Sedative nootropics. Modern nootropic drugs for children and adults. Prospects for Nootropics

Nootropic drugs are drugs that have a direct effect on the higher functions of the brain, increasing its resistance to excessive stress and the influence of other negative factors (intoxication, trauma, hypoxia). The intake of such drugs helps to improve memory, increase intelligence and cognitive activity of the brain. Not without reason, translated from Greek, the concept of "nootropics" means "the desire to think." In the people, popular medicines were called "smart" pills.

Nootropic drugs are used in various fields of medicine - neurology, cardiology, psychology, psychiatry, narcology, pediatrics. With their help, you can "escape" from a stroke and maintain brain functions not only in old age, but also in a completely working age.

Good to know

Nootropics do not disrupt the functions of the brain, do not cause addiction and drug dependence, and do not have a hypnotic effect.

Today we will learn more about the properties and benefits of nootropics, tell you about the most popular drugs and how to use them.

Classification of nootropic drugs

The first representative of the pharmacological group of drugs that improve the functioning of the brain was Pirocetam. This drug was synthesized in 1963 and after a series of clinical trials that confirmed its therapeutic effect (improvement of mental abilities, memory), it was admitted to the pharmaceutical market and became the founder of the now popular medicinal group of nootropics. Today, all nootropics are conventionally divided into two categories:

1. Nootropics are true - the therapeutic effect is to improve memory, speech and mental abilities.
2. Neuroprotectors are combined agents that additionally exhibit anticonvulsant, sedative, antihypoxic and relaxing effects.

According to the mechanism of action, drugs are divided into the following subgroups:

• drugs that accelerate metabolic processes in the brain (Piracetam, Phenibut, Actovegin, Glycine, Cerebrolysin, folic acid, vitamins E and B).
• vasotropic agents that positively affect the vessels in the brain (Cinnarizine, Vinpocetine, Instenon);
• medicines that improve memory and stimulate the processes of assimilation and perception of educational material (choline, galantamine, corticotropin).

Currently, pharmacological laboratories are developing the latest nootropic drugs, which have a minimum of contraindications, practically do not have a toxic effect on the body and provide high efficiency.

Beneficial features

Initially, doctors prescribed drugs from the nootropic group to older people suffering from brain dysfunction. But in recent years, drugs of this group are widely used in representatives of different age groups. This became possible due to the versatile spectrum of therapeutic action of nootropics. The positive effect of taking the drugs is as follows:

• improves memory and speed of thought processes;
• the processes of assimilation and preservation of new information, the ability to learn are activated;
• the activity of brain cells is normalized by eliminating hypoxia and improving blood supply;
• the ability to withstand stress factors is restored;
• concentration of attention increases, brain functions are activated;
• metabolic processes in the cerebral cortex are stimulated;
• the work of the nervous system, disturbed due to injuries and insufficient supply of tissues with oxygen, is restored;
• efficiency increases, symptoms of asthenia disappear, a feeling of cheerfulness and clarity of consciousness returns;
• a psycho-stimulating factor is manifested, which allows you to fight apathy and lethargy;
• intellectual abilities increase;
• the body's resistance to the influence of adverse factors improves, as a result of which the risk of stroke and other vascular disorders is reduced.

At the same time, nootropic drugs do not provoke drug dependence, do not have a negative effect on higher nervous activity, do not cause psychomotor agitation and physical exhaustion of the body.

The latest nootropics have a positive effect on increasing physical activity and endurance, which allows them to be used without harm to health during intense sports loads.

Preparations from the group of nootropics are prescribed to representatives of different age groups. Nootropic drugs for the elderly are used to correct age-related intellectual disabilities. For students and schoolchildren, these tools help to assimilate information and support brain functions during intense mental stress during training and passing exams. For children, nootropics are used when it comes to developmental delay.

When are nootropics prescribed?

Drugs that improve nutrition and blood circulation of the brain are used in the following conditions:

• chronic cerebrovascular insufficiency;
• the consequences of a stroke (impaired cerebral circulation);
• senile or vascular dementia;
• neuroinfections, cortical myoclonus;
• craniocerebral injuries;
• with neurotic and neurosis-like disorders;
• with manifestations of vegetovascular dystonia, depressive states;
• psychoorganic syndrome, accompanied by impaired memory, decreased concentration and mental performance;
• with drug addiction, and related conditions (withdrawal syndrome, delirium, encephalopathy);
• with sleep disorders, frequent headaches, dizziness;
• in chronic cerebrovascular insufficiency;
• with organic disorders of the brain in the elderly;
• with sickle cell anemia;
• with urinary disorders caused by neurogenic causes;
• with psychopathologies (schizophrenia, oligophrenia).

The list of indications for the use of nootropics is quite wide and allows them to be used in various fields of medicine.

Features of the use of nootropics in children

Today, new generation nootropic drugs are being produced, which are highly effective and have fewer contraindications and side effects. However, in pediatrics, their use is limited, since drugs in this group cause increased excitability and insomnia in children. And such a reaction is quite natural, because the mechanism of action of drugs is aimed at accelerating the metabolism in the brain and activating its functions.

Therefore, the use of nootropic drugs for children is limited to the following conditions:

• delayed mental, speech, mental development;
• attention deficit disorder;
• congenital pathologies, cerebral palsy;
• damage to the nervous system of the baby during childbirth.

With these pathologies, the use of nootropics is a necessity, but all drugs should be prescribed by a doctor, taking into account the condition and age of the child. Today, a new nootropic Pantogam has been developed specifically for use in pediatrics, which has a mild effect and is better tolerated by young patients, since it does not cause sleep disturbances and other side effects.

Contraindications for admission

Any drug from the group of nootropics has its own list of contraindications. Therefore, before using the drug, you need to consult a doctor and carefully read the instructions. However, there are a number of general limitations inherent in most nootropics. This list contains the following states:

• renal and liver failure;
• the period of pregnancy and breastfeeding;
• individual intolerance to the components of the drug;
• hereditary diseases of the nervous system (Huntington's disease);
• recovery period after a hemorrhagic stroke.

