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02.05.2019

Nootropics are contraindicated for use. Nootropics - features of the pharmaceutical group and a list of the best drugs for effective treatment

NOOTROPICS. ACTOSHUTECTORS

NOOTROPICS

Nootropic drugs (psnhometabolic stimulants), providing a selective mnemotropic effect (Greek, tpete - memory, (city - direction), improve higher integrative functions of the brain - intelligence, attention, short- and long-term memory, create the ability to quickly reproduce information, accelerate learning, and reduce the number of errors when solving problems. Nootropic drugs weaken the perception of stressful situations, restore interest in life, goals, a sense of self-confidence, optimism, vitality, and increase the brain’s resistance to harmful influences.

The action of nootropics is aimed at the cortex cerebral hemispheres. They facilitate the interhemispheric transmission of nerve impulses, enhance the controlling influence of the cortex on subcortical structures, and improve the function of both neurons and neuroglia.

The cerebral cortex (especially the temporal and frontal lobes) and the gigoscampus are involved in the formation of memory. amygdala, thalamus, cerebellum (learning of motor conditioned reflexes). The transition from short-term to long-term memory is the transformation of the process of obtaining information into the process of storing it. Such a transformation is provided by the medial temporal lobe cortex, hippocampus (carry out memorization and consolidation of memory traces), reticular formation (regulates attention).

The accumulation and storage of information in memory is caused by electrical and chemical processes in the brain, leading to structural changes. Short-term memory is based on trace phenomena - the circulation of nerve impulses in a chain of neurons after the cessation of the stimulus.

Long-term memory is associated with the chemical encoding of information and the activation of synapses. When neurons are excited repeatedly and for a long time, the concentration of calcium ions in their postsynaptic membrane increases. These ions activate calcium-dependent proteinase (callin), which cleaves the membrane protein (fodrin), followed by unmasking and increasing the number of functioning glutamic acid receptors. Synapses become more sensitive as their conductivity increases due to an increase in the number of glutamic acid receptors.

Acetylcholine is necessary for memory processes. Serotonin accelerates learning and prolongs retention of skills when they are based on positive emotional reinforcement (for example, food). Norepinephrine accelerates learning when negative emotional reinforcement (eg, electrocutaneous reinforcement) is used. Neuropeptides are also involved in the regulation of memory - fragments of ACTT, vasopressin, substance R.

During the formation of long-term memory, the synthesis of RNA and informational neuropeptides - enzymes, cytoreceptors - increases. Already in the first hours after the start of learning, these neuropeptides are transported along axons from neuron bodies to synaptic endings, where they increase the efficiency of synaptic transmission of nerve impulses.

The first nootropic drug piracetam was created in the 1980s by G. Giurgea and V. Skondia, employees of the company SALT(Belgium). The most famous nootropic drugs:

* PIRACETAM (NOOTROPIL) - a pyrrolidone derivative, a cyclic derivative of GABA;

* AMINALONE (GAMMALON) - GABA in pure form:

* PHENIBUT - phenyl derivative of GABA;

* PIKAMILON - a combination of GABA molecules and nicotinic acid;

* 1TIRIDITOL (PYRITINOL, ENERGY BALL. ENCEPHABOL) is a chemical analogue of pyridoxine, but

without the properties of vitamin Sg, it can even act as its antagonist.

Mechanism of action of nootropics

Improving brain bioenergy

Nootropic drugs increase the synthesis of ATP and cAMP, glucose utilization, intensify glycolysis and aerobic respiration, and promote an increase in the activity of adenylate cyclase. As is known, aging and neuropsychiatric diseases are characterized by energy deficiency and decreased adenylate cyclase activity in neurons.

Nootropic drugs with a GABA structure have an antihypoxic effect by modifying the biochemical reactions of the GABA shunt,

The GABA shunt is a bypass between two successive metabolites of the tricarboxylic acid cycle - α-ketoglutaric and succinic acids. Part of a-ketoglutaric acid is converted into succinic acid not directly, but by first undergoing reductive amination into glutamic acid. Glutamic acid is then decarboxylated into GABA. GABA enters into a transamination reaction with α-ketoglutarate. forms glutamic acid and succinic semialdehyde. The latter is either reduced to GHB or oxidized to succinic acid. The GHB-succinic semialdehyde system, under conditions of oxygen deficiency, supplies an additional pool of oxidized NAD*, necessary for the oxidation of lactate to pyruvate. This reduces the toxic effect of lactate on cell enzyme systems and prevents the accumulation of ammonia. There is no correlation between the antihypertensive and myemotropic effects of nootropic drugs. Promotionsynthesis and release of neurotransmitters

