it would be good to determine the cause of the violations. Memory deterioration, decreased mental performance, as well as headaches and noise in the head may be the first signs of serious diseases associated with impaired blood flow in the brain.

As a rule, this occurs when vasoconstriction occurs against the background of arterial hypertension or atherosclerosis. Both of these conditions progress without proper treatment and often lead to serious consequences such as stroke or heart attack.

In addition, mental decline may be associated with a disease such as Alzheimer's disease. Therefore, at the first alarming signs, it is better to consult a doctor and figure out what is happening in the body. If the examination confirms the pathology, the person needs long-term and serious treatment.

However, fortunately, memory impairment can also be completely harmless. After all, we often work at a high pace, sparing no effort, and stress, physical and mental overstrain make themselves felt by natural fatigue. And what kind of intellectual success can we talk about if an exhausted body directs all its efforts to ensure at least the uninterrupted operation of vital systems? This is where you can pay attention to nootropics.

"Smart" pills

The word “nootropic” was first proposed by the Romanian physiologist and chemist Cornelius Ghirge in 1972. He combined it from two Greek components: noos - mind and tropos - direction. The main goal of nootropics is to improve cognitive function.

For decades, debates have continued in world psychiatry and neurology about the advisability of using drugs in this group by healthy people. The reasons for this are the possible side effects of drugs along with unproven effectiveness. However, in 2015, global sales of this group’s products exceeded $1 billion, and demand for them is constantly growing.

According to the instructions for use, nootropics are able to accelerate the transmission of impulses between the hemispheres of the brain, normalize metabolic processes and enhance microcirculation. It is also said that nootropic drugs improve mental performance, learning and memory, and in addition increase the brain's resistance to damaging factors, such as high stress or lack of oxygen.

Today, nootropics of different classes are used in domestic practice, including:

• racetams, of which Piracetam is a prominent representative;
• derivatives of gamma-aminobutyric acid (Phenibut);
• herbal preparations such as ginkgo biloba extract;
• amino acids (Glycine);
• substances from other groups with a nootropic effect, including correctors of cerebral circulatory disorders (Vinpocetine, Cinnarizine) and general tonics (ginseng extract, melatonin).

Let's look at the features of each group.

Briefly about the properties

Each representative of nootropics can be given a separate article, but we will try to describe them briefly and to the point.

Piracetam. He owns the laurels of primacy: piracetam became the first “drug that improves cognitive function.” It is produced under various trade names (Lucetam, Nootropil, Piracetam) in various forms of release (solution for intramuscular and intravenous injections, tablets, capsules) and is used for various conditions and diseases accompanied by intellectual disabilities.

It should be noted that piracetam is not used in the USA. The FDA defines drugs in the United States as drugs that are intended to diagnose, treat, treat, or prevent disease. Food supplements should include vitamins, minerals, amino acids, and plant compounds. Piracetam, alas, does not satisfy either the first or the second requirement, and therefore, according to American laws, it cannot be either a drug or a dietary supplement. But in European countries it is used, although some experts, including domestic ones, are extremely skeptical about its evidence base. Piracetam is even included in the well-known list of placebo drugs, presented by the Chairman of the Formulary Committee of the Russian Academy of Medical Sciences, Professor Vorobyov.

Gamma-aminobutyric acid (GABA) derivatives. Drugs in this series include Aminalon, Picamilon, Phenibut, etc. Phenibut, along with improving mental performance, eliminates tension, irritability and improves sleep. True, again in the West, unlike the CIS countries, funds from this group are not used as nootropics. In addition, Picamilon and Phenibut were included in Professor Vorobyov’s list mentioned above.

Ginkgo biloba extract. According to the instructions for use, it has a combined nootropic and antihypoxic effect, improves blood circulation in the brain, thereby helping to improve cognitive functions and improve memory. It is sold both in the form of medicines (Bilobil, Tanakan, Memoplant) and as part of dietary supplements. How dietary supplements are used in the West. However, clinical studies have not confirmed the beneficial effects of ginkgo biloba on intellectual performance and memory in healthy people.

Glycine. This amino acid regulates metabolic processes in the nervous system, normalizes excitation and inhibition, and at the same time has a very high safety profile. Therefore, over-the-counter Glycine is often used for various disorders of the psycho-emotional state: irritability, insomnia, and decreased mental performance, including in children. In the USA, Glycine is used as a dietary supplement, and in some European countries, for example Poland, Italy, it is part of combined analgesic drugs (Alka-Prim). As an independent nootropic, it is used mainly in the post-Soviet space.

Normalizing cerebral circulation. Representatives of this group act by improving blood supply to the brain. For example, Vinpocetine is a synthetic analogue of an alkaloid isolated from Vinca minor. The drug was created by Hungarian pharmacologists and is used mainly in Eastern European countries. Studies by the Cochrane Collaboration have not confirmed the beneficial effects of Vinpocetine on mental performance.

Another popular drug of this subgroup is Cinnarizine, in the West it is used mostly for seasickness, since it relieves nausea and vomiting in vestibular disorders, and in the post-Soviet space it is often prescribed as an affordable nootropic.

Ginseng extract. Ginseng extract is believed to improve mental and physical performance by stimulating the central nervous system. However, this herbal preparation did not defend its nootropic properties in clinical studies. According to the Cochrane Collaboration, there is no convincing evidence that ginseng extract helps improve mental performance.

To the rhetorical question “to take or not to take medications to improve memory,” everyone may have their own answer. And there is a truth of its own: one, unsightly, among scientists, and a completely different, optimistic one, among consumers. Despite the depressing research data, many patients readily take nootropics and feel improvement with treatment. Moreover, most of the products in this group are well tolerated, and some, such as ginkgo biloba extract and glycine, are even sold without a doctor’s prescription.