Nootropic drugs, even of a new generation, can cause a number of adverse reactions, of which the most common are manifestations of anxiety, insomnia, weakness or hyperactivity, dyspeptic disorders, impaired coordination of movements, convulsive syndrome and other manifestations.

It should be borne in mind that most nottrops have a toxic effect on the liver and kidneys. Therefore, you should not self-medicate, all drugs should be prescribed by a specialist, taking into account the individual characteristics of the patient and possible contraindications.

The best nootropic drugs that improve brain nutrition

In the list of the best drugs, true nootropics hold the palm, which do not have additional effects and directly affect the improvement of thought processes. Among them are the following drugs:

• (nootropil). This is the first drug that has been used in clinical practice to improve memory and activate brain functions. Available in the form of tablets and solution for intravenous injection. It is used to treat patients from different age categories. It improves the nutrition of nerve cells, eliminates hypoxia, increases the resistance of the brain to high mental stress. Often recommended to schoolchildren and students in the learning process and passing exams. Helps to stop the withdrawal syndrome in the treatment of chronic alcoholism. Contraindications for use are renal failure and the recovery period after a stroke. The cost of the drug - from 250 rubles.
• (vinpocetine). Corrects cerebral circulation, alleviates the effects of hypoxia, dilates brain vessels, protects nerve cells from free radicals. Available in tablet form and in the form of solutions for parenteral administration. The scope of its application is wide - the drug helps to cope with the consequences of strokes, is used for vascular disorders, glaucoma, diabetic retinopathy. A powerful nootropic effect allows it to be included in the complex therapy of traumatic brain injuries and concussions. The drug is well tolerated at any age and is used in both elderly and young patients. The average price of Cavinton is from 280 rubles.
• Pantogam. One of the best and modern nootropics used in pediatric practice. The basis of the drug is hopantenic acid. This substance has been well studied and has been successfully used to treat children with organic and functional disorders. Pantogam is produced in the form of tablets, capsules and cherry-flavored sweet syrup, which is very popular with young patients. Mild action and a minimum of side effects allows you to use the drug from the first days of a child's life. Pantogam successfully combines a stimulating effect with a slight sedative effect and well levels out various toxic effects on brain tissue. The drug is used to treat cerebral palsy, mental retardation and mental development. It allows you to eliminate neurosis-like conditions and hyperactivity syndrome, is used in the treatment of urinary incontinence (enuresis). The cost of the drug is from 500 rubles.

The best nootropics with an additional energizing effect

• . A drug from the group of neuroleptics, which has a pronounced psychostimulating effect, therefore it is widely used in the treatment of asthenic syndrome, which develops against the background of severe infections and somatic diseases. Phenotropil has a powerful activating effect on subcortical structures, accelerates the exchange of information, improves the emotional background and additionally exhibits an anticonvulsant effect. The drug is able to increase the pain threshold, so it can be used as an anesthetic for neuropathic pain. Phenotropil helps the body adapt to high mental and physical stress and it is easier to endure stress. Additionally, it improves color perception, increases the field of view, and can be used as part of the complex therapy of varicose veins and obesity. The average price is from 900 rubles.

The best nootropics with calming effects

• . The drug relieves increased anxiety, relieves unreasonable fears, normalizes sleep, and provides a slight sedative effect. It is successfully used in the complex therapy of encephalopathy, helps to recover from a stroke, improves psychological performance. It is used to prevent seasickness. It is well tolerated by patients, does not have a depressing effect on the psyche when used in the elderly. The price of the drug is from 350 rubles.
• . The most inexpensive and affordable nootropic drug based on a purified amino acid. It is used to improve memory in the process of teaching schoolchildren and students, as well as in the treatment of the consequences of strokes. Glycine helps to fight mental burnout, relieves neurosis-like states, relieves manifestations of vegetative-vascular dystonia, alleviates the condition during hypertensive and hypotensive crises, and increases the body's resistance to stress factors. The drug has practically no side effects and can be used in different age groups. The price of Glycine is from 40 rubles.

Popular New Generation Nootropics

• Orocetam. Combined remedy with a nootropic effect based on piracetam and orotic acid. Available in the form of a solution for intravenous injection. It is used for severe intoxication of the brain, improves metabolic processes in nerve cells and activates the detoxification functions of the liver. The price of one ampoule of Orocetam is about 50 rubles.
• . Combined drug, which includes piracetam and cinnarizine. Produced in the form of capsules. The drug improves blood microcirculation in the brain, promotes the expansion of blood vessels, improves visual and auditory perception. Phezam relieves headaches well, fights dizziness, the effects of hypoxia and cerebrovascular disorders, and helps fight amnesia. The new nootropic agent is included in the complex therapy of encephalitis, craniocerebral injuries, and is used to combat the consequences of a stroke. The cost of the drug - from 260 rubles.
• Thiocetam. The basis of the drug is a combination of piracetam and thiotriosalin. Available in the form of tablets and solution for injection. They will be used to treat speech disorders caused by impaired cerebral circulation, as well as to eliminate the consequences of intoxication of the body in chronic alcoholism. The price of tablets is from 550 rubles.

The list of nootropic drugs used to eliminate functional disorders of the brain and improve intellectual abilities is not limited to the above means. Demanded drugs widely used in neurological practice are such drugs as:

• cinnarizine,
• Actovegin,
• Cerebrolysin.

This list is supplemented by such popular medicines as Semax, Tanakan, Lucetam, Instenon or Biotropil. Only a specialist can decide which drug will be the most effective in a particular case.

Nootropics are widely used in various fields of medicine, in their practice they are used by ophthalmologists, cardiologists, pediatricians or neurosurgeons. But most often, neurologists and psychiatrists resort to prescribing nootropics.

It is this group of medicines that helps a person cope with intellectual and physical stress, which are inevitable in the frantic pace of modern life. Patient reviews indicate that nootropics normalize the state of vascular disorders, help to cope with cerebrovascular insufficiency and reduce the risk of stroke.

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, trauma or hypoxia. Nootropics improve memory, increase intelligence, stimulate cognitive activity.

From the ancient Greek language, the term "nootropics" means "the desire for thinking." For the first time this concept was introduced in the last century by pharmacologists from Belgium. Cerebroprotectors activate neurometabolic processes in the brain and increase the overall resistance of the body to the action of extreme factors.

