Vinpocetine or glycine which is better. When should you take nootropics? There are such indications of nootropics for their appointment

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 ancestor 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 nootropics, which are distinguished by 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 the new generation, can cause a number of adverse reactions, of which the most common are 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 accidents, and helps to fight the manifestations of 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 the appointment of 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.

Modern medicine offers a wide range of different drugs for children. These include tools that are used in neurology. Often, with any deviations in the neurological development of the child, the doctor prescribes nootropic drugs. Are nootropic drugs safe for children and what effects will their intake entail, we will tell in the article.

What is a nootropic drug?

These drugs got their name from the merger of two Greek words noos - mind and tropos - direction. The main effect of these funds is to improve mental activity. In addition, nootropics help level neurological deficits and increase the endurance of nerve cells under extreme conditions (stress, hypoxia).

In scientific circles, it is believed that the difference between nootropics and other psychotropic drugs is the absence of such effects on the nervous system as stimulation and sedation (sedation). When taking these drugs, the bioelectrical activity of the brain does not change. The only drug that is an exception is Cortexin.

Another positive quality of drugs in this group is low toxicity and inability to disrupt blood circulation.

Mechanism of action and effects of nootropics

The basis of the pharmacological action of these drugs is their beneficial effect on metabolic processes in the brain:

• They enhance the synthesis of high-energy phosphates (biological molecules that store and transfer energy), proteins, and some enzymes.
• Nootropics stabilize the membranes (shells) of neurons that have been damaged.

The following effects that nootropic drugs can have can be distinguished:

• Reducing the manifestations of asthenic syndrome (weakness, fatigue, drowsiness, decreased concentration, sleep disturbances);
• Stimulation by some mental activity;
• Fight against depression;
• Have a moderate inhibitory effect on the nervous system;
• Contribute to the resistance of brain cells (neurons) to oxygen deficiency;
• Reducing the manifestations of epilepsy (moderate anticonvulsant effect);
• Improvement of cerebral blood flow in vegetovascular dystonia;
• Promotes the activation of cognitive activity;
• Contribute to the adaptation of the body to changing environmental conditions;
• Strengthening immunity and overall resilience.

These funds have positive effects only with their long-term use. Nootropic drugs for children with speech disorders and developmental disabilities should be used for at least 2 weeks in combination with other therapeutic measures.

Indications and contraindications for use

Like any drug, nootropic drugs have their own indications and contraindications, which must be taken into account by the doctor when prescribing these drugs.

• Cerebral palsy;
• Epilepsy;
• Lagging behind in physical and mental development;
• Speech disorders and delay in its development;
• Sequelae of traumatic brain injury;
• Perinatal damage to the nervous system of various origins;
• Transferred neuroinfections;
• Restlessness, disinhibition, attention deficit.

In addition to positive effects, nootropics can also have a negative impact if the child has the following contraindications to their use:

• Violation of the kidneys;
• Increased intracranial pressure;
• Severe psychomotor agitation;
• Pathology of the liver;
• Individual intolerance to any component of the drug

When new generation nootropic drugs are prescribed, the list for children is limited precisely to contraindications to their use. The use of any medication should be agreed with the attending physician.

The Best Nootropics for Kids

The modern pharmaceutical market offers a large number of nootropic products. Such drugs are used in children of any age. Modern drugs are available in various dosage forms that are suitable for use even in the neonatal period.

Cortexin

Produced in the form of bottles with a ready-made solution. The route of administration is only injection (intramuscularly). Contains a complex of polypeptide fractions obtained from the brain of piglets and/or calves.

The mechanism of action of the drug is in such processes as:

• Activation of neuropeptides (proteins that regulate the functioning of nerve cells) and factors that provide nutrition to the brain;
• Optimization of the balance of inhibitory and excitatory substances in the brain;
• inhibitory effect on the nervous system;
• Decreased seizure activity;
• Prevents the formation of free radicals.

More information about indications and contraindications, the method of administration can be found in a separate article on Cortexin.

encephabol

The drug is available in the form of a suspension and tablets. Can be used from the neonatal period (the first 28 days of life). The main effects of this drug are as follows:

1. Improves metabolic processes in brain cells;
2. Promotes the transmission of nerve impulses;
3. Stabilizes the structure of cell membranes, preventing the effects of free radicals (antioxidant action);
4. Reduces blood viscosity and improves blood flow;
5. Improves blood circulation in ischemic areas.