However, relying on the achievements of pharmacology, it would be good to help the body, which reacts to difficult working conditions and lack of normal rest with a deterioration in mental abilities. Give yourself a temporary break, switch to other activities, go to the pool or gym. And perhaps you will soon see how deep your intellectual capabilities are even without any drug support.

Marina Pozdeeva

Photo istockphoto.com

Nootropic drugs that improve nutrition and blood circulation in the brain belong to the category of drugs that improve the activity of higher mental functions of the brain:

Another positive effect is considered to be the protection of the gray matter of the brain from overload and oxygen starvation. They are also used in the treatment of strokes and heart attacks.

Pharmacological group

Nootropics are placed in a separate pharmacological group (ATC code: N06ВХ).

Piracetam (1963) is considered the first discovered nootropic, which gave rise to the “racetome” branch. It became the main competitor for psychostimulants, but did not have the side effects (addiction, exhaustion, psychomotor agitation, intoxication) that the latter were prone to. The new synthesized drug improved memory, attention, and helped to concentrate better. In its early days, the new drug was used to treat brain dysfunction in older people.

In 1972, a new designation was proposed - “nootropic”. Piracetam is now known under the trade name Nootropil. However, the mechanism of its action has not yet been fully studied.

What determines the therapeutic effect of drugs from this group?

Ensures the operation of the following mechanisms, thanks to which the positive effect of taking nootropics is achieved:

• supports the energy structure of the neuron;
• improves the main and conductive functions of the central nervous system;
• activates the plastic function of the central nervous system;
• improves metabolic processes (glucose utilization);
• stabilizes cell membranes;
• reduces the neuron's need for oxygen;
• has a neuroprotective effect.

Pharmacological properties and mechanism of action

The active substances of nootropic drugs penetrate well through the myelin barrier of nerve fibers. In the neuron, metabolism, bioenergetic and bioelectric processes are enhanced, and neurotransmitter exchanges are accelerated.

In the nerve cell, the concentration of adenylate cyclase and norepinephrine increases; ATP (even in conditions of lack of oxygen), GABA, and dopamine are more actively produced. The work and release of the mediator serotonin occurs faster, and glucose is utilized more efficiently.

Due to these processes, the body receives a stimulating effect in relation to cognitive functions, for which nootropics received the additional name “cognition stimulants.” In addition to positive changes in the nerve cell, neurostimulants improve microcirculation and blood flow in the brain.

Result of action and expected effect

Nootropic action leads to the following effects:

• the thinking function is activated;
• memory improves;
• consciousness clears up;
• physical strength increases;
• an antidepressant effect occurs;
• a sedative effect appears;
• fat burning occurs;
• immunity is strengthened;
• operational readiness is activated.

Classification of modern nootropics

There is a huge number of developed nootropic drugs around the world (the full list includes up to 132 items). In pharmacology, the following groups of drugs have been synthesized, which are divided according to their chemical composition:

1. Pyrrolidine group (“racetams”): Etiracetam; Oxiracetam; Pramiracetam.
2. Group derived from dimethylaminoethanol: Phenotropil; Deanol aceglumate; Meclofenoxate.
3. GABAergic: Aminalon; Picamilon; Phenibut.
4. Group derived from pyridoxine: Pyritinol; Biotredin.
5. Neuropeptides: Noopept; Semax; Selank.
6. Polypeptides: Cortexin; Cerebrolysin; Cerebramin.
7. Amino acids: Glycine; Biotredin.
8. Group derived from 2-mercantobenzimidazole: ethylthiobenzimidazole hydrobromide (Bemityl).
9. Vitamin: Idebenone.

Old and new generation drugs

Nootropic drugs are also divided into old and new generation groups. Old-generation nootropics include drugs discovered at the dawn of the synthesis of neurostimulants. This is the so-called derivatives of the first discovered nootropic – Piracetam (“racetams”). These include:

• Oxiracetam;
• Aniracetam;
• Etiracetam;
• Pramiracetam;
• Dupracetam;
• Rolisiracetam;
• Cebracetam;
• Nefiracetam;
• Isacetam;
• Detiracetam.

With the onset of the 90s of the 20th century. A new page is opening in the history of the development of nootropics. Modern drugs have a more flexible selective action and fewer side effects. Here is a list of the most popular new generation nootropic drugs:

• Phezam (improves cerebral circulation, protein and energy metabolism, has a vasodilating effect);
• Phenylpiracetam (recovery after a stroke, improved attention, concentration, memory, improves the transfer of information between the hemispheres, anticonvulsant effect);
• Noopept (memory restoration and other lost cognitive functions, relief of anxiety, treatment of headaches);
• Selank (relieves anxiety and stress, enhances mental capabilities, elevates mood).

What is good for a Russian is death for a German

In the post-Soviet space, nootropics are associated with drugs that enhance “brain metabolism.” However, in addition to nootropic, these drugs also have a number of other therapeutic effects. Therefore, brain stimulants are also used as medicines for brain diseases.

Drugs of this group can be prescribed for the following disorders:

Basically, such treatment is experimental in nature and often leads to side effects and increased symptoms of certain diseases.

Let's consider the indications and contraindications for use for the most popular drugs in this group.

Piracetam

Has structural similarities to GABA. It has neuroprotective and vascular effects. Indications for use of piracetam:

Despite the fact that in Western medicine this drug is not a drug, in Russia piracetam began to be used for therapeutic purposes for a number of diseases:

Contraindications to the use of the drug:

Fenotropil

A new generation nootropic, which belongs to the group of so-called. "racetams". Stimulates motor reactions (similar to doping). It has an anticonvulsant and antiasthenic effect. Indications for use:

Contraindications for use: individual intolerance.