Nootropics were not singled out as an independent pharmacological group, they were combined with psychostimulants. Unlike the latter, nootropics are antihypoxants, but they 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 and analgesic effect. Nootropics do not increase psychophysical activity and do not cause pharmacological dependence.

All nootropics are divided into 2 large groups:

• "True" nootropics that have the only effect - improving memory and speech;
• with antihypoxic, sedative, anticonvulsant, 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, prevention and hypoxia. Nootropics stimulate metabolic processes in the nervous tissue and normalize them in case of poisoning and traumatic injury.

Currently, pharmacologists are developing and synthesizing the latest 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 narcology.

Mechanism of action

Nootropics have a direct impact 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. Nootropics rejuvenate the body and prolong life.

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

Mechanisms of action of nootropics:

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

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

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

Nootropic drugs are most often prescribed for the elderly 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

Nootropics have the following effects on the human body:

spectrum of action of nootropics

1. Psychostimulating - stimulation of brain functions in mentally inert individuals suffering from hypobulia, apathy, psychomotor retardation.
2. Antihypoxic - formation of resistance of brain cells to oxygen deficiency.
3. Sedative - soothing, inhibiting effect on the body.
4. Antiasthenic - elimination of symptoms of asthenic syndrome.
5. Antidepressant - the fight against depression.
6. Antiepileptic - prevention of convulsions, loss and confusion of consciousness, behavioral and autonomic disorders.
7. Nootropic - stimulation of cognitive activity.
8. Adaptogenic - the development of the body's resistance to the effects of negative factors.
9. Vasovegetative - acceleration of cerebral blood flow and elimination of the main symptoms.
10. Lipolytic - the use of fatty acids as an energy source.
11. Antitoxic - neutralization or excretion 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 nootropics:

Nootropics are contraindicated in individuals with individual hypersensitivity to the main active ingredient of the drug, severe psychomotor agitation, hepatic and renal insufficiency or bulimia, as well as those who have had acute, suffering from Hettington's chorea, who have severe renal dysfunction, pregnant and lactating women.

Side effects

Side effects that occur during treatment with nootropic drugs:

1. hyperexcitability,
2. Weakness,
3. Insomnia,
4. Anxiety, anxiety,
5. dyspeptic symptoms,
6. Hepato- or nephrotoxicity,
7. eosinophilia,
8. Frequent attacks of angina pectoris
9. Convulsions, epileptic seizures,
10. imbalance,
11. hallucinations,
12. Ataxia,
13. confusion,
14. Fever,
15. Thrombophlebitis and pain at the injection site,
16. motor disinhibition,
17. Feeling of heat and flushing of the face,
18. Eruptions on the face and body like urticaria.

Description of drugs

List of the best nootropic drugs that have become widespread in medical practice:

• "Piracetam" has a positive effect on metabolic processes in the brain. The drug is prescribed for the treatment, memory improvement, correction of dyslexia, cerebrosthenia and in children. "Piracetam" is an emergency remedy for withdrawal symptoms and delirium in alcoholics. It is used for viral neuroinfections and in the complex therapy of myocardial infarction.
• "Vinpocetine"- a neurometabolic agent that dilates the vessels of the brain and improves microcirculation. The drug supplies the brain tissue with oxygen and nutrients, reduces systemic blood pressure. Vinpocetine tablets thin the blood and improve its rheological properties. The drug has an antioxidant and neuroprotective effect. First, the drug is administered intravenously by drip for 14 days, and then proceed to oral administration of tablets.
• "Fenibut" appoint patients with asthenia, neurosis, insomnia, dysfunction of the vestibular apparatus. Children "Fenibut" helps to 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"- an effective nootropic agent, widely used for the treatment of children. The main active ingredient of the drug is vitamin B 15. This is a physiologically active substance found in almost all plants and products.
• Phenotropil- a drug of the latest generation, which is popular with both patients and doctors. It has a pronounced adaptogenic effect and increases the body's resistance to stress. The drug does not cause dependence. It is often recommended to students during preparation 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, dilates blood vessels, stimulates the functioning of the organ of hearing and vision. "Fezam" eliminates the effects of hypoxia, relieves headaches, fights against dizziness and amnesia. Persons who have had a stroke, 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 the vessels of 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, the metabolism in the cells of the nervous system improves.
• "Cinnarizine"- a nootropic drug that strengthens the walls of cerebral vessels and causes them to dilate without changing blood pressure indicators. "Cinnarizine" has a sensitizing effect, suppresses nystagmus and is an effective prophylactic against motion sickness. It dilates small arteries and peripheral capillaries. The drug is released in a single dosage form - in the form of tablets for oral administration. "Cinnarizine" is prescribed not only for the treatment of cerebrovascular insufficiency, but also for the prevention of migraine attacks and kinetosis. The medicine stops the symptoms of vegetovascular dystonia and: weakness, headache, dizziness. "Cinnarizine" is used to alleviate the condition in menopause. The drug normalizes sleep, relieves irritability, eliminates.
• "Cerebrolysin"- a complex nootropic drug that has passed clinical trials that confirmed its effectiveness and safety. The drug 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 the processes of mental activity and improves mood. Long-term use of the drug improves memory processes, increases concentration and learning ability.
• "Actovegin"- antihypoxant, intended for the treatment of metabolic and vascular disorders of the brain and promotes rapid healing of wounds. The drug is used for the prevention and treatment of radiation skin lesions, peripheral vascular disorders, diabetic polyneuropathy. "Actovegin" is produced in tablets for oral administration, as well as in the form of a solution for intramuscular, intravenous and intra-arterial injections. Gel, ointment and cream "Actovegin" is used topically.

The list of drugs in this group contains substances that help protect the brain from damage and stimulate nerve cells to restore them to the level of healthy people.

Nootropic, what is it?

The concept of "nootropic drug" was first introduced in the last century by Belgian pharmacologists.

Nootropics are neurometabolic stimulants that activate metabolic processes in the brain, increasing its overall resistance to extreme situations and impacts.

A distinctive factor from psychostimulants is that nootropics are antihypoxants (oppose oxygen starvation of the brain), but they do not negatively affect the human body, do not lead to brain malfunctions, and do not disrupt movement coordination.