• Violations of memory, thinking, fatigue, reduced concentration of attention;
• Delayed development of the psyche;
• encephalopathy;
• Conditions after suffering encephalitis (inflammation of brain tissues).

Encephabol is contraindicated in cases of:

• Sensitivity to pyritinol (the main active ingredient);
• Kidney disorders;
• Severe liver damage;
• Changes in peripheral blood tests;
• Autoimmune diseases in the acute period;
• myasthenia gravis;
• Pemphigus.

The drug is prescribed in dosages depending on age. It is not recommended to take in the evening and at night. When using Encephabol in newborns with a risk of developing perinatal pathology, the duration of the course of treatment is 6 months, followed by repetition, if necessary, after 3 months.

Aminalon

The drug is produced and produced in tablet form. It is prescribed for children from 1 year. The main active ingredient of the drug is gamma-aminobutyric acid. The effects of the drug are expressed in the fact that it:

• Restoration of metabolic processes in the brain;
• Promotes the removal of toxic substances;
• Improves memory and mental activity;
• It has a mild stimulating effect on the psyche;
• It has a positive effect on the restoration of movements and speech;
• Stabilizes blood pressure.

In addition to the indications inherent in all nootropics, Aminalon is used for sleep disorders caused by increased pressure and motion sickness (seasickness, in land transport).

Of the contraindications, only hypersensitivity to the main component of the drug stands out.

Aminalon is dosed according to age. The daily dose is divided into 3 doses, before meals. The duration of treatment is from 2 weeks to 4 months.

Glutamic acid

This substance is produced in tablets. It is prescribed for children from infancy. Glutamic acid belongs to the group of non-essential amino acids. Actively participates in the metabolism and nutrition of the brain, protecting it from toxins and the effects of hypoxia.

Indications for use are:

• Minor epileptic seizures;
• Schizophrenia;
• Cerebral palsy;
• Mental exhaustion, insomnia;
• Consequences of encephalitis and meningitis;
• Consequences of birth trauma;
• Polio;
• Down's disease.

Glutamic acid is contraindicated in:

• Damage to the kidneys and liver;
• Anemia and oppression of bone hematopoiesis;
• fever;
• peptic ulcer;
• Hypersensitivity to glutamic acid;
• Obesity.

Of the side effects, allergic reactions, abdominal pain, diarrhea, vomiting, overexcitation can be observed. With prolonged use, anemia and a decrease in the level of leukocytes may occur, therefore, when taking this drug, blood tests should be monitored.

Semax

The only nootropic drug that comes in the form of nasal drops. Approved for use in children from 7 years. It is used in pediatrics in the complex treatment of minimal brain dysfunctions.

1-2 drops are prescribed in each nasal passage in the morning and afternoon. The course of treatment is a month. Contraindicated in the presence of seizures in history and in acute mental disorders.

Phenibut

The release form of this drug is tablets. Approved for use in children. Phenibut is prescribed strictly according to indications and in doses according to the age of the child.

The positive properties of the drug are expressed in such effects as:

• Improvement of cerebral circulation;
• Increase mental and physical performance;
• Reducing headaches, sleep disturbances;
• Decreased irritability, emotional lability;
• Improving the condition with motor and speech disorders;
• Improving memory, attention.

The main indications for its use are:

• Asthenic syndrome and anxiety;
• Neurosis and obsessive states;
• stuttering, tics;
• Urinary incontinence;
• Prevention of motion sickness.

Phenibut is contraindicated only with individual sensitivity to the drug, and is also used with caution in diseases of the kidneys and stomach.

Nootropic drugs are widely used in pediatric practice. They have a wide range of positive effects on the functioning of the nervous system. At the same time, they are classified as low-toxic agents. An experienced neurologist will be able to choose an effective drug and prescribe the proper treatment regimen. Therefore, before using a nootropic, you should definitely consult a doctor.