Nootropic drugs activate the synthesis, release and turnover of dopamine, norepinephrine, acetylcholine, inhibit MAO, increase the formation of beta-adrenergic receptors, cholinergic receptors and neuronal uptake of choline. In the mechanism of neurotransmitter release, blockade of potassium channels is important, which facilitates membrane depolarization. Increased protein and membrane phospholipid synthesis

Nootropic drugs improve the regeneration of neurons, activate their genome and increase the synthesis of informational neuropeptides, intensifying the exchange of phosphatidylcholine and phosphatidylethanolamine.

It has been shown that cycloheximnd administered to rat pups on the 7th day of postnatal development causes behavioral and learning disorders. Taking nootropic drugs from the 8th to the 14th day eliminates these disorders. Piracetam stimulates the incorporation of leucine into brain proteins, stabilizes neuronal lysosomes and prevents catabolic processes in the brain during aging.

Improved cerebral blood flowand hemorheological parameters

Nootropic drugs dilate cerebral vessels, improve blood flow in areas of cerebral ischemia, prevent the development of cerebral edema, and block platelet aggregation and thrombus formation. improve the elasticity of erythrocytes and microcirculation. Nicotinic acid in the composition of picamilon has a direct vasodilator and anti-atherosclerotic effect. Antioxidant action

Nootropic drugs, by inhibiting free radical peroxidation, protect neuronal membrane phospholipids from destruction, which facilitates the fixation of memory traces. Lipid peroxidation increases in the brain during organic diseases, aging and stress.

Potentiation of mnemotropic effects of memory neuropeptides

Piracetam, the hormone ring of which does not open to form a linear GABA molecule, is an agonist of receptors that perceive signals from memory neuropeptides (fragments of ACTH, vasopressin, substance R). In terms of its chemical structure, piracetam is similar to the cyclic form of the terminal amino acid of memory neuropeptides - pyroglutamate and affects receptors as an exogenous ligand Probably the most important for the mnemotropic effect of piracetam is the activation of AMPA receptors of glutamic acid (quisqualate receptors),

Application and features of the action of nootropic drugs

Indications for prescribing nootropic drugs are as follows:

Mental retardation, cerebral palsy, prevention of cerebral disorders in newborn children from high-risk groups;

Atherosclerosis of cerebral vessels, hypertensive encephalopathy, consequences of cerebral stroke;

* Mnestic disorders in alcoholism, epilepsy, neurological infections;

Post-traumatic acute and chronic brain lesions;

Senile dementia, asthenia and depression in the elderly;

Neurosis, severe stress with overwork, impaired mental and social adaptation;

Dizziness;

Comatose states of vascular, toxic or traumatic etiology.

Thus, nootropics address the mind, which is fading either due to pathological processes or as a result of stress caused by physical, chemical, biological and social factors.

Nootropics have therapeutic effect only with long-term course use. The effectiveness of therapy depends on the age of the patient: the younger he is, the better the response to treatment.

PIRACETAM has a stress-protective and anti-anxiety effect as a ligand of benzodiazepine receptors activated during fear and anxiety. The anti-anxiety effect enhances emotional reactivity in conditions conflict situation. Thus, piracetam is a daytime tranquilizer. It is considered the drug of choice for exam stress, when nootropic properties are important. When piracetam is administered into a vein or muscle, the depression of the central nervous system in patients in a state of stupor and coma is reduced.

AMINALONE reduces heart rate and blood pressure in patients with arterial hypertension, accelerates awakening during coma, normalizes blood glucose levels during hyperglycemia, and has a moderate anticonvulsant effect in epilepsy.

PHENIBUT has the properties of a weak daytime tranquilizer with analgesic, anticonvulsant and neurorelaxing activity, potentiates the effect medicines, depressing the central nervous system. It is an agonist of GABA receptors, inhibits GABA transaminase and increases the release of GABA. Phenibut is prescribed to calm excited children and neurotic children, elderly people with anxious fussiness, night restlessness, sleep disorders, before operations and painful diagnostic procedures, for the treatment of stuttering, tics, spasticity.

PIKAMILON has a moderate tranquilizing effect with a stimulating component, significantly improves cerebral circulation, prevents the suppression of atherosclerosis, reduces the content of GABA in the brain and the activity of GABA transaminase.