Medicines of this group are often of interest to students and people who experience strong intellectual or stressful loads, since the instructions indicate that the drugs contribute to better assimilation of information, quick thinking, improvements in learning and smoothes the effect on the brain during stress and mental stress.

In pharmacology, there is one division of nootropics, into two groups:

What pharmacological group do they belong to?

The nootropic group includes drugs with nootropic action, and they are assigned in pharmacology under the coding (ATC code: N06BX).

The first drug in the group of nootropic drugs is Piracetam.

It was opened back in 1963, and gave a start to their development. The nootropic became the main competitor of psychostimulants, since the side effects from it were not so serious.

Therapy with nootropics does not cause addiction, toxic damage, excitation and exhaustion of the body, inherent in psychostimulants. In the early stages of drug development, it was used to treat brain dysfunction in the elderly.

Fact! In modern pharmacology, Piracetam is listed under the name Nootropil.

The table shows a list of drugs that are most often prescribed in the treatment of nootropics.

The mechanism of action of nootropics

Most drugs of the nootropic group act on neurotransmitters (substances that promote the interaction of nerve cells with each other).

Nootropic therapy affects acetylcholine (which carries out neuromuscular transmission), serotonin (hormone of happiness), dopamine (the precursor of norepinephrine, is a necessary part of the "reward system" of the brain, as it induces a feeling of pleasure, which affects the processes of motivation and learning) and norepinephrine ( one of the most important mediators of wakefulness).

The nootropic effect can prolong life and rejuvenate the body.

Also, these drugs protect nerve cells from deformation and eliminate oxygen starvation, stimulate metabolic processes and simply improve blood circulation in brain tissues.

Different drugs of the nootropic group can have different effects on the body, it all depends on the group to which the drug belongs.

Among them:

Fact! It may take from a couple of days to a couple of weeks to initiate biochemical processes in the brain, depending on the drug used. This explains the fact that nootropics are used in courses. It does not make sense to drink pills immediately before brain loads, you need to start using them about a month in advance.

What effect do nootropics have?

The impact on the above mechanisms in the brain makes it possible to conclude that the following positive effects on the body and its systems are:

• Vasovegetative action characterized by the acceleration of blood circulation and the elimination of the main signs of neurocircular dystonia;
• Antihypoxic action due to the formation of increased resistance of brain cells to oxygen starvation;
• Antidepressant action. Separate nootropics are prescribed for depression, and are aimed at counteracting it;
• Psychostimulating action due to stimulation of the functioning of the brain in people with mental disorders suffering from apathy, motor retardation;
• Antiepileptic action characterized by the fact that it prevents convulsions, confusion and its complete loss, as well as the prevention of behavioral disorders and the autonomic system;
• Action with a sedative effect characterized by a calming effect;
• Nootropic action directed to the stimulation of cognitive activity;
• Antitoxic action e is the neutralization, or removal of toxins from the human body;
• Adaptogenic action due to the development of the body's resistance to the influence of negative factors;
• Immunostimulating action characterized by strengthening the immune system and increasing the overall resistance of the body;
• Lipolytic action due to the use of fatty acids as an energy source.

Note! Nootropics, in most cases, are prescribed for the elderly and children. This is explained by the fact that in old age it is necessary to correct deviations in the functionality of intellectual activity (memory, attention). Appointment in childhood occurs in the fight against violations of the intellectual development of the child.

Is it dangerous to treat nootropics and are they harmful?

The consequences of using nootropics can range from headaches and dizziness to overexcitation of the nervous system.

But since they are not pathologically dangerous, the catalog of drugs can be prescribed to almost any patient.

The most serious and common side effect is withdrawal.

It can occur with a sharp cessation of the use of medicines, which leads to the suffering of the body.

Its most common manifestations can be in headaches, lethargy, aggressiveness, sleep loss, dizziness, etc. that is why the termination of the course of treatment occurs with a gradual decrease in the drugs used.

The main side effects noted with nootropics are listed below:

Indications for the use of nootropics

The main indications for the appointment of nootropics and their therapy are as follows:

Contraindications to the use of nootropics are:

• hemorrhagic stroke;
• Severe kidney pathology;
• The period of bearing and feeding a child;
• Insufficiency of the kidneys, or liver;
• Clearly manifested psychomotor agitation;
• Sensitivity to the active substances of the drug.

Most Common Nootropics

Medicines of nootropic therapy are divided into groups of new and old generation. The latter include medicines that were discovered a long time ago, even at the start of neurostimulators. These are production forms from Piracetam.

These drugs are:

• Pramiracetam;
• Aniracetam;
• Oxiracetam;
• Isacetam;
• Etiracetam;
• detiracetam;
• Nefiracetam.

After the nineties of the twentieth century, there was a new round in the history of the development of nootropics. New drugs are distinguished by a selective effect on individual functions of the body.

The most commonly prescribed new generation drugs are:

• Pantogam- the most effective nootropic agent, often used for treatment in childhood. The main active ingredient is vitamin B15, which is found in almost all plant substances;
• Phenibut is prescribed for a state of general weakness, neuroses, sleep disturbances and deviations in the normal functioning of the vestibular apparatus. The interaction of Phenibut helps children overcome stuttering and various tics. This drug normalizes metabolism, stimulates mental processes (memory, attention, etc.), and also has an antioxidant effect. This preparation practically does not contain toxins and does not cause allergies;
• Phezam is a nootropic prescribed in combination with other drugs for malfunctions of blood circulation in the brain cavity. This drug eliminates the effects of oxygen starvation, helps with headaches, migraines, dizziness and memory loss. Long courses of treatment are prescribed for stroke, traumatic brain injury and inflammation of the membranes and tissues of the brain;
• Piracetam is a classic remedy prescribed to improve metabolic processes in the brain. Effectively treats dizziness, improves memory, and treats encephalopathy in childhood. The drug quickly removes the negative effects of excessive consumption of alcoholic beverages. It is used for viral neuroinfections and as one of the drugs for recovery after the death of cardiac muscle tissue. The drug is sold both in tablets and in ampoules, solutions, syrups and capsules, which helps to choose the most convenient form of application;
• Cinnarazine- a drug of the nootropic group, which helps to expand the walls of cerebral vessels and helps to increase their size without violating blood pressure indicators. Nootropil cinnarizine is an effective drug against motion sickness, as well as suppression of nystagmus. The drug helps to stop high blood pressure, sensation of tinnitus, general weakness, pain in the head, restores normal sleep, removes aggressiveness, etc .;
• Actovegin- a drug of the nootropic group, aimed at combating oxygen starvation of the brain, restoring metabolic processes, and contributing to the rapid healing of wounds. The drug is available in tablets and in the form of an ointment or cream;
• Cerebrolysin is a nootropic used in combination with other drugs. This drug has passed all the tests, and confirmed its safety and effectiveness. Stimulates mental activity and improves mood. Long-term use of the drug improves memory processes, increases concentration and the ability to learn.