Semax

A domestic development belonging to the group of neuropeptide nootropic drugs. Applicable for the following cases:

• increasing adaptive capabilities under stress;
• prevention of psycho-emotional overload;
• deterioration in concentration;
• memory impairment;
• recovery after craniocerebral surgery;
• migraine.

There are the following contraindications:

• increased sensitivity to nootropic components;
• acute mental illness;
• anxiety;
• convulsions.

Side effects

Nootropics are a double-edged sword when it comes to brain function. Taking them in compliance with all instructions will have a beneficial effect. However, if you deviate even one step from the doctors’ instructions, this can lead to an increase in the symptoms of the disease for which the drug is prescribed, or have a negative effect on cognitive functions.

Let's look at the pronounced side effects using examples of the most popular drugs:

1. Piracetam. Side effects caused by this drug: deterioration of intellectual abilities; worsening dementia; increased anxiety and irritability; sleep disturbance or drowsiness; decreased concentration; disruption of the gastrointestinal tract (nausea, vomiting, diarrhea).
2. Phenotropil. The side effects caused by this drug are as follows: insomnia; psychomotor agitation; hyperemia of the skin; increased blood pressure; feeling of warmth.
3. Semax. No side effects have been identified, except for irritation of the nasal mucosa with frequent use of the bottle.

Features of application

It should be remembered that a drug that stimulates brain activity must be used only after certain conditions are met.

The first thing to do is consult a neurologist. After you receive a positive verdict from the doctor, you should prepare your body to take the nootropic.

This preparation consists of a kind of laying the foundation on which the building of the effective influence of the brain stimulator will be erected. This foundation is the fortification of the body, in which the necessary substances when taking a nootropic will quickly and efficiently reach the brain at the molecular level, which will allow the stimulant to be better absorbed. Fortification includes the following substances and natural complexes:

Dosages and regimens for taking nootropics from the TOP-3

Nuances of use and dosage of popular nootropic drugs.

He was the first

The beneficial effects of Piracetam appear only after long-term use. Excretion from the body through the kidneys. Course 6-8 weeks mg/day.

• capsules;
• solution for intramuscular and intravenous administration;
• solution for oral administration;
• syrup;
• pills.

Fenotropil

After administration, Phenotropil is quickly absorbed by the body and penetrates into all tissues. Excretion from the body is carried out through the kidneys and liver.

Domestic development

Methods of taking Semax:

Release form: dropper bottle.

Golden ten

Based on reviews, we have compiled a list of the best nootropic drugs according to people:

Efficiency not proven?

The attitude of medical luminaries towards nootropics is shrouded in doubt and uncertainty. Countless clinical trials of nootropics are still being conducted, but this pharmacological group has not managed to gain a foothold in the status of drugs with proven effectiveness.

Observations by specialists have made it possible to draw a number of more or less stable conclusions regarding the following drugs:

1. Piracetam. Clinical studies (333 studies since 1972) have shown that the drug has an enhancing effect on the effect of taking antidepressants, psychostimulants and indirect anticoagulants. Its effectiveness has been proven in the treatment of ischemic strokes (except acute) and heart attacks, due to its ability to relieve oxygen deficiency.
2. Vinpocetine. This drug, which has passed 27 clinical trials, still remains unconvincing for specialists in some of its properties. However, it was noted that the drug can have a vascular effect (vasodilator) and stimulates metabolism in brain tissue. It is used for brain injuries, strokes, cerebral atherosclerosis, and memory disorders.
3. Cerebrolysin. 53 clinical trials. Doctors noted that the drug has a positive effect in the treatment of acute strokes and helps alleviate the condition of patients with Alzheimer's disease.

What is there for children?

For children, there are special granules for making syrup. In pediatric practice, there are cases of the use of nootropics in cases of the following disorders:

• cerebrasthenic;
• encephalopathic;
• memory impairment;
• intellectual inhibition.

Indications for the use of nootropics in childhood:

Patient reviews and a doctor's review of nootropics will help to finally clarify the situation.

The opinion of ordinary people

I took Piracetam capsules. The drug really works, but you shouldn't expect anything supernatural from it. I never became a genius, but the learning processes are really improving, which helped me successfully prepare for the exam at the institute. It also helped me concentrate on exams.

The first nootropic I came across was Piracetam. I took it according to all the rules (along with vitamins and lecithin). After a two-month course, I can say that I liked the effect: increased excitement, desire to do something, long-term concentration.

I became interested in the topic of nootropics for a long time, I tried a lot and I especially want to mention Phenotropil. After taking it, you feel the effect of slowing down time. I have time for everything. More than enough strength. I once wrote a coursework in 3 hours (I took 3 pills).

Doctor review

As a doctor, I am interested in the effect of nootropics within the framework of evidence-based medicine. Let's define the terms. Evidence-based medicine is a series of studies of a drug or treatment method on a certain number of patients. Methods and drugs that have passed this selection can be considered proven effective.

Does this mean that all methods and medicines that have not received recognition from doctors and remain with the status of “ineffective” cannot be used in medical practice? Rated drugs that have successfully passed testing do not always have the desired effect. Just like drugs that were screened out during research may still be useful.

Nootropics are heavily criticized in the light of evidence-based medicine; their effect is equated to the placebo effect. Most of these drugs have not gained acceptance.

But I cannot agree with this position, since for 15 years I have been observing a pronounced clinical effect from some nootropic drugs (Phenibut). On the other hand, the drug Picamelon does not give such a rosy picture - the desired effect is not observed.

The well-known stimulant of brain activity Nootropil has shown itself remarkably in terms of stimulating operational readiness. However, none of these drugs have received recognition from the scientific community.

Thus, the doctor should not blindly focus on the standards of evidence-based medicine. He must select what is appropriate for this particular patient in this particular situation.

Summing up

Over the course of its almost half-century history, this pharmacological group has undergone significant evolution. More than a hundred trade names of nootropics have been created.

