




































Chauhan & Agarwal                                                                                                                    Nootropics: boon or bane 

Vol 1 | Issue 2 | Jul – Sep 2022                                                                                       Indian J Pharm Drug Studies | 71  

Letter to Editor 

Piracetam induced psychotic symptoms in a preadolescent girl with 

intellectual disability  

Nidhi Chauhan1, Sonali Agarwal2 

From, 1Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 2Junior Resident, 

Department of Psychiatry, Government Medical College & Hospital, Chandigarh, India  

Correspondence to: Nidhi Chauhan, Assistant Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and 

Research, Chandigarh, India. Email: dr.nidhichauhan@gmail.com 

iracetam, a nootropic agent, is believed to improve 

higher brain functions, like learning & memory 

justifying use in individuals with intellectual disability. 

It has a GABA-mimetic action, activating AMPA type 

glutamate receptors and its uses extend beyond the nootropic 

effects. It’s commonly used as an off-label drug, usually 

prescribed for learning difficulties, poor memory and speech 

disorders [1]. Due to its purported effects as intelligence 

enhancers/memory boosters, nootropics are also referred to as 

‘smart drugs’ and are construed as wonder drugs with ‘only 

beneficial effects’ and no side effects [2]. Literature reports 

that this is a serious public health concern similar to that 

associated with anabolic steroid use [2]. Since, piracetam 

crosses blood brain barrier, its central nervous system 

stimulatory effects- psycho- motor agitation, aggression, 

irritability, dysphoria, sleep disturbances, headache, decreased 

appetite are reported in literature [3,4]. In this background, we 

discuss the case of a girl with intellectual disability who 

developed auditory and visual hallucinations in addition to 

CNS adverse effects on prescription of piracetam. Till date, to 

the best of our knowledge no such case with piracetam induced 

psychotic symptoms has been reported.   

An 11 years old girl was admitted to the psychiatry 

emergency room for recent onset change in behaviour i.e., 

irritability, agitation and hallucinatory behaviour. History 

exploration and assessments revealed that she had a preterm 

birth, delayed cry, delayed development in all domains. She 

had learning difficulties since early childhood but no help was 

sought. In May 2021, for persisting academic difficulties and 

poor academic performance, parents consulted a private 

pediatrician who prescribed her Syrup Piracetam (syrup Noofit 

500 mg/ 5 ml) 500 mg BD. Within 5-6 days of its initiation, 

she was observed to remain fearful, complained of hearing and 

seeing things which others could neither see nor hear, was 

agitated and confused, with sleep and appetite disturbances. 

Attributing these behaviors due to the new drug started, parents 

discontinued it. Within next 45 days, improvement was 

observed in agitation, confusion, hallucinatory behaviour and 

sleep.   

Parents restarted syrup piracetam but this was associated 

withreemergence of earlier symptoms. They again 

discontinued piracetam following continued worsening for 5-6 

days and brought her to psychiatry emergency services. No 

history of seizures, other neurodevelopmental disorders, 

substance use, skin rash (porphyria), drug use (steroids) was 

obtained. Mental status examination revealed, confused state, 

increased psychomotor activity, perseveration, echolalia, 

palilalia and impaired attention-concentration. Naranjo 

algorithm score was 5 indicative of probable drug indued 

adverse effect.   

A provisional diagnosis of Piracetam induced psychotic 

symptoms with moderate intellectual disability was kept. She 

was admitted and kept drug naïve.  Investigations (serum 

lactate, urine for ketones/ porphyrins, EEG, MRI) did not 

reveal any abnormalities. She improved within 4-5 days of 

ward stay and within a week was her premorbid self. The 

family members were educated about intellectual disability, 

and that medicines/supplements would not improve her 

memory, rather constant practice in doing things will bring 

about some change. She was discharged in a satisfactory 

condition with attainment of premorbid level of functioning. 

The index case highlights indiscriminate use of piracetam for 

intelligence enhancer/ memory booster effect in a girl with 

intellectual disability despite literature reporting thatpiracetam 

therapy does not improve cognitive function rather is 

associated with adverse effects.4 It is approved for use in 

Europe for treatment of seizure disorder; however, it is not US 

FDA approved for any indication and its sale as a dietary 

supplement is also prohibited [5]. Despite having insufficient 

evidence to establish its safety, piracetam is available in 

markets and being used as off label/over the counter drug [6].  