What actions will help you recover faster and keep your body in good shape?

Preventive actions in order not to come to the use of nootropics are:

• Compliance with the regime of the day with proper rest and sleep (at least 8 hours);
• Proper nutrition should be balanced and versatile, with a large amount of vitamins and nutrients;
• Maintaining water balance (at least 1.5 liters of pure water per day) will help the blood not to thicken and circulate normally;
• Avoid stressful situations, psycho-emotional and intellectual overload;
• Quit smoking, alcohol and drugs;
• Get a full check-up once a year.

Conclusion

Preparations of the nootropic group are effective means used to improve the functioning of brain processes.

It is especially effective to take them in courses, in advance of intellectual or psycho-emotional stress.

A wide range of drugs and a low chance of side effects make drugs affordable and effective. In order to prevent burdens, it is better to consult a qualified doctor.

Currently, many people, especially those living in megacities, regularly experience mental stress. The bad ecological situation also has a negative impact on the organism of the inhabitants of large cities. Stress is far from harmless. Frequent overexertion of the nervous system over time leads to its exhaustion, resulting in more or less pronounced nervous disorders and even mental illness. Exposure to stress factors greatly increases the likelihood of pathologies of the cardiovascular system. On "nervous soil" and often develop.

In a person subject to regular stress, the ability to memorize decreases and cognitive activity worsens. He becomes more irritable and susceptible. For many decades, experts have been trying to find means to prevent and minimize the adverse effects of stress on the human body.

Nootropics are medicines that improve the ability to remember, stimulate mental activity and make the human brain more resistant to factors such as oxygen starvation, the effects of toxic substances, and even injury.

Note:the first effective nootropic - Piracetam was obtained over half a century ago. It was created by pharmacologists from Belgium. The drug passed extensive clinical trials in 1963.

Work on the creation of new drugs-nootropics is actively underway today. Currently, there are a number of very effective means that increase the functional activity of the brain. They help people cope with psycho-emotional overstrain and stabilize the nervous system.

The nootropic effect is a positive effect on the higher functions of the cortex.

Other positive effects of modern nootropics include:

Note:antiasthenic action is to reduce the feeling of general weakness and lethargy, as well as to minimize the manifestations of mental asthenia. The mnemotropic effect implies an improvement in the ability to remember and learn in general. Under the vasovegetative action is understood the stimulation of blood circulation in the so-called. "brain pool". Nootropic drugs are strong adaptogens that allow the body to adapt to the effects of various (mostly unfavorable) environmental factors.

The latest generation nootropics are able to increase the clarity of consciousness. Modern drugs of this class do not provoke psychomotor agitation. They do not cause drug dependence (addiction) and even with prolonged use do not deplete the body's own resources.

Nootropics are able to activate the process of biosynthesis of ribonucleic acid and protein compounds in the central nervous system. They accelerate energy processes in the processes of cells of the nervous system and improve the transmission of nerve impulses. Preparations at the cellular level significantly reduce the formation of free radicals, i.e., have an antioxidant effect. They optimize the utilization of glucose and other polysaccharide compounds. Nootropics are responsible for the formation of proteins and phospholipids in neurocytes, due to which their membranes are stabilized. The drugs of this group increase the concentration of adenylate cyclase in the cells of the nervous system, due to which the ATP process, the main energy base of cells, is normalized. Adenosine triphosphoric acid in conditions of insufficient oxygen supply stabilizes metabolism in the brain.

Important:nootropic drugs increase the level of formation and release of neurotransmitters - serotonin, dopamine, norepinephrine and acetylcholine.

Classification of nootropic drugs

Nootropics include the means of several clinical and pharmacological groups.

1. Metabolic stimulants in nerve cells:
   • GABA derivatives:

• Phenibut;
• Aminalon;
• Hopantenic acid.
  • Pyrrolidone derivatives:
• Piracetam;
• Phenylpiracetam;
• Pramiracetam.

Note:pantothenic acid compounds include the common nootropic Pantogam, and Pyritinol is produced on the basis of vitamin B6.

• Products containing dimethylaminoethanol include:

• Centrophenoxin;
• Acephen.
  • Among the drugs with peptides and amino acids are the following drugs:
• Actovegin;
• Glycine;
• Cerebrolysin.

1. Nootropics that reduce the negative effects of oxygen deficiency include, in particular, Oxymethylethylpyridine succinate.
2. Vitamin-like preparations and nootropic adaptogens include succinic acid, vitamins E and B15, and an extract from ginseng root.
3. Vasotropic, i.e., drugs that positively affect cerebral blood vessels, are Vinpocetine, Cinnarizine and Instenon.
4. To improve memory, tools with a different mechanism of action are used:
   • Anticholesterase agents and cholinomimetics:

• Choline;
• Galantamine;
• Amiridin.
  • Hormonal preparations:
• endorphins;
• enkephalins;
• ACTH;
• Corticotropin.

Indications for the use of nootropic drugs

Drugs of this clinical and pharmacological group are prescribed for such diseases and pathological conditions:

• decreased mental and physical activity;
• deterioration of mental abilities;
• problems with memory and concentration;
• neuroinfections (for example, encephalitis or poliomyelitis);
• effects on the brain of toxic substances;
• consequences of impaired cerebral blood flow;
• senile dementia;
• encephalopathy and abstinence against the background of regular alcohol abuse;
• stuttering;
• consequences of TBI (brain damage);
• ischemic stroke;
• enuresis;
• hyperkinesis.