Their functionality includes a wide practical range: from the treatment of senile brain dysfunction to use in obstetrics, neurology and psychiatry. However, the mechanisms of their effect on the human body have not yet been solved - scientists have not yet come to the main proven hypothesis of his work.

Further testing of the drug is ongoing, and new samples are being synthesized.

I really like nootronic, my wife and I drink it, now we don’t sit at home exhausted after a hard day at work))

I don't know if nootropics work. I prescribe them because the old guys at the institute said that this is how it should be done. Children have been taking them for years and there is an effect, but how to prove that this effect is precisely from the nootropic, and not from other methods of treatment or simply compensation by the body? I read the results of studies (333 on Piracetam, of which exactly 0 (N-O-L-L) - proved that it has an effect), I read about the clinical experience of foreign colleagues - “nootropics are considered dietary supplements and are not on the list of drugs in the USA and Europe” . Parents ask me “Do they work?!”

I convince them, persuade them to take Cortexin, Pantogam, Phenibut, Cerebrolysin, etc. But I myself am not sure of their effectiveness.

P.S.: My friend Socrates, let's define the terms - “evidence-based medicine” is based on evidence, not the opinion of doctors (the opinion of experts is the criterion of effectiveness D, while the results of research are criterion A or B. There is also C - this is the result of studies of effectiveness , but on a very narrow sample and specific conditions. There are also F. and E).

P.P.S. There is drug No. 1 and drug No. 2. It has been proven that drug No. 1 acts on the body and leads to result X and does not lead to result Y, Z.

It has been proven that drug No. 2 acts on the body and does not lead to result Y.

And then there is a researcher who wants to see result Y after drug No. 2.

and having seen result Y after using drugs No. 1, No. 2, No. 3, No. 4, do you think it is logical to explain this as a result of the action of drug No. 2?

Nootropics: action, indications, list of modern and effective ones, reviews

Nootropics are a group of psychotropic drugs that affect the higher functions of the brain and increase its resistance to negative exogenous factors: excessive stress, intoxication, injury or hypoxia. Nootropic drugs improve memory, increase intelligence, and stimulate cognitive activity.

From the ancient Greek language, the term “nootropics” means “the desire for thinking.” This concept was first introduced in the last century by pharmacologists from Belgium. Cerebroprotectors activate neurometabolic processes in the brain and increase the body’s overall resistance to extreme factors.

Nootropics were not separated into an independent pharmacological group; they were combined with psychostimulants. Unlike the latter, nootropic drugs are antihypoxants, but do not have a negative effect on the body, do not disrupt brain activity, do not affect motor reactions, and do not have a hypnotic or analgesic effect. Nootropics do not increase psychophysical activity and do not cause pharmacological dependence.

All nootropic drugs are divided into 2 large groups:

• “True” nootropics that have the only effect - improving memory and speech;
• “Neuroprotectors” with antihypoxic, sedative, anticonvulsant, and muscle relaxant effects.

Nootropics have a primary effect, which is a direct effect on the structures of the nervous system, and a secondary effect aimed at improving microcirculation in the brain, preventing thrombosis and hypoxia. Nootropic drugs stimulate metabolic processes in nervous tissue and normalize them during ischemia, poisoning and traumatic injury.

Currently, pharmacologists are developing and synthesizing new nootropic drugs that have fewer side effects and are more effective. They are characterized by low toxicity and practically do not cause complications. The therapeutic effect of nootropics develops gradually. They should be taken continuously and for a long time.

New generation nootropics are used in various medical fields: pediatrics, obstetrics, neurology, psychiatry and addiction medicine.

Mechanism of action

Nootropics have a direct effect on a number of brain functions, activate them, stimulate mental activity and memory processes. They facilitate the interaction of the right and left hemispheres, as well as the main centers located in the cerebral cortex. Nootropic drugs rejuvenate the body and prolong life.

Neurometabolic cerebroprotectors are nootropic drugs that received their second name due to their biogenic origin and effect on cellular metabolism. These medications increase glucose utilization and ATP formation, stimulate the biosynthesis of proteins and RNA, suppress the process of oxidative phosphorylation, and stabilize cell membranes.

Mechanisms of action of nootropics:

• Membrane stabilizing;
• Antioxidant;
• Antihypoxic;
• Neuroprotective.

As a result of a course of use of nootropic drugs, mental and cognitive processes improve, intelligence increases, metabolism in the nervous tissue is activated, and the brain's resistance to the negative effects of endogenous and exogenous factors increases. Cerebrovasoactive drugs also have a special mechanism of vasodilatory action.

The effectiveness of nootropics increases when they are combined with angioprotectors and psychostimulants, especially in weakened individuals.

Nootropic drugs are most often prescribed to older people and children. In old age, it is necessary to correct impaired functions of the intellect: attention and memory, as well as increase creative activity. For children, neurometabolic stimulants will help in the fight against mental retardation.

Main effects

Nootropic drugs have the following effects on the human body:

spectrum of action of nootropics

1. Psychostimulant - stimulation of brain functions in mentally inert individuals suffering from hypobulia, apathy, and psychomotor retardation.
2. Antihypoxic - formation of resistance of brain cells to oxygen deficiency.
3. Sedative - a calming, slowing effect on the body.
4. Antiasthenic - elimination of symptoms of asthenic syndrome.
5. Antidepressant - fight against depression.
6. Antiepileptic - prevention of seizures, loss and confusion, behavioral and autonomic disorders.
7. Nootropic - stimulation of cognitive activity.
8. Adaptogenic - the development of resistance of the body to the effects of negative factors.
9. Vasovegetative - acceleration of cerebral blood flow and elimination of the main symptoms of neurocirculatory dystonia.
10. Lipolytic - the use of fatty acids as a source of energy.
11. Antitoxic - neutralization or removal of various toxic substances from the body.
12. Immunostimulating - strengthening the immune system and increasing the overall resistance of the body.