PYRIDITOL increases the permeability of the blood-brain barrier to glucose, fatty acids, acetic acid and amino acids, stimulates their oxidation and ATP production in neurons, reduces the formation of lactate, creates conditions for metabolic processes to occur without an increase in oxygen demand, and also increases protein synthesis and the flow of sodium ions into the brain. Pyriditol occupies an intermediate position between nootropic drugs and psychostimulants. It activates the ideational and motor spheres of activity, increases physical endurance. Indications for the use of pyriditol are mild depression, asthenic and neurosis-like disorders of organic origin. The use of this drug in gerontological practice is limited due to its pronounced psychostimulating effect.

ACEPHEN (MEO1OPHENOXATE HYDROCHLORIDE, CENTROPHENOXIN) undergoes hydrolysis to form lara-chlorophenoxyacetic acid (a synthetic analogue of plant auxin) and dimethylaminoethanol (an active antioxidant). Acefen has a myemotropic and moderate psychostimulating effect, activates glucose transport across the blood-brain barrier, stabilizes mitochondrial membranes, improves oxidative phosphorylation, ATP synthesis in neurons, increases synaptic transmission of nerve impulses and the number of cholinergic receptors, in the experiment it promotes the disappearance of lipofuscin granules (neurons of old animals look like nerve cells of young animals). Indicated for asthenia, intellectual impairment in old age, somatogenic psychoses, trauma and vascular diseases of the brain, neurosis obsessive states, diencephalon and lateral amyogrophic syndromes. Dimethyllaminoethanol is used as a nootropic under the name DEANOL ACEGLUMATE (DEMANOL).

PANTOGAM (HOMOPANTOTENOBIC ACID) - calcium salt of P-homo-pantothenic acid, in which the fragment (3-alanine is replaced by GABA. Normally, the content of homopantothenic acid in the brain is 0.5-1% of the amount of GABA. It is a reserve form of GABA. Pantogam is characterized by pronounced irotivoconvulsive and anti-anxiety effects, the ability to reduce the reaction to painful stimulation.This nootropic agent enhances the oxidation of fatty acids in the brain, the oxidative decarboxylation of α-keto acids, the tricarboxylic acid cycle, and has a hypocholesterol-mimetic effect.

The use of Pantogam is recommended for neurosis, Parkinson's disease, some forms of epilepsy, tremor, stuttering, motor complications of antipsychotic therapy, encephalitis, cerebral palsy, mental retardation, neuralgia trigeminal nerve. It is not effective for symptomatic parkinsonism, depression and chronic alcoholism.

Nootropic drugs are well tolerated by patients. In selected patients receiving piracetam. picamilon, pyriditol or acephen, irritability, restlessness, insomnia, anxiety, dyspeptic disorders occur, allergic reactions. Piracetam sometimes causes exacerbation of angina in older people. Sick diabetes mellitus should be considered a large number of sugar in piracetam granules. Taking aminalon may be accompanied by vomiting, a feeling of fever, and fluctuations in blood pressure. Acefen increases delirium, hallucinations, anxiety in mental patients, provokes arrhythmia (Dimethylaminoethanol acts as a choline antagonist in the synthesis of acetylcholine). When treated with pantogam, a syndrome similar to Reis' syndrome (encephalopathy and fatty degeneration of internal organs) has been described. This severe complication is caused by impaired carnitine metabolism.

Piracetam is contraindicated in acute renal failure, diabetes mellitus (granules), and children under one year of age. Picamilon is not prescribed against the background of acute and chronic kidney disease, pyriditol and acephen - for mental agitation, neuroinfections, epilepsy and other convulsive conditions.

Therapy with nootropic drugs is inappropriate for persistent and significant impairment of mental activity and intelligence.

ACTOPROTEKT ORY

Actoprotectors increase physical and mental performance in difficult conditions. A drug in this group, the mercaptobenzimidazole derivative BEMITIL, increases motivation, mental activity and attention, and improves cerebral circulation. It has a strong antihypoxic effect, as it reduces oxygen consumption by tissues, heat production, consumption of energy resources per unit of work performed, increases the conjugation of oxidative phosphorylation and the synthesis of high-energy phosphates. Activates glyconeogenesis, improves the utilization of glucose by the brain, heart and skeletal muscles, while the body is cleansed of lactic acid and ammonia, utilized in the glucosolactate and glucose-alanine cycles. Stimulates RNA, protein synthesis and tissue regeneration. Potentiates the effects of endogenous antioxidant systems - superoxide dismutase and catalase.