Valentina Ignasheva, pediatrician, specially for the site

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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 desire) was proposed in 1972 by S. Giurgea (Dzhurgea) 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 turned out that piracetam facilitates learning processes and improves memory, but, unlike classical psychostimulants, does not cause such side effects as speech and motor arousal, depletion of the body's functionality 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 that are used primarily to correct disturbed memory 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 pediatric practice, nootropic drugs are used to treat cerebrovascular disease, 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 mainly 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 elucidation of the 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 pyrrolidone drugs 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), changes in mood and psyche (aggressiveness, irritability), extrapyramidal disorders (stiffness and trembling of the limbs), obstruction of the urinary tract (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 hydroxybutyrate, 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 oxybutyrate 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, 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 us 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 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 neuron membrane 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 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 over-the-counter sales 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 self-limited dyspepsia, even less often in the form of 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, cases of intracranial hemorrhages and postoperative bleeding after laparoscopic cholecystectomy are given. 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 borne in mind 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 - hexobendin, 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.

Literature

1. Astakhova AV Side effects of dietary supplement components. Precautions regarding their use in the pre- and postoperative periods // Safety of drugs. Express Information. 2002. No. 1. P. 16-23.
2. Voronina T. A., Seredenin S. B. Nootropic drugs, achievements and new problems // Expert. and wedge. Pharmacology. 1998. T. 61, No. 4. P. 3-9.
3. Voronina T. A., Garibova T. L., Ostrovskaya R. U., Mirzoyan R. S. Polycomponent mechanism of action of new substances with nootropic and neuroprotective effects // 3rd Intern. conf. "Biological basis of individual sensitivity to psychotropic drugs". Suzdal, 2001. P. 41.
4. Gromova OA Neurometabolic pharmacotherapy / Ed. corresponding member RAMS E. M. Burtseva. M., 2000. 85 p.
5. Gromova O. A., Skalny A. V., Burtsev E. M., Avdeenko T. V., Solovyov O. I. Structural analysis of nootropics of natural origin // Man and Medicine: Proceedings of the 7th Russian Congress. M., 1998. P. 330.
6. Drogovoz S. M., Strashny V. V. Pharmacology to help the doctor, pharmacist and student. Kharkiv, 2002. 480 p.
7. Elinov N. P., Gromova E. G. Modern drugs: a reference book with a recipe. St. Petersburg: Publishing House "Piter", 2000. 928 p.
8. Information about medicines for healthcare professionals. Issue. 1. Drugs acting on the central nervous system. M.: RC "Farmedinfo", 1996. 316 p.
9. Kiryushchenkov A.P., Tarakhovsky M.L. Effect of drugs on the fetus. M.: Meditsina, 1990. 272 ​​p.
10. Kovalev G. V. Nootropics. Volgograd: Nizh.-Volzhsk. book. publishing house, 1990. 368 p.
11. Compendium 2001/2002 drugs / Ed. V. N. Kovalenko, A. P. Viktorova. K.: Morion, 2001. 1536 p.
12. Limanova O. A., Shtrygol S. Yu., Gromova O. A., Andreev A. V. Cerebrovascular, renal effects of bilobil and its effect on metal ligand homeostasis (clinical and experimental study) // Eksper. and wedge. Pharmacology. 2002. T. 65, No. 6. P. 28-31.
13. Mashkovsky M.D. Medicines. Kharkov: Torsing, 1997. T. 1. P. 108-109.
14. Register of medicines of Russia. Encyclopedia of Medicines. M., 2002. 1520 p.
15. Vidal's Handbook: Medicines in Russia. M.: AstraPharmService, 2002. 1488 p.
16. Pharmacology: Pidruchnik / I. S. Chekman, N. O. Gorchakova, V. A. Tumanov et al.
17. Windisch M. Cognition-Enhancing (Nootropic) Drugs. Brain mechanisms and psychotropic drugs. New York London Tokyo, 1996. P. 239-257.

Nootropics have ceased to be the lot of geeks, as they were just a few years ago. They quickly became fashionable among students and freelancers, and today they have become commonplace for many other segments of the population. The share of nootropic drugs in the global pharmacological market is already more than $1 billion and continues to grow rapidly.