Indications and contraindications

Indications for the use of nootropic drugs:

• Psychoorganic syndrome is a broad group of diseases manifested by dystrophic changes in nervous tissue. These include dementia of various etiologies, neuroinfection, epilepsy, parkinsonism, ischemic stroke, and cerebral palsy.
• Chronic alcoholism with withdrawal symptoms or delirium.
• Addiction.
• Correction of neuroleptic syndrome.
• Asthenia of neurotic or organic origin: asthenodepressive and asthenoneurotic syndromes, vegetative-vascular dystonia, insomnia, migraine, emotional lability.
• Somatovegetative disorders.
• Urinary disorders of neurogenic origin.
• Chronic cerebrovascular insufficiency.
• Neurosis-like and neurotic disorders.
• Chronic psychopathology: neurosis-like disorders, schizophrenia, depressive states, mental retardation in children.
• Sickle cell anemia.
• Organic brain syndrome in the elderly.
• Complex therapy of ophthalmological pathology.

Nootropics are contraindicated in persons with individual hypersensitivity to the main active ingredient of the drug, severe psychomotor agitation, hepatic-renal failure or bulimia, as well as those who have suffered an acute hemorrhagic stroke, suffer from Gettington's chorea, have severe renal impairment, and pregnant and lactating women.

Side effects

Side effects that occur during treatment with nootropic drugs:

1. Hyperexcitability,
2. Weakness,
3. Insomnia,
4. Worry, anxiety,
5. Dyspeptic symptoms
6. Hypotension,
7. Hepato- or nephrotoxicity,
8. Eosinophilia,
9. Frequent attacks of angina pectoris,
10. Convulsions, seizures,
11. Balance imbalance
12. Hallucinations,
13. Ataxia,
14. confusion,
15. Fever,
16. Thrombophlebitis and pain at the injection site,
17. Motor disinhibition,
18. Feeling of heat and facial flushing,
19. Rash on the face and body like urticaria.

Description of drugs

List of the best nootropic drugs that are widely used in medical practice:

• Piracetam has a positive effect on metabolic processes in the brain. The drug is prescribed for the treatment of dizziness, improving memory, correction of dyslexia, cerebrovascular disease and encephalopathy in children. Piracetam is a first-aid remedy for withdrawal symptoms and delirium in alcoholics. It is used for viral neuroinfections and in complex therapy of myocardial infarction.
• Vinpocetine is a neurometabolic agent that dilates blood vessels in the brain and improves microcirculation. The drug supplies brain tissue with oxygen and nutrients and reduces systemic blood pressure. Vinpocetine tablets thin the blood and improve its rheological properties. The medicine has an antioxidant and neuroprotective effect. First, the drug is administered intravenously for 14 days, and then proceed to oral administration of tablets.
• "Phenibut" is prescribed to patients with asthenia, neuroses, insomnia, and dysfunction of the vestibular apparatus. Phenibut helps children cope with stuttering and tics. The drug normalizes metabolism in tissues, has a psychostimulating, antiplatelet and antioxidant effect. Phenibut is low-toxic and non-allergic.
• "Pantogam" is an effective nootropic drug widely used to treat children. The main active ingredient of the medicine is vitamin B 15. This is a physiologically active substance found in almost all plants and products.
• "Phenotropil" is a latest generation drug that is popular with both patients and doctors. It has a pronounced adaptogenic effect and increases the body's resistance to stress. The drug is not addictive. It is often recommended to students while preparing for a session.
• Phezam is a nootropic drug intended for the complex treatment of cerebrovascular disorders. It has an effective effect on the nervous system, improves brain microcirculation, dilates blood vessels, and stimulates the functioning of the organ of hearing and vision. “Fezam” eliminates the effects of hypoxia, relieves headaches, fights dizziness and amnesia. Persons who have suffered a stroke, encephalitis or TBI take Phezam for a long time. It helps patients recover quickly and eliminates the negative consequences of pathologies. “Piracetam” and “Cinnarizine”, which are part of the drug, dilate blood vessels in the brain, improve brain nutrition, protein and carbohydrate metabolism, stimulate local blood flow, and reduce blood viscosity. Thanks to both components, the antihypoxic effect and antiplatelet activity are enhanced, and metabolism in the cells of the nervous system improves.
• "Cinnarizine" is a nootropic drug that strengthens the walls of brain vessels and causes their dilation without changing blood pressure. Cinnarizine has a sensitizing effect, suppresses nystagmus and is an effective preventative against motion sickness. It dilates small arteries and peripheral capillaries. The drug is produced in a single dosage form - in the form of tablets for oral use. "Cinnarizine" is prescribed not only for the treatment of cerebrovascular insufficiency, but also for the prevention of migraine attacks and kinetosis. The medicine relieves the symptoms of vegetative-vascular dystonia and hypertension: tinnitus, weakness, headache, dizziness. "Cinnarizine" is used to alleviate the condition during menopause. The drug normalizes sleep, relieves irritability, headaches, and eliminates hot flashes.
• "Cerebrolysin" is a complex nootropic drug that has undergone clinical trials that have confirmed its effectiveness and safety. The medicine is produced in the form of tablets and solution for injection. Cerebrolysin is prescribed for the treatment of patients with various forms of mental and neurological diseases. According to reviews, Cerebrolysin activates mental processes and improves mood. Long-term use of the drug improves memory processes, increases concentration and learning ability.
• "Actovegin" is an antihypoxic drug intended for the treatment of metabolic and vascular disorders of the brain and promotes rapid wound healing. The medicine is used for the prevention and treatment of radiation skin lesions, peripheral vascular disorders, and diabetic polyneuropathy. "Actovegin" is produced in tablets for oral use, as well as in the form of a solution for intramuscular, intravenous and intra-arterial injections. Actovegin gel, ointment and cream are used topically.