Bemitil used for the treatment of diseases accompanied by chronic hypoxia, for example, psychasthenia, vestibular disorders, myocardial dystrophy, acute hepatitis, radiation sickness. It is prescribed for rapid recovery during intense physical activity in sports and industrial medicine. The drug is also used as a stimulator of humoral and cellular immunity.

Some sick Bemitil causes dyspeptic disorders, irritability and insomnia, and is contraindicated in case of hypoglycemia.

Nootropics are neurometabolic stimulants, drugs that influence higher mental functions of the brain.

The best nootropics, unlike psychostimulants, cause an increase in activity when stimulated nerve cells precisely quantitative, not qualitative. In this case, the following are observed medicinal effects:

  • sedative (calming);
  • psychostimulant;
  • antidepressant;
  • antiasthenic (reduction and cessation of lethargy and weakness);
  • mnemotropic (improving learning and memory);
  • antiepileptic;
  • adaptogenic;
  • nootropic (improving speech, attention, thinking), etc.

Increasing concentration adenylate cyclase enzyme, nootropics activate its action in nerve cells.

Exactly this substance necessary for cell synthesis of ATP- the main source of energy in the implementation of biochemical and physiological processes.

According to their effects, all nootropics are divided into 3 groups:

  1. Drugs that stimulate metabolic processes;
  2. Medicines that have a positive effect on vascular system(vasotropic drugs);
  3. Means for stimulating memory and learning processes.

The drugs are used in the treatment and prevention of a number of neurological and psychological disorders:

  • deterioration of thinking abilities;
  • decreased mental and physical activity;
  • effects of toxic substances on the brain;
  • neuroinfections (encephalitis, polio);
  • senile dementia;
  • consequences of traumatic brain injury;
  • ischemic stroke, enuresis, stuttering, etc.

Medicines can be prescribed not only to patients with the above diseases, but also to healthy people experiencing increased stress on the psyche and nervous system.

It’s quite difficult to figure out the list of the most popular nootropics on your own, so it’s best to seek medical advice. We will talk about several drugs that top the rating of nootropic drugs.

Table of the best nootropic drugs
Drug name Classification Alcohol compatibility Age restrictions Doctor's prescription Drug price
Nootropics (neurometabolic stimulants) absolutely incompatible from one year needed from 254 rub.
Bad undesirable from 12 years old over the counter from 2710 rub.
Bad undesirable from 14 years old over the counter from 891 rub.
nootropic drugs undesirable from 12 years old without a doctor's prescription from 489 rub.
nootropics, anxiolytics absolutely incompatible from 8 years old needed from 24 rub.
nootropics, disorder correctors cerebral circulation often used in the treatment of alcohol withdrawal syndrome. from 3 years old needed from 76 rub.
nootropic drugs does not enter into drug interactions with alcohol from 18 years old over the counter from 323 rub.

Nootropil

The second name of the drug is Piracetam, based on the name of the active substance. Available in the form of tablets, syrup (including for children), capsules, solutions for injections.

Prescribed for diseases of a neurological and psychiatric nature, used in narcology and pediatrics, for the treatment sickle cell anemia(consisting of combination therapy).

Contraindicated in case of impaired renal function, hemorrhagic stroke, intolerance to components. At doses above 5 g/day there is a high probability of developing side effects.

Phenibut

Nootropic with dual effects:

  1. stimulates blood circulation and metabolism;
  2. has a sedative effect.

The active substance is hydrochloride. The drug is available in tablet form. Prescribed for:

  • Asthenic and anxious-neurotic states;
  • Meniere's disease, dizziness, for the prevention of motion sickness;
  • Stuttering and tics in children;
  • To prevent anxiety.

Contraindications: individual intolerance, liver failure, periods of pregnancy and lactation. With caution - in case of gastrointestinal lesions.


The main active ingredient is nicotinoyl-gammaaminobutyric acid, the drug is available in the form of tablets and solution for injection.

The drug has a number of therapeutic effects:

  • stimulating metabolism;
  • antihypoxic;
  • antioxidant;
  • moderately tranquilizing;
  • selective detoxification (in relation to alcohol).

Prescribed for the treatment of the following diseases or conditions:

Among main contraindications: chronic and acute pathologies kidneys, individual intolerance to components, periods of pregnancy and breastfeeding.