There is, of course, nothing to be surprised here. If there are pills that promise to make you smarter and more focused, then you are more likely to take them - provided the risks don't outweigh the benefits (you will?)

True, nootropics by themselves have not made anyone smarter yet, but to cope with study loads, successfully pass a session, get out alive from work time pressure, or perform better in the daily tasks of a knowledge worker, they seem to help. But "it seems" here - not from excessive delicacy.

In the English-speaking world, nootropics are also called "smart drugs". There are also such cute definitions as "professors" little helpers ".

There is bad and good news. Let's start with the first one: the effectiveness of most nootropic drugs that are common on the Russian market has not been confirmed by serious clinical trials. Supporters of evidence-based medicine, as a rule, conclude from this that taking nootropics is simply useless. But here one cannot confine oneself to a simple statement.

Now the good news is that nootropics really help a lot of people. Of course, no one has canceled the significance of the placebo effect, but in the case of nootropics, it can be argued that there are other reasons as well.

So, let's try to figure out how nootropics work and what effects to expect from their use.

What do nootropics do to the brain?

Once again, I’ll make a reservation: nootropics by themselves will not make you smarter and will not save you from an overwhelmed session. It would be rather strange to expect that some pills modify your intelligence if you do not put effort into it and do not distribute the mental load more or less rationally.

It is not yet possible to fully understand exactly how nootropics work, and in what cases they can be recommended to healthy people to improve cognitive activity. I am afraid that this will not work, even if you first pump yourself up with some kind of modafinil or pramiracetam and immerse yourself in reading literature on the topic for a year or two.

According to the results of an informal survey conducted on the website of the journal Nature in 2008, out of more than 1400 scientists who took part in it, about 20% use some kind of nootropics.

Let's start with the fact that this class of drugs includes drugs with a variety of pharmacological properties and effects. In the most general sense, nootropics are means that “have a direct activating effect on learning, improve memory and mental activity, increase the resistance of the brain to aggressive environmental influences” (WHO definition).

They operate as follows:

• Stimulate cerebral circulation;
• Improve the intake and absorption of glucose (it is easier to penetrate the blood-brain barrier between the circulatory and nervous systems, and the brain does not lack energy);
• Prevent hypoxia (oxygen starvation) of the brain;
• Improve the interaction between the prefrontal cortex and other areas of the brain, accelerate the exchange of information between its hemispheres;
• They stimulate cognitive functions, processing and memorization of information, influencing the production of certain neurotransmitters, with the help of which neurons exchange their "messages".

It is believed that nootropics optimize metabolism and neural activity, but do not have the same side effects as psychostimulants. For example, caffeine, although it promotes concentration, is not usually considered a nootropic.

Dummy or drug?

Although nootropics are used in medical practice for the treatment of clinical depression, recovery from a stroke, ADHD or asthenic disease, they have not received clinical confirmation in the framework of evidence-based medicine.

This means that in the so-called "blind" studies, when neither doctors nor patients know where the placebo is and where the tested drug is, it was not possible to find a statistically significant difference between the nootropic and the empty pill. Therefore, in the USA, for example, piracetam (also known as Nootropil) is not considered a medical drug at all and is registered as a biologically active food supplement.

But you need to take into account, firstly, that not all nootropics generally passed tests of this kind; and secondly, that they tend to test for a very specific effect of the drug (for example, helping with recovery from strokes, as in the case of Cerebrolysin).

In addition, separate studies have nevertheless demonstrated an improvement in cognitive abilities with the medical and non-medical use of nootropics. This is also evidenced by the experience of many people who take nootropics to increase their intellectual productivity.

According to one of the domestic studies, 69.7% of people out of 120 students who took nootropics felt subjective improvement during the session - however, there was no improvement in the average score.

The fact is that nootropics act very individually. The effects obtained are highly dependent on the properties of your body and what you are doing while taking them. In addition, most nootropics have a cumulative effect (results only show themselves over time), so it is quite difficult to fix it.

In general, the entire range of nootropic drugs can be divided into three groups:

Harmless, but (almost) ineffective. These are brain vitamins like glycine. This amino acid, which is really important for memory and cognitive processes, our body produces on its own. If you already have enough of it, then the effect will depend only on your ability to self-hypnosis.