Reviews of nootropics from patients

Most reviews of nootropic drugs are positive, due to their effectiveness in various vascular disorders. Nootropics normalize the condition of patients for a long time, eliminating the symptoms of cerebrovascular insufficiency.

Maria: The drug “Phenibut” helped me cope with a difficult life situation, which first made me depressed, and then completely deprived me of peace and sleep. I wanted to cry and scream all the time. A neurologist prescribed Phenibut to my child. After reading the instructions, I decided to drink it. The pills gave me back my sleep, peace and tranquility. Nervousness, irritability and anxiety no longer torment me. My child began to sleep better after treatment with Phenibut. He no longer throws me tantrums for no reason. I would recommend this drug to people suffering from insomnia, apathy towards everything, and depression. For me, Phenibut is the best nootropic!

Oleg Anatolyevich: “Piracetam” is a classic, true nootropic drug that has had the most beneficial effect on my body. For many years I have been suffering from arthrosis, chondrosis, and vegetative-vascular dystonia. Problems with the spine and blood vessels led to the fact that the brain stopped regularly receiving oxygen and the nutrients it needed. After the first three days of taking Piracetam, I developed drowsiness, which quietly went away on its own, and along with it anxiety, tension and apathy. An amazing lightness appeared in the body. The brain began to work much better, attention and memory improved, and performance increased. My mood improved noticeably and steadily; it became smooth and positive throughout the day. It costs a lot!

Dmitry: Headaches have plagued me since childhood. And not so long ago, panic attacks appeared, rapid heartbeat, pulsation in the temples. The neurologist prescribed me the nootropic drug Phezam. You need to take it in a course of one tablet three times a day. I took a pill during an attack, after which the pulse returned to normal, the headache disappeared, and the anxiety dulled. In addition, I noticed that Phezam is an excellent remedy for nausea, motion sickness and dizziness. I rarely take this drug, but it always helps. I recommend it to anyone who is anxious and often nervous.

Zinaida: I took Picamilon for prophylactic purposes. The body does not always recover quickly after physical or mental stress. Nootropics speed up the healing process. “Picamilon” improves mental state, increases the resistance of the nervous system to aggressive influences, and is used for depression and heavy physical exertion. This harmless drug always helps me. In addition, it is an excellent price-quality ratio. The cost of Picamilon tablets is rubles, and the solution for injection is 120 rubles. In general, I'm satisfied!

Most reviews about the use of nootropics for children are positive. 10 days after the start of treatment, children's sleep improves, it becomes deep and long. They focus better on their studies and comprehend the learning material. The newest nootropic drugs are well tolerated by children. The only disadvantage of drugs in this group is their ability to cause drowsiness and lethargy in the first days of treatment.

Nootropics: list of drugs

Nootropics are a widely used group of drugs in neurology. They improve brain function and have many other positive effects.

Nootropics - what kind of medicine?

Nootropics are understood as a group of psychotropic drugs that increase the resistance of the central nervous system to the effects of negative factors - injuries, poisoning, oxygen starvation, insomnia, stress. Another name for the drugs is cerebroprotectors.

Nootropics are combined into one section with psychostimulants, but they have a significant difference from the latter. They do not cause addiction, do not increase physical activity, are not harmful to the body, and do not affect reactions and essential processes. New generation nootropics are now widely used in neurology, pediatrics, psychiatry, and narcology. The mechanism of action of drugs is based on:

• increasing glucose utilization;
• accelerating the formation of ATP, proteins and RNA;
• suppression of oxidative processes;
• stabilization of cell membranes.

The primary effect of nootropics is a positive effect on the nervous system. The secondary effect is aimed at optimizing blood flow in the brain, preventing the appearance of blood clots, and preventing oxygen deficiency.

Types and functions of nootropics

The entire list of nootropics can be divided into 2 groups - true and neuroprotectors. The former improve memory, speech and a number of other brain functions. The second ones are higher in effectiveness, as they have additional effects - relaxing, sedative, antihypoxic, etc.

Only a doctor can determine which nootropics are best to take. There are different groups of drugs, each of which has its own indications.

Some medications should be taken to improve metabolism in the brain, others are better for increasing cerebral blood flow, and others optimize memory and learning material. Due to the difference in indications, the selection of medications should be entrusted to a specialist.

Who are the drugs indicated for?

Now nootropics are prescribed to adults and children, because the range of their use is very wide. Medicines increase physical activity and endurance, therefore they are indicated for athletes and people involved in physical labor. They will help an elderly person correct age-related changes in memory, intelligence, and impairments due to dementia.

Schoolchildren and students will find medications useful for better assimilation of information during intense workloads and exams.

What other indications exist for taking medications? This:

1. chronic vascular insufficiency;
2. suffered a stroke and head injury;
3. neuroses, neurotic disorders;
4. vegetative-vascular dystonia;
5. stressful conditions, depression;

Even with urinary disorders that are caused by nervous disorders, nootropics can help. They are also prescribed for anemia, diseases of the eyes and spine.

The most popular nootropics

In the ranking of cerebroprotectors, the first places are occupied by true nootropics without additional effects. Many of them belong to medicines of previous generations, but they are not losing ground due to their high efficiency, low price, and availability. If we consider widely prescribed nootropics, the list of drugs will be as follows:

1. Nootropil (Piracetam) - from 25 rubles. It is prescribed to almost all neurologist patients and is available in solution and tablets. Improves the mechanisms of storing information, has a positive effect on learning, increases the nutrition of nervous tissue and glial cells. The medicine also protects the brain from hypoxia and increases stress resistance. Piracetam should not be taken if you have a hemorrhagic stroke or kidney failure.