Its use in dose of 500 mg twice/day (higher range of usual 

dose 40 mg/kg/d; body weight 27 kg) in a girl with already 

compromised brain functions exposed her to the unwarranted 

CNS adverse effects, to the extent that she experienced visual 

and auditory hallucinations in addition to irritability, 

P 

mailto:dr.nidhichauhan@gmail.com


Chauhan & Agarwal                                                                                                                    Nootropics: boon or bane 

Vol 1 | Issue 2 | Jul – Sep 2022                                                                                       Indian J Pharm Drug Studies | 72  

psychomotor agitation, confusion, sleep and appetite 

disturbances which are reported in literature. It was further 

supported by a score of 5 in Naranjo algorithm scale for 

adverse drug reactions. CNS adverse effects are explained on 

the basis of its neuroexcitatory effect on AMPA receptor 

induced calcium influx, thus increasing maximal density of 

AMPA glutamate and acetylcholine receptors and potassium 

induced glutamate release in the brain. It has also been 

postulated to have a role in increasing the availability of 

oxygen, permeability and fluidity of the mitochondrial cell 

membrane in the intermediate stages of the Krebs cycle, 

increasing activity of adenylate kinase, thus increasing ATP 

production in the brain. [7]. Adverse effects like anxiety, 

insomnia, agitation, irritability is identical to symptoms of 

excess acetylcholine/glutamate neuroactivity as seen in one of 

the previous case reports8 and are in sync with the index case.   

Clinical research on clinical use of nootropics is yet 

inconclusive. However, the use of nootropics to treat cognitive 

problems among healthy as well as in children with learning 

difficulties/ memory disturbances/ poor academic performance 

cannot be prevented. Casual, unsupervised, nonmedical use of 

nootropic drugs to improve academic performance could have 

unanticipated negative mental health effects. Health 

professionals need to be cognizant of the fact that nootropics 

may be to the human mind what steroids are to the body 

(misuse/abuse for muscle building, improving 

performance/physical shape despite dverse physical & 

psychological effects) and thus promote judicious use.  

REFERENCES  

1. Donma MM. Clinical efficacy of piracetam in treatment of breath-

holding spells. PediatrNeurol 1998;18:41-5 . 

2. Canterbury RJ, Lloyd E. Smart drugs: implications of student use. 

J PrimPrev 1994;14:197-207. 

3. Winblad B. Piracetam: a review of pharmacological properties 

and clinical uses. CNS Drug Rev 2005;11:169-82. 

4. Lobaugh NJ, Karaskov V, Rombough V, Rovet J, Bryson S, 

Greenbaum R et al. Piracetam therapy does not enhance cognitive 

functioning in children with down syndrome. Arch 

PediatrAdolesc Med 2001;155:442-8. 

5. Wong C. What you should know about piracetam. Said to 

enhance memory and cognition, this drug is not approved by 

FDA. Holistic Health 2021 https://www.verywellhealth.com/get-

smart-withpiracetam-89499.  

6. U.S. Food and Drug Administration: Office of Nutritional 

Products, Labeling and Dietary Supplements. 75-day premarket 

notification of new dietary ingredients: piracetam. Updated March 

3 2004 https://www.fda.gov/food/new-dietary-ingredients-

ndinotification-process/submitted-75-day-premarketnotifications-

new-dietary-ingredients.  

7. Colucci L, Bosco M, Rosario Ziello A, Rea R, Amenta F, 

Fasanaro AM. Effectiveness of nootropic drugs with cholinergic 

activity in treatment of cognitive deficit: a review. J 

ExpPharmacol 2012;4:163-72.  

8. Talih F, Ajaltouni J. Probable Nootropicinduced Psychiatric 

Adverse Effects: A Series of Four Cases. InnovClinNeurosci 

2015;12:21-5.  

 

How to cite this article: Chauhan N, Agarwal S, 

Piracetam Induced Psychotic Symptoms in A 

Preadolescent Girl with Intellectual Disability. Indian J 

Pharm Drug Studies. 2022;1(2) 71-72.  

Funding: None                  Conflict of Interest: None Stated 

 

 

https://www.verywellhealth.com/get-smart-withpiracetam-89499
https://www.verywellhealth.com/get-smart-withpiracetam-89499
https://www.fda.gov/food/new-dietary-ingredients-ndinotification-process/submitted-75-day-premarketnotifications-new-dietary-ingredients
https://www.fda.gov/food/new-dietary-ingredients-ndinotification-process/submitted-75-day-premarketnotifications-new-dietary-ingredients
https://www.fda.gov/food/new-dietary-ingredients-ndinotification-process/submitted-75-day-premarketnotifications-new-dietary-ingredients