Note:nootropic drugs are used in the treatment of ophthalmic diseases such as diabetic retinopathy, retinal pathology of vascular origin and open-angle glaucoma

Nootropics in Pediatrics

Pediatricians can prescribe nootropics to children suffering from the following pathologies:

• delayed speech development;
• deviations in general mental development;
• mental retardation of varying severity;
• defeat at the time of birth (for example, with hypoxia).

Contraindications to the use of nootropics

Nootropics are not prescribed to patients when diagnosing:

• hypersensitivity to the active ingredient or intolerance to auxiliary ingredients;
• pronounced decrease in the functional activity of the kidneys (acute or chronic renal failure);
• hemorrhagic stroke (acute period);
• chorea of ​​Hettington (hereditary degenerative disease of the central nervous system).

Important:Nootropics are not prescribed for pregnant and lactating women!

Side effects

The vast majority of patients tolerate nootropic therapy well.

In some cases, the following side effects may develop:

• unmotivated feeling of anxiety;
• night sleep disturbances;
• daytime sleepiness;
• increased irritability;
• instability of blood pressure;
• dyspeptic disorders;
• allergy.

Note:in elderly and senile patients, nootropics in rare cases can provoke an increase in the severity of the clinical manifestations of coronary insufficiency.

Drugs that are currently most widely used in clinical practice

1. Piracetam (analogues - Nootropil and Lucetam) It is produced in tablet form for per os administration, as well as in the form of a solution for intramuscular injections and intravenous infusions. The tool improves metabolism in the central nervous system and stimulates cerebral circulation. Piracetam has a negative effect on platelet aggregation, and therefore, in cases of blood clotting disorders, it should be used with caution.

1. Pramiracetam, which is available in the form of tablets, is characterized by a high degree of affinity for choline. The drug increases cognitive abilities and improves memory. It does not have a sedative (sedative) property. The tool is recommended for long-term course treatment; The effect fully develops after 1-2 months from the start of the intake. Use with caution in patients with renal insufficiency!
2. Cavinton (analogues - Vinpocetine and Neurovin). The drug is produced by pharmaceutical companies both in the form of tablets and in an injection solution. It improves blood flow in the cerebral vessels. The tool is widely used in neurology, as well as in ophthalmic practice in the complex treatment of retinal pathologies. It is also effective in improving hearing acuity. Course treatment is recommended for 1-8 months, depending on the nosological form and dynamics. The drug should be canceled by gradually reducing the dose within 4-5 days. In the acute period of the disease, parenteral administration of the solution is indicated; as the condition improves, the injection form is replaced with tablets.

1. Phenibut (analogues - Noobut ​​and Bifren)- Produced in the form of powder, capsules and tablets. The drug allows you to deal with memory impairment and oxygen starvation of nerve cells. It increases not only mental, but also physical performance, allows you to reduce nervous tension, get rid of feelings of anxiety and normalize sleep. Phenibut should be prescribed with caution in parallel with hypnotics and antipsychotics, since the nootropic potentiates their effect. The drug is indicated for a decrease in intelligence and neurosis-like disorders. It is recommended to travelers as a remedy for seasickness and motion sickness. Shown course reception for 1-1.5 months.

1. Cerebrolysin- has a positive effect in the treatment of serious organic lesions and neurodegenerative pathologies of the central nervous system, including even Alzheimer's disease. The drug is widely used in the complex therapy of the consequences of head injuries and strokes. The tool is produced in the form of an injection solution.

1. encephabol- for adults it is available in tablets, and for children - in the form of a suspension with a pleasant taste and smell. The drug is a powerful neuroprotector and antioxidant. The tool normalizes behavioral functions and improves cognitive abilities.

Side effects of nootropics

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

The last 30 years have been marked by an increasing use of nootropics. The term "nootropic drug" (from the Greek noos - thinking, mind; tropos - aspiration) was proposed in 1972 by S. Giurgea (Giurgea) to refer to drugs that have a specific activating effect on the integrative functions of the brain, stimulate learning, memory and mental activities that increase the resistance of the brain to damaging factors, 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, it does not cause such side effects as speech and motor arousal, depletion of the body's functional capabilities with prolonged 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 time, a significant number of drugs were created, which are used primarily to correct disturbed mnestic functions, as well as to reduce the level of vital activity that occurs with many diseases and extreme effects. 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 frequency of diseases associated with age.

In addition, nootropics are used for disorders of cerebral circulation, intoxication (including alcohol), withdrawal symptoms, sleep deprivation, fatigue, asthenic and depressive conditions after traumatic brain injuries and neuroinfections, as well as for correcting the side effects of psychopharmacotherapy (in the treatment of neuroleptics, antidepressants, psychostimulants). In children's practice, nootropic drugs are used to treat cerebral palsy, encephalopathy, intellectual disability, disorders that develop in premature babies as a result of intrauterine hypoxia and other damaging effects.

A feature of nootropics is the possibility of their use not only by sick people, but also by healthy people in extreme situations to relieve mental fatigue, improve mental performance.

In general, nootropic drugs are characterized by relatively low toxicity and relatively infrequent development of undesirable effects. According to OA Gromova, the latter are observed in slightly 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 classification of nootropic drugs.

Nootropics include numerous drugs with different chemical structures and mechanisms of action. This circumstance alone makes it difficult to classify them. 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, nootropic action is only one of the components of pharmacodynamics. So, many GABAergic drugs, along with nootropics, have anxiolytic, sedative, anticonvulsant, muscle relaxant, antihypoxic effects (even such terms as "nootropic agent", "tranquilonotropic" etc.). The nootropic effect may be associated with an improvement in cerebral circulation (vinpocetine, nicergoline and other cerebrovasoactive drugs). Such polyvalent preparations 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 action

pyrrolidone derivatives

Considering the side effects of nootropic drugs, let's start with the historically first group - pyrrolidone derivatives, or racetams. Today, more than 1,500 substances of this 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 improved blood circulation in the brain.