Effective but not safe. You will either not find these drugs on legal sale at all, or you can only get them by prescription. These include, for example, Ritalin, Modafinil, Adderall and Pramiracetam. They have a strong effect on the nervous system and can be addictive. In Russia, some of them are banned and considered drugs (much to the outrage of transhumanists).

Moderately effective and (almost) safe. Drugs that can act as a placebo, and also improve blood flow to the brain, stimulate the production of certain neurotransmitters, or have an inhibitory effect - help relieve irritability and improve concentration. Phenotropil, for example, rather accelerates, and Phenibut, on the contrary, calms the nervous system (although in some cases it can cause heart rhythm disturbance and anxiety). If you have problems with the blood supply to the brain, such drugs will really help, but if everything is fine, with the right attitude, the placebo effect will come to your aid.

The formula of piracetam is the first drug to be called a nootropic. It was synthesized in 1963 by Belgian pharmacologists and has been used to improve cognitive function in the elderly. In Russia, it remains the most popular drug in this group.

For those wishing to learn more about the effects of various nootropics, we can recommend, for example, a site where there are results of amateur studies and recommendations on the use of nootropics.

More recently, the results of a large-scale (albeit informal) study of nootropics, in which 850 people participated, were published. There were no clinical trials - the participants simply answered a few surveys about their experience with such drugs. In addition to the banned Adderol and Modafinil, domestic drugs Phenibut, Semax and Cerebrolysin received the highest marks in it.

Even if the effect of legal nootropics on healthy people is reduced to placebo, you can distinguish different degrees of their effectiveness: some drugs work better than others for some reason.

In general, reviews about nootropics are more than contradictory. Intelligence is a too complex human property, which, moreover, is highly dependent on heredity. Therefore, it is unlikely that it will be possible to improve it simply with the help of chemical compounds.

Nootropics can temporarily improve certain intellectual abilities - for example, memory or concentration - but at the same time weaken other brain functions and cause addiction. As a result, without the help of magic pills, you will generally forget how to think well.

According to some studies, the results of IQ tests can improve after taking nootropics - but they can change for the worse if they were already high.

In addition to purely medical, there are also ethical considerations. Some people think it's just not fair. Can nootropics be considered doping drugs? It even seems to some that it is time for universities to organize special commissions that will weed out students for such a “scam”. But, in fact, there is nothing to worry about yet: nootropics will not help to radically improve learning abilities anyway.

The cognitive mechanisms of the brain have not yet been studied enough, and pharmacology lags behind neuroscience for decades. Among the most popular nootropics now are still those substances that were synthesized in the 60-70s of the last century.

It can be hoped that the invention of truly effective and at the same time harmless drugs that improve brain function is a matter of the near future. The nootropics that exist now can really increase your intellectual productivity, but in the case of legal drugs, this is most likely to be associated with a placebo effect, and in the case of illegal ones, with unpleasant side effects.

Almost all popular nootropics were originally developed for patients with severe cognitive impairment. While some of them have been shown to be useful in medical applications, they seem to have no effect on healthy people. The conclusion is as follows: if everything is in order with your blood supply and brain function, the effect of nootropics will be slightly less than completely limited only by your subjective feelings.

And of course, it is better to consult a doctor before trying the effects of nootropics on your own brain.

Nootropics, the list of drugs of which today is represented by a wide range of products, originate from 1963. At that time, Belgian clinicians and pharmacologists managed to synthesize and apply in medical practice the first drug from the group of nootropics - Piracetam.

Numerous studies have proven clinical improvements in patients of various groups on the background of continuous use of Piracetam, including memory enhancement, facilitating learning processes.

In 1972, the term "nootropics" was proposed, denoting a class of drugs for improving the integrative functionality of the brain. In modern neurology, nootropic drugs are an integral part of the treatment of various disorders in children and adults.

Characteristics of the pharmaceutical group

Nootropics(from the Greek noos - mind, thoughts and tropos - vector, direction) are widely used in neurological practice for a positive impact on the higher integrative functions of the brain. With the help of drugs, they correct some behavioral reactions in people and adults, increase resistance to stressful situations, the ability to learn, and chronic hypoxia. Other functions of drugs are:

maintaining the energy structure of a neuron (nerve cell);

improving the functionality of the central nervous system;

activation of the plastic functionality of the central nervous system;

providing a pronounced neuroprotective effect;

normalization and stabilization of the cell membrane;

minimizes the need for nerve cells in oxygen.