The drug belongs to the group of nootropics, has anti-anxiety, vegetostabilizing, neuroprotective effects. Unlike other drugs in this group, it has a positive effect on all elements of memory: processing, storage, data retrieval.

Available in tablet form, it is prescribed for the treatment of:

  • asthenic conditions;
  • encephalopathy of various origins;
  • consequences of brain injuries.

It is possible to use the drug for diseases causing disruption cognitive functions and decreased intelligence.

Contraindicated in childhood, during pregnancy and lactation, with impaired renal and liver function, individual intolerance, impaired absorption of lactose and glucose.

Which nootropic to choose?

When choosing a medicine, you should pay attention to the following indicators:

  1. effectiveness and breadth of the therapeutic spectrum (indications for use);
  2. safety (list of contraindications and side effects);
  3. breadth of dose range (possibility of using different treatment regimens);
  4. interdrug effects (possibility of use in monotherapy and complex treatment);
  5. economic accessibility.

However, even the most powerful nootropics will not be able to cure the disease if they are used incorrectly. Therefore, the main selection criterion is the doctor’s recommendation after extensive diagnostics.

Sources

  1. Titova, N. V. Modern look for nootropic therapy / N.V. Titova // Neurology. Psychiatry. 2007. - T. 15, No. 24.
  2. Vilensky, B.S. Stroke: prevention, diagnosis, treatment Text. /B.S. Vilensky. 2nd ed., add. - St. Petersburg: Foliot, 2002. - 397 p.
  3. Hultsch, D. F., & Hertzog, C. (1989). A manual of twenty-five three-tiered structurally equivalent texts for use in aging research. Collaborative Research Group on Cognitive AgingTechnical Report No.2. University of Victoria and Georgia Institute of Technology.
  4. Lachman, M. E. (1983). Perceptions of intellectual aging: Antecedent or consequence of intellectual functioning? Developmental Psychology, 19,482-498.
  5. Fischer, G. D. Pharmacology of nootropics / G. D. Fischer, K. A. Wustman, E. S. Rudolf. -M., 1989.-S. 156.
  6. James, L. E., Fogler, K. A., & Tauber, S. K. (2008). Recognition memory measures yield disproportionate effects of aging on learning face-name associations. Psychology and Aging, 23(3), 657-664. doi: 10.1037/a0013008
Anatoly Maslov

Graduated from Moscow State University medical University them. I. M. Sechenov. After which he completed an internship in the specialty “Neurology”. She has been working as a neurologist in a Moscow clinic for more than 10 years.

Nowadays, to stimulate brain function and protect nervous reactions, new generation nootropic drugs are used, the list of which is so impressive that it takes up several pages. Mainly complex means, consisting directly of a nootropic component and auxiliary substances that improve the nutrition of nerve cells - amino acids, vitamins, etc.

How do new nootropic drugs differ from old ones?

People have been using nootropic drugs for a long time and don’t even know it. For example, the simplest nootropic, choline, is found in eggs, meat, fish and seafood. By eating foods rich in animal protein, we stimulate the production of the hormone serotonin, which is not only responsible for the feeling of pleasure, but also has a beneficial effect on neural connections. The brain begins to work more actively, memory and thought processes improve. The simplest nootropics also include coffee, green tea, nicotine, and amphetamines. These are so-called brain stimulants. The well-known vitamin B6 and Glycine tablets also belong to this type of remedy; they improve metabolic processes in the spinal cord and brain.

In the mid-twentieth century, there was a major leap forward in the study of brain function. The following types of nootropic drugs have been developed, studied and classified:

  • reversible acetylcholinesterase inhibitors;
  • vasodilators and metabolic enhancers;
  • stimulants;
  • racetams.

There is another classification based on the origin of the main active substance and its functions, but it is quite complex and confusing, and therefore is of interest only to doctors. In addition, today racetams are mainly used in therapy. This is the basis of new generation nootropic drugs. Racetams are chemical structure derivatives of pyrrolidine. Here short list the most popular drugs in this category:

  • Piracetam;
  • Oxiracetam;
  • Etiracetam;
  • Aniracetam;
  • Pramiracetam;
  • Nebracetam;
  • Nefiracetam;
  • Isacetam;
  • Detiracetam;
  • Dipracetam and others.