A unique cerebroprotector is the drug Semax (nasal drops, from 400 rubles). It contains peptides that have a powerful nootropic, protective, antioxidant, and antihypoxic effect.

What other nootropics do doctors prescribe?

In addition to the medications described, there are other cerebroprotectors recommended by doctors. For example, the drug Phenotropil (RUB 1,070) is one of the best nootropics prescribed for asthenic syndrome, as a neuromodulator and anticonvulsant.

The medicine improves mood, accelerates the exchange of information between the hemispheres, increases the threshold for pain perception and the body's resistance during periods of increased stress. The drug optimizes the quality of life in many nervous disorders.

Due to its psychostimulating effect, Phenotropil cannot be purchased without a prescription!

The list of nootropic drugs is impressive. Among the medical prescriptions you can find the following:

1. Actovegin (600 rub.). Indicated after strokes, with diabetic neuropathy, head injury, trophic pathologies, well tolerated by patients, even approved for pregnant women.

Other well-known cerebroprotectors are Meclofenoxate, Aminalon, Bemitil, Calcium Hopanthenate, Neurobutal, Instenon, etc.

New generation drugs

Nowadays, combination drugs containing several active ingredients are very popular. A representative of the latest generation of drugs is Orocetam (from 500 rubles) - a derivative of orotic acid and piracetam. The drug is used for severe injuries, intoxications, improves the metabolism of brain tissue, and prevents the development of hypoxic phenomena.

Another remedy is Phezam (piracetam and cinnarizine). The price of the medicine is rubles, it is indicated for migraines, headaches, after strokes, injuries, improves memory, normalizes brain function in case of dementia, decreased intelligence. At the same time, the drug dilates blood vessels, optimizing cerebral blood flow.

New generation nootropics are widely prescribed in ophthalmology - they seriously improve the functioning of the optic nerve.

Among the combined cerebroprotectors, it is worth noting Thiocetam, Tanakan, Akatinol, Omaron, Olatropil, as well as gamma-aminobutyric acid derivatives - Picamilon, Gammalon, Gamalate B6, Neuro-norm.

Nootropics for children

In pediatrics, only those medications are used that have a minimum of side effects and contraindications. But in children, with long-term treatment, they can still increase nervous excitability and cause sleep disturbances, so the indications for use are very strict:

• developmental delay;
• attention deficit hyperactivity syndrome;

Children are most often prescribed medications Phenibut and Pantogam in syrups; older children can be given tablets and capsules. Glycine, an amino acid related to the body, is considered harmless to the body. Also used in pediatrics are Cortexin, Picamilon, and to a limited extent - Mexidol, Neuromultivit. Course use corrects childhood pathologies of the central nervous system and prevents the progression of diseases.

Thioctic acid did not help me, and nothing has helped me yet, but I was only poisoned by the medicines, now

Just when I had a cold, I had a severe cough. The pharmacy advised for treatment

I've heard of many of these remedies. But in my opinion, Bronchobos helps best with coughs. By the way I

I got rid of papilloma on my palm in just one day with the help of Celandine, I just applied it to it

I can’t tell you about children, I don’t have any. But I buy Ingavirin for myself. It's quite enough for me

What are new generation nootropic drugs and how do they differ from other drugs in this group, what active ingredients do they contain and for what diseases and disorders are they indicated, rules for using nootropics.

New generation nootropic drugs are drugs that are responsible for stimulating the brain and its work, protecting nervous reactions. The list of new drugs in this group is quite large. As a rule, these are complex substances that consist of the nootropic component itself, as well as a number of additional ingredients, such as amino acids, antioxidants, vitamins, which improve the functioning of brain cells.

Features and types of new generation nootropics

People have been using nootropics in various forms since ancient times. The simplest and very first known nootropic is choline. The substance contains eggs, meat, fish, and seafood. After eating food that is rich in animal protein, the hormone serotonin is produced in the brain.

It is responsible for the feeling of pleasure and also has a positive effect on neuronal connections. The brain starts to work actively, memory becomes better, as do thought processes. Similar nootropic simple substances are found in green tea, coffee, nicotine, and amphetamines.

After nootropic drugs were developed and studied in the laboratory in the mid-20th century, a classification of these drugs was created: stimulants, reversible acetylcholinesterase inhibitors, racetams, vasodilators, metabolic enhancers.

Currently, racetams are mainly used in medicine. These substances are the basis of new nootropic drugs. Racetams are a chemical structure that is derived from pyrrolidine. Today there are many different new generation pharmacological drugs.

Previously, in order to improve mental activity, plant components such as lemongrass, ginseng, and ginkgo biloba were widely used. These plants are still used as ingredients in nootropic drugs. Unlike natural stimulants, the latter have a more precise effect on specific areas of the brain.

This makes it possible to use new drugs not only to enhance memory and improve intelligence, but also in the treatment of more serious disorders and ailments, such as Parkinson's and Alzheimer's diseases. Thanks to this, these drugs are considered the most effective among all nootropic drugs.

Composition and characteristics of the components of new nootropic agents

As a rule, such drugs contain two or more components that complement each other’s action. Often in the composition of new nootropic drugs you can find:

1. Dimethylaminoethanol. This is a substance that is actively involved in the synthesis of acetylcholine. Acts as an antioxidant, improves memory, mental abilities, and physical endurance.
2. Gamma-aminobutyric acid. The main inhibitory neurotransmitter of the central nervous system. Takes an active part in brain metabolism, as well as in neurotransmitter processes.
3. Pantothenic acid (B5). Participates in metabolic processes of the brain, the synthesis of acetylcholine. Participates in the synthesis of neurotransmitters.
4. Pyridoxine (B6). This is a protein coenzyme that is involved in the uniform supply of glucose to the body’s cells and is involved in the processing of amino acids.
5. Vitamin B15. Helps eliminate cell hypoxia, has a vasodilating effect, and has a detoxifying property.
6. Vitamin E. Takes part in the synthesis of hormones, acts as an antioxidant, prevents the formation of blood clots, and helps muscles function normally.
7. Folic acid. Participates in the processes of DNA replication and cell division.