The nootropic effect can be primary with a direct effect on neurons and secondary with an improvement in general cerebral circulation. There are two main groups of nootropics:

true (improvement of mnestic functions of the brain and nervous system);

combined action (a combination of several functions at the same time).

Synonyms of the pharmacological group of nootropics are cerebroprotectors, neuroregulators, neuroanabolics, eutotrophic, neurometabolic drugs. All terms reflect the general effect of drugs - the ability to stimulate metabolic processes in the nervous structures of the human body.

Mechanism of action

Nootropic drugs directly affect a whole range of functional abilities of the brain, contributing to their vigorous activity. Thanks to adequate therapy, concentration of attention improves, interactions between the right and left hemispheres are facilitated. It has been proven that the drugs rejuvenate the body and prolong the life of patients with a burdened clinical neurological history.

The biogenic origin of the drug largely affects all processes of intracellular metabolism, stimulating the synthesis of proteins, the excretion of excess glucose, and the formation of ATP. The following mechanisms and effects of exposure are distinguished:

membrane stabilizing effect;

antioxidant;

antihypoxic;

neuroprotective.

There is a significant increase in the resistance of the brain to the negative effects of exogenous and endogenous factors. The effectiveness of drugs is enhanced with the simultaneous use of angioprotectors, psychostimulants. The main category of patients who are prescribed nootropics are children and the elderly.

Main indications for use

Typical indications for the appointment of nootropic drugs are the following conditions:

psychoorganic syndrome (dystrophic changes in the nervous tissue of any origin);

alcoholism with withdrawal syndrome;

drug addiction;

neuroleptic syndrome (as a combination therapy);

neurotic or organic asthenia;

cerebrovascular insufficiency;

sickle cell anemia;

ophthalmic pathologies (complex therapy).

With the help of nootropics, urinary disorders of a neurogenic nature are treated. Nootropic drugs are a necessary measure for Parkinson's disease, ischemia, cerebral palsy, epileptic seizures.

Contraindications and side effects

Nootropics may be prescribed for relative contraindications at the discretion of the attending physician. Among the absolute contraindications are acute or chronic renal failure, pregnancy and lactation, hepatic diseases with aggravated course, acute hemorrhagic stroke, hypersensitivity, severe psychomotor agitation. Side effects of the drug are the following conditions:

sleep disturbance, insomnia;

dyspeptic disorders;

hyperexcitability:

anxiety syndrome, panic attacks;

hypotension;

increased effect on hepatic or renal functions;

convulsive syndrome, epileptic seizures;

impaired coordination, unsteady gait;

redness of the face, feeling of heat;

pronounced iosinophilia;

hallucinations and confusion;

thrombophlebitis, febrile syndrome.

Against the background of taking the drug, allergic rashes on the body like urticaria, itching, burning on the skin, mainly in the neck, face, back, are possible. If any discomfort occurs, it is recommended to stop treatment or adjust the daily dosage. Cases of drug overdose are not registered.

Basic nootropics

Which is better in the treatment of neurological diseases? The use of nootropic drugs can be combined and independent. Usually, nootropics as a stand-alone therapy are used for minor disorders. The following drugs with proven efficacy are widely used in neurological practice:

Piracetam.

Probably the most popular nootropic. The drug enhances metabolic processes in the brain. It is used to treat systematic dizziness, correction of dyslexic syndrome. In adult patients, the drug is used as a complex therapy for myocardial infarction, withdrawal syndrome with addictions of any origin. Doctors prescribe a remedy for the treatment of neuroinfections caused by viral agents.

Memoplant

One of the best herbal nootropics. The German drug Memoplant contains a highly purified extract of ginkgo biloba EGb 761®. Many preparations of ginkgo biloba contain a significant amount of harmful impurities - ginkgolic acids. Memoplant is devoid of this drawback, as it is cleaned during 27 stages of production.
The drug increases the resistance of the nervous tissue to a lack of oxygen, improves cerebral circulation. It is effective for dizziness, noise in the ears or head, as well as for memory and performance problems.

Vinpocetine.


Against the background of constant intake, the vessels of the brain expand, microcirculation increases. The active substance of the drug provides a full transport of oxygen to the brain tissues, increases the absorption of nutrients. Vinpocetine has a pronounced neuroprotective and antioxidant effect. The treatment regimen changes from the introduction of intravenous solutions first with the transition after to the tablet form of the drug. It is used as an adjuvant in antihypertensive therapy.

Phenibut.


There is a high efficiency in functional disorders of the vestibular apparatus, sleep disorders, neurosthenia, asthenic syndrome. Against the background of long-term use, metabolic processes in the brain tissues at the cellular level are normalized. The strengths of the drug are psychostimulating ability and antioxidant effect. The drug is characterized by low toxicity, low side effects.

Phenotropil.


The drug belongs to a new generation of nootropics with a pronounced adaptogenic effect. Patients have resistance to stressful situations, without causing, at the same time, drug dependence. Phenotropil is prescribed to patients with severe emotional and mental stress.

Phezam.


Nootropic, directly intended for the treatment of impaired blood circulation in the brain. It is effective for serious diseases of the nervous system, circulation disorders in the vascular system of the brain. In complex therapy, headaches are stopped with increased intracranial pressure, improves the functioning of the organs of hearing and vision. Phezam is prescribed for amnesia, it is highly effective in hypoxic syndrome.

Cinnarizine.


A drug designed to strengthen the vascular walls of the brain during their dilatation (stretching). At the same time, blood pressure indicators remain in the usual norm. Effective as a prevention of motion sickness, disorders of the vestibular apparatus. It is prescribed for chronic migraines, with increased hypertension, accompanied by dizziness, tinnitus, headache. Cinnarizine is used in adult women to reduce symptoms of menopause.

Cerebrolysin.


The safety and efficacy of the drug has been proven by numerous studies. Used as adjuvant therapy against serious psychiatric and neurological disorders. With the correct dosage, mental processes are activated, concentration of attention and mood increase. Long-term use improves memory, increases the ability to learn.

Actovegin.


A drug related to nootropics-antihypoxants. Used to treat metabolic disorders in the brain, promotes rapid healing of wounds. The drug is used as a complex therapy for radiation skin lesions, with diabetic polyneuropathy. Actovegin is available in the form of tablets, intramuscular, intravenous solutions and intra-arterial injections. There is a form of the drug for topical use.

Nootropic drugs for the treatment of serious neurological disorders are used in adult neurological practice. When used as a complex therapy, the probability of a decrease or increase in the activity of other drugs is taken into account.

Best nootropics for kids

In pediatric practice, nootropics are used to treat mental retardation, to improve attention, speech development, with poor school performance. Children's nootropics have been widely used since 1952. The main reasons for the appointment are the following conditions in children of different ages:

cerebrosthenia;

hypoxic syndrome in cerebral palsy:

poor development of speech;

intellectual insufficiency;

encephalopathy.

It has been proven that in childhood the tolerability of nootropic drugs is much better than in adults. The following are considered essential medicines for children:

Piracetam(Nootropil, Cerebril, Lucetam, Oykamid).


They are used in children from 1 year old, available in tablets, ampoules, capsules. It is not prescribed for children with increased emotional excitability. The active substance has a beneficial effect on the brain, enhances susceptibility to intellectual stress, stabilizes concentration, and promotes learning.

Pantogam.


An anticonvulsant drug suitable for children from the first days of life. From pharmacies it is released in the form of syrups and tablets. It is used to treat cerebral palsy, improve the condition in autism, schizophrenia. Pantogam is used for children with neurogenic or stress urinary incontinence. Also, against the background of constant use, the emotional background of the child is normalized, especially with a delay in mental and speech development. Reduced and the likelihood of side effects: drowsiness, allergic reactions, dyspeptic disorders.

Picamilon.