Unlike natural stimulants, these drugs have a very precise effect on certain areas of the brain, which allows them to be used not only to improve memory and intelligence, but also in the treatment of strokes, Alzheimer's and Parkinson's diseases. These are the most effective nootropic drugs.

Newest nootropic drugs

Because the the latest tools are combined, they combine new generation racetams and excipients. Modern nootropic drugs such as:

  • Diapiram;
  • Orocetam;
  • Yukamen;
  • Thiocetam;
  • Apik;
  • Binotropil.

Most often, patients who have suffered a stroke are prescribed Phezam. This medicine is a combination of piracetam and cinnarizine. This antihistamine improves blood circulation in the brain and strengthens the walls of even the smallest vessels. Many It is considered the best nootropic drug. We agree with this statement, but we would like to note that other means have also shown themselves to be very good. In addition, almost all nootropic drugs have few contraindications and side effects, which greatly simplifies the prescription and use.

Elderly patients should give preference to the latest combination drugs. But young people seeking to improve brain function can buy any Racetam and supplement it with regular exercise and proper nutrition. The effect will be no worse, since the body reacts to moderate physical activity the release of serotonin and other hormones that have a beneficial effect on neural connections and the nervous system as a whole.

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

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

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

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

All nootropic drugs are divided into 2 large groups:

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

Nootropics have a primary effect, which is a direct effect on the structures nervous system, And secondary action, aimed at improving microcirculation in the brain, preventing hypoxia. Nootropics stimulate metabolic processes in nervous tissue and normalize them in case of poisoning and traumatic damage.

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

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

Mechanism of action

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

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

Mechanisms of action of nootropics:

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

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

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

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

Main effects

Nootropic drugs have the following effects on the human body:

spectrum of action of nootropics

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

Indications and contraindications

Indications for the use of nootropic drugs:

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

Side effects

Side effects that occur during treatment with nootropic drugs:

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

Description of drugs

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

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

A short, sad, but necessary preface.

The uniqueness of the existing order of things is that

  • the vast majority of doctors find it much easier to prescribe THIS than to explain why a child does not need THIS;
  • for the vast majority of parents it is much easier to go to the pharmacy, buy and feed THIS to their own child for weeks, rather than try to read and understand, re-read and still understand;
  • and for those who are especially impressionable, THIS is available in injections...

Nootropic drugs are drugs that stimulate metabolic processes in nervous tissue.

The pharmacological effects of drugs in this group are improved memory and learning ability, increased resistance of nervous system cells to adverse external influences (in particular, lack of oxygen).

All nootropic drugs (nootropics) are similar in their chemical structure to natural biologically active substances- neurotransmitters, vitamins, amino acids. This explains the fact that most nootropics are non-toxic and do not have dangerous side effects.

Basic indications for the use of nootropics in childhood :

The pharmacological effects we mentioned above are identified by drug manufacturers; the indications for use are formulated just below - these are again the recommendations of the manufacturers of nootropic drugs.

Nootropic drugs are extremely widely used in pediatrics, but the breadth of their use is limited mainly by the borders of the former Soviet Union.

Despite the vast experience of use, despite the many discovered in experiments positive properties, despite the extreme attractiveness of the identified pharmacological effects and the breadth of indications for use, and so, despite all this, no one has been able to substantiate the benefits and effectiveness of nootropic drugs using evidence-based medicine methods to date.

This is hard for doctors to believe, and even harder for patients and parents of patients, but neither in the USA nor in Western Europe nootropic drugs are not used because, once again, there is no evidence of their effectiveness.

Readers who have read the list of nootropic drugs and discovered well-known, one might even say familiar, drug names in it will probably expect the author to detailed stories about when and how they should be taken. And assurances that all these are drugs with unproven effectiveness can cause disagreement and bewilderment: nootropic drugs have entered too actively into daily life doctors, pharmacists, patients, relatives of patients.

No one doubts the fact that the child (even absolutely healthy child!) is born with an “immature” nervous system, which is very actively improving (“ripening”) in the first years of life. This process of “ripening” is accompanied, firstly, by many specific symptoms(physiological reflexes of the newborn period, increased muscle tone, trembling of the lips, chin and limbs, etc., etc.), and secondly, the constantly present concern of the parents.

It is in the first years of life that parents discover certain “oddities” of behavior in their children, which they cannot explain based on own experience. It is in the first years of life that questions and doubts regarding the normality or abnormality of one’s own child constantly bother all mothers and fathers without exception.

Oddities, questions and doubts lead parents