Beneficial properties of new generation nootropic drugs

According to the definition of the World Health Organization, the group of new generation nootropics should include drugs that have a direct activating effect on the learning process, memory, and mental activity. In addition, these drugs increase the brain’s resistance to various aggressive factors.

The general properties of new nootropic drugs are as follows:

• Improving thought processes - learning or cognitive functions;
• Increasing the speed of memorization and strength of data storage;
• Growth of intellectual activity, increase in the volume of intellectual abilities;
• Forgetting stressful conditions and information about various pains;
• Stimulation of metabolic processes in neural tissue, mainly in various pathologies, such as intoxication, injury, anoxia;
• Improving the impact on the mental state and higher nervous activity in morphological and functional pathologies;
• Increased resistance of the brain's thought processes to unfavorable factors of the internal and external environment: stroke, trauma, hypoxia.

New generation nootropic drugs do not affect the psyche and higher nervous activity of a healthy person.

Indications for the use of new nootropics

Let's take a closer look at the indications for taking new generation nootropic drugs to improve mental performance:

1. Psychoorganic syndrome. In medicine, it is understood as a broad group of diseases that manifest themselves in dystrophic changes in nerve tissue. These are the following illnesses: epilepsy, various types of dementia, Parkinson's disease, neuroinfections, cerebral palsy, ischemic stroke.
2. Chronic alcoholism, which is accompanied by withdrawal syndrome and delirium.
3. Addiction.
4. Asthenia of organic and neurotic origin, asthenoneurotic and asthenodepressive syndromes, VSD, migraine, sleep disorders, emotional lability.
5. Correction of neuroleptic syndrome.
6. Impaired proper urination of neurogenic etiology.
7. Somatic-vegetative disorders.
8. Neurotic and neurosis-like pathologies.
9. Chronic cerebrovascular insufficiency.
10. Sickle cell anemia.
11. Chronic psychopathologies, schizophrenia, childhood mental retardation, neurosis-like disorders, depression.
12. Organic brain syndrome of elderly people.
13. As part of the complex treatment of ophthalmological pathologies.

Side effects and contraindications of new nootropics

Each drug of the nootropic class has its own contraindications. In general terms the following can be distinguished:

• Pregnancy;
• Lactation;
• Individual intolerance to components;
• Psychomotor agitation;
• Bulimia;
• Kidney failure;
• Liver failure;
• Huntington's chorea;
• The period after acute hemorrhagic stroke;
• Severe renal dysfunction.

The mechanism of action of new generation nootropic drugs

Nootropic drugs directly affect a number of brain functions. As a result, the interaction between the hemispheres and the main centers of the cortex improves.

New generation medications increase the utilization of sugar, as well as the formation of ATP, and have a stimulating effect on the synthesis of RNA and proteins. The process of oxidative phospholation under their influence is suspended, and cell membranes are stabilized.

The mechanisms of action of new nootropics include:

1. Antioxidant;
2. Membrane stabilizing;
3. Neuroprotective;
4. Antihypoxic.

The advantage of this mechanism of action is that no irreversible changes occur in the cortex. With the ease with which racetam molecules bind to receptors, they become detached.

Additionally, since the human body does not produce racetams on its own, there are unlikely to be any byproducts that could cause negative effects. Thus, a powerful nootropic effect is achieved without side effects.

Each racetam has a unique formula that allows it to bind to specific neuroreceptors. As a rule, such drugs are used in groups in order to achieve a better effect.

The effectiveness of new generation nootropic drugs for older people increases if they are combined with psychostimulants and angioprotectors. This is how impaired intellectual functions are stimulated and corrected. For children, neurometabolic stimulants are recommended to combat mental retardation.

Instructions for use of new nootropics

Self-administration of new generation nootropic drugs without the advice of a doctor is prohibited. It is only permissible to use herbal medicines based on ginkgo biloba, lemongrass and other plants without prescription. Such drugs are more likely to be dietary supplements than medications.

There are many different drugs in this group. They have different shapes and directions of action. They are mainly produced in the form of tablets, capsules, injection solutions and suspensions.

It is worth noting that the maximum effectiveness of these medications is achieved only after several weeks or even months.

Review of new generation nootropics

The list of new generation nootropic drugs is quite extensive. As a rule, the newest drugs have a combination composition and combine racetams and excipients.

Popular means are:

• Fezam. It is a combination of piracetam and cinarizine. The medicine is in the form of capsules. Recommended as a remedy as part of complex therapy for the treatment of circulatory disorders in the brain. After its use, microcirculation in the brain improves, blood vessels dilate, vision and hearing improve. The drug eliminates the effects of hypoxia, relieves headaches, dizziness, and fights amnesia. As a rule, people who have suffered a stroke, encephalitis and various traumatic brain injuries are prescribed long-term use of Phezam. The price for a package of the drug (60 capsules) ranges from 170 to 250 rubles.
• Orocetam. Combination of piracetam and orotic acid. These are injections for intravenous administration. The drug helps overcome severe brain intoxication. Improves metabolic processes in brain cells. Activates the reparative and detoxification function of the liver. The price is about 50 rubles per ampoule of the drug.
• Thiocetam. Combination of piracetam and thiotriosaline. It comes in the form of tablets and injections. Used to improve cerebral blood circulation in the cerebral cortex. Often used to treat speech disorders and the consequences of alcohol intoxication. The price of the new generation nootropic drug Thiocetam is 540 rubles per package of 60 tablets.