The drug, designed to expand the vessels of the brain, is an analogue of Piracetam in terms of active substance and effectiveness. It has a slight tranquilizing effect. From pharmacies it is released in the form of injections for intravenous and intramuscular administration, in tablets. In pediatrics, it is prescribed for children from 3 years old. The nootropic agent is especially effective at high emotional stress, with increased physical and mental activity.

Phenibut.


The tool belongs to the latest generation of drugs. It is prescribed for children to stimulate the normal functioning of the nervous system, increase mental and intellectual activity, at the same time helping to cope with overload. The drug has a low degree of toxicity, suitable for children over 2 years old. The main side effects include nausea, increased drowsiness, dizziness. From pharmacy chains it is released in the form of powder and tablets.

Pyritinol.


The drug is intended for the effect of mild sedation. Necessary in the treatment of depressive syndrome in adolescents, with vegetative-vascular dystonia, excessive fatigue. It is a complex drug for mental retardation and mental development. Not recommended for use in children under 12 months of age. Despite the high activity, the remedy has a number of side effects: loss of taste, dyspnea, polymyositis, nausea and dizziness.

Cinnarizine(Vertizin, Diziron, Tsirizin, Baltsinnarzin, Cinnaron).


It is used in pediatrics for the treatment of children over 12 years old, but recently it has been practiced to use the remedy in children from 1 year of age. The drug has many side effects from typical nausea to epileptic seizures, impaired renal and hepatic function, arterial hypotension. The effectiveness of the drug has not been proven. The drug is released in the form of capsules and tablets.

Semax.


The drug is widely used in pediatric practice due to its high efficiency and convenient pharmacological form. The drug eliminates excessive capriciousness, emotional excitability. Side effects are expressed in dizziness, nausea, irritation of the nasal mucosa. It is used in children with delayed speech development, with sleep disorders.

Glycine.


The active ingredient is aminoacetic acid. The drug is well tolerated by young children, effective in case of excessive emotional arousal. Against the background of long-term use, working capacity, learning ability are activated, night sleep is regulated, concentration of attention increases. Glycine is suitable for the treatment of children at any age.

Gammalon.


New from Japan, is a follower of Piracetam. A similar composition of Gammalon is contained in Aminalon, but the price of the drug is much lower. If the cost of a Japanese nootropic reaches 2500 rubles. per package, then Aminalon costs 100-150 rubles. for packing. The effectiveness of both drugs has not been studied and proven. The price and quality of the Japanese product is more of a marketing ploy.

The opinions of experts about the effectiveness of nootropics in children differ. Some consider drugs indispensable in the treatment of any neurogenic disorders, psycho-emotional disorders. Others doubt the effectiveness of nootropic drugs due to the lack of clinical data for use in childhood. Basically, nootropics are used for "sedation" as an adjunct treatment to the base treatment. All drugs are dispensed from pharmacy chains without a prescription.

List of the best nootropics

What is better to take drugs in a particular clinical situation should be decided by the attending physician. To date, there are several of the most effective drugs that have found the widest application both in pediatrics and in adult practice in the treatment of diseases of a neurogenic nature:

Piracetam;

Nootropil;

• Cerebrolysin;

  Vinpocetine;

  Biotredin;

  Aminalon;

  Biotredin.

The effect of the constant intake of modern nootropic drugs begins only after a few months. As an independent drug, nootropics are used as a prevention of neurological diseases, decreased performance in adults, and impaired concentration.

Combined funds

Among nootropics, there are preparations with a combined composition. Such funds include two or more active components, which, to one degree or another, enhance or reduce the effect of each other. The main drugs of the series are:

Gamalate B6 (as part of Pyridoxine hydrochloride, magnesium glutamate hydrobromide);

Omaron, Phezam, Evryza, Noozom (Piracetam and Cinnarizine, auxiliary components);

Neuronorm (active substances Piracetam and Cinnarizine);

Olatropil (Piracetam and GABA);

(Piracetam and Thiotriazolin).

All funds are similar in effectiveness to Piracetam. Combined drugs are used for severe problems, similarly to popular drugs, they are used in monotherapy and in combination with other drugs.

All drugs, despite the absence of side effects, require a prescription from a doctor. Only on the basis of medical research data can an accurate diagnosis be established, which will determine further adequate treatment.

• Piracetam (Nootropil)