The main and most commonly used representative of this group is piracetam. Its side effects are rare and mostly in the mentally ill. These effects include dizziness, tremors, nervousness, irritability. Sleep disturbances are possible - mainly insomnia, less often drowsiness. Due to the risk of sleep disturbances, piracetam should not be taken at night. In isolated cases, when using piracetam, sexual arousal is noted. Sometimes there are dyspeptic phenomena: 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 for the duration of treatment), in infancy (up to 1 year). According to the data summarized by A.P. Kiryushchenkov and M.L. Tarakhovskiy, G.V. Kovalev, the effect of piracetam and many other nootropic agents on the fetus has not been studied enough, although experimental data indicate the absence of embryotoxicity and teratogenicity. Obviously, in-depth studies are needed, including the elucidation of possible long-term effects of the long-term effect of piracetam on the fetus. At the same time, there are indications of a positive effect of high doses of piracetam (up to 3-10 g) on ​​distress syndrome in newborns (the drug was administered intravenously to parturient women).

Relative contraindications associated with the side effects of piracetam are states of psychomotor agitation (manic, hebephrenic, catatonic, hallucinatory-paranoid, psychopathic). Special care is needed 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 not advisable to prescribe the drug to children with diabetes mellitus, with a history of allergic reactions to the use of fruit juices, essences, etc. When treating with piracetam in 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 in this disease usually brings only a temporary effect, followed by a rapidly progressive decline in memory and intelligence. Since the mechanisms of mnestic disorders in Alzheimer's disease are mainly associated with a deficiency of cholinergic transmission in the brain, the use of drugs that enhance it has the greatest positive effect. The leading place today is occupied by anticholinesterase drugs, namely amyridine and tacrine. They contribute to the accumulation of acetylcholine due to the inhibition of the cholinesterase enzyme that destroys it.

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

Amyridine is contraindicated in patients with 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, amyridine should not be prescribed during pregnancy and lactation.

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

The list of contraindications to the appointment of tacrine is quite large. 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), obstruction of the gastrointestinal intestinal tract or urinary tract, liver dysfunction (even in history), Parkinson's disease and symptomatic parkinsonism, peptic ulcer of the stomach and duodenum.

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

Another approach to enhance cholinergic transmission involves increasing the synthesis of the mediator acetylcholine. This mechanism of action is gliatilin (choline alfoscerate). In the body, it is broken down into choline and glycerophosphate. Choline is used for the synthesis of acetylcholine, and glycerophosphate is used for the synthesis of phosphatidylcholine in neuronal membranes. Unlike anticholinesterase drugs, gliatilin is almost devoid of side effects. May cause nausea, apparently associated with the 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, an increase in glucose utilization by brain cells), and with an improvement in cerebral blood flow, 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 (aminalon, gammalon) usually well tolerated. Only sometimes such side effects as a feeling of heat, insomnia, nausea, vomiting, dyspeptic disorders, fluctuations in blood pressure (in the first days of treatment, are associated with the vasoactive properties of GABA), an increase in body temperature are possible. When the dose is reduced, these phenomena usually pass quickly. This drug is contraindicated in case of hypersensitivity to it.

Using pantogam (hopantenic acid) allergic reactions (rhinitis, conjunctivitis, skin rash) are possible, disappearing with the withdrawal 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, 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 disease.

Phenibut, due to increased inhibitory GABA-ergic processes, can cause such a side effect as drowsiness during the first doses. Sometimes allergic reactions are noted. Contraindicated in case of individual intolerance, liver failure.

sodium oxybutyrate, combining nootropic, antihypoxic, hypothermic, sedative, hypnotic, anesthetic effects, has side effects most often with rapid intravenous administration. The drug is capable of causing motor excitation, convulsive twitching of the limbs and tongue, even cases of respiratory arrest are known. Therefore, a slow introduction of sodium hydroxybutyrate into a vein is necessary. 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 sleepiness. With prolonged use of large doses of the drug, hypokalemia may develop (the corrector for this side effect is potassium chloride, asparkam, panangin).

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

Glutamatergic drugs

The glutamatergic system plays one of the important roles 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 action. Glutamate is an excitatory neurotransmitter, and glutamate receptors (particularly NMDA receptors) are increasingly involved in the mechanisms of memory impairment in various CNS diseases.

Glycine, which is a non-essential amino acid and affects 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, a non-competitive NMDA receptor antagonist, along with a nootropic effect, has a neuroprotective effect and is able to correct movement 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, heaviness in the head. In addition, nausea is sometimes possible. Contraindications to the appointment of memantine are confusion and severe renal dysfunction, since 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 of this group are being developed, many of which, obviously, will soon appear on the pharmaceutical market. Let's dwell 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, acute psychotic conditions.

Cerebrolysin is a complex of neuropeptides (15%) with a molecular weight of not more than 10,000 daltons, free amino acids (85%) and trace elements (O. A. Gromova, 2000) obtained from the brain of young pigs. It has been used as a neuroprotector and nootropic for over 20 years. 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 anti-radical, membrane-protective and neurotrophic activity, inhibits the release of excitatory amino acids (glutamate), improves cerebral blood flow.

Cerebrolysin shows good tolerance. Its side effects are infrequent and are represented by an increase in body temperature (pyrogenic reaction), which occurs mainly with rapid intravenous administration. Therefore, it is necessary to administer the drug 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.

Considering cerebrolysin, one should dwell on such a brain hydrolyzate containing neuropeptides as cerebrolysate. The latter cannot be considered an analogue of Cerebrolysin either in terms of composition or pharmacotherapeutic efficacy 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 transmission of the bovine spongiform encephalopathy virus ("rabies" of cows), which causes an incurable neurodegenerative disease in humans - Creutzfeld's disease. Cerebrolysate should not be injected into a vein, and when administered intramuscularly, it often causes severe irritation. The appointment of cerebrolysate to children is unacceptable.

Antioxidants and membrane protectors

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

Since 1993, Mexidol has been used in the clinic, which contains a residue of succinic acid and has a pronounced nootropic and neuroprotective activity. Along with antioxidant and membrane-protective action (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 well tolerated and rarely has side effects, which include nausea, dry mouth, drowsiness (the latter - mainly when using high doses). Mexidol is contraindicated in acute disorders of the liver and kidneys. The experiment did not reveal embryotoxic, teratogenic, mutagenic effects of the drug.

Meclofenoxate (Cerutil) also well tolerated, only occasionally causing sleep disturbances (therefore, it is not recommended to take the drug later than 16 hours), anxiety, slight pain in the stomach, heartburn, increased appetite. In rare cases, allergic skin reactions are possible. A feature of meclofenoxate is the ability to exacerbate psychotic symptoms (delusions, hallucinations in which the drug is contraindicated), as well as contribute to the emergence of fear and anxiety. It is not recommended to prescribe the drug with a pronounced state of anxiety and arousal. With regard to pregnancy, meclofenoxate can be used if there is a strong indication.

Pyritinol (pyriditol, encephabol), which is a molecule of pyridoxine (vitamin B6, which has an antihypoxic effect) doubled with the help of a disulfide bridge, is devoid of vitamin activity. It exhibits pronounced nootropic properties in combination with antidepressant and sedative effects, being a low-toxic drug. Comparatively infrequent side effects include nausea, headache, insomnia, irritability, in children - psychomotor agitation, sleep disturbance. In such cases, the dose of the drug is reduced, do not prescribe it in the evening. In addition, in some cases, there may be a decrease in appetite, a change in taste, cholestasis, an increase in the level of transaminases, dizziness, fatigue, leukopenia, joint pain, lichen planus, skin allergic reactions, hair loss.

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

ginkgo biloba preparations

Standardized extracts of the relict gymnosperm Ginkgo biloba ( bilobil, memoplant, tanakan etc.) 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. in the extract of ginkgo (bilobil) neuroactive elements were found - magnesium, copper, manganese, selenium, high activity of superoxide dismutase was revealed.

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 blood rheology and microcirculation. Usually ginkgo extracts allowed for non-prescription sale are well tolerated - the frequency of side effects, according to O. A. Gromova, is about 1.7%. These isolated cases manifest themselves in the form of spontaneously passing dyspepsia, even more rarely - in the form of a headache and allergic skin rash.

However, the side effect of ginkgo preparations, such as hemorrhages, is little known and not included in the reference books. In the review by A. V. Astakhova, summarizing the data of clinical observations, there are cases of intracranial hemorrhage and postoperative bleeding after laparoscopic cholecystectomy. Apparently, these complications are associated with the effect of ginkgolides, which inhibit the platelet activating factor and reduce their 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 food supplements, in patients with thrombocytopenia, thrombocytopathies.

Ginkgo preparations are contraindicated in case of individual hypersensitivity. Their appointment 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 apoptosis of neurons. In this regard, calcium channel blockers, which mainly improve cerebral blood flow and are used in cerebral ischemia, also have a proper nootropic effect, the mechanism of which remains not fully understood. Among the numerous "anti-calcium" drugs, nimodipine and cinnarizine demonstrate the greatest affinity for cerebral vessels and the nootropic component of pharmacodynamics. The relatively good tolerability of calcium channel blockers is explained by the wide breadth of their therapeutic action.

The efficacy 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, in dementia, the drug is used in tablets. The spectrum of its side effects is quite wide. Lowering of arterial pressure (due to systemic vasodilation) and dizziness lead in frequency. In addition, the drug can cause dyspepsia, headache, attention and sleep disturbances, psychomotor agitation, a feeling of heat and redness of the face, sweating, less often - tachycardia, thrombocytopenia, angioedema and skin rash.

Nimodipine is contraindicated in pregnancy and lactation, severe liver dysfunction, cerebral edema. Great care must be taken when deciding whether to prescribe the drug to patients with low blood pressure, increased intracranial pressure. You can not use nimodipine during work to persons whose profession is associated with the need for a high concentration of attention (drivers, etc.)

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

Cinnarizine (stugeron) is a popular drug that improves cerebral circulation and has nootropic and vestibuloprotective properties, as well as antihistamine activity. With good tolerance, 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 with long-term treatment with cinnarizine have polymenorrhea, so in such cases it is advisable to cancel it on the days of menstruation.

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

Cerebral vasodilators

The drugs of 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 possible. Thus, vinpocetine (Cavinton) is able to block NMDA receptors, inhibit calcium and sodium channels, inhibit cAMP phosphodiesterase, increase the neurophysiological parameter of long-term potentiation (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 lacks a sedative effect. Usually, when it is used, the level of wakefulness and the parameters of systemic hemodynamics are preserved. 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 cardiac arrhythmias. 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 can be accompanied by a variety of side effects, but their frequency is low. It should be noted that with an increase in the duration of the course of treatment, they are less common. More often than others, erythema, a feeling of heat with reddening of the skin of the face, fatigue, sleep disturbances, decreased appetite, nausea, increased acidity of gastric juice and abdominal pain (stopped by antacids), diarrhea occur. Orthostatic hypotension is less common (due to the risk of which, after the injection of nicergoline, the patient must lie down for some time). It is possible to enhance the effects of antihypertensive drugs, anticoagulants, antiplatelet agents and alcohol.

Contraindications to the use of nicergoline are bleeding, recent myocardial infarction, arterial hypotension, severe bradycardia, pregnancy and lactation. You can not combine this drug with other α-blockers, as well as with β-blockers in order to avoid increasing 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 proper nootropic properties. Compared with previous cerebrovascular drugs, it is somewhat more likely to show side effects, especially when administered intravenously. The frequency of their occurrence is about 4%. There may be a pronounced decrease in blood pressure, tachycardia, headaches due to increased intracranial pressure, discomfort in the heart, flushing of the face. Therefore, intravenous administration should be only drip and very slow (within 3 hours), and the appearance of these symptoms requires the infusion to be stopped. With intramuscular injections, and even more so when using tablets, side effects are less common. 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 in epilepsy, increased intracranial pressure, cerebral hemorrhage. During pregnancy and lactation, it is permissible to use it only under strict indications.

In conclusion of the review of the side effects of the most commonly used nootropic drugs, it should be emphasized that their prevention and correction, taking into account contraindications and adverse drug interactions by doctors and pharmacists are an important reserve for improving the safety of pharmacotherapy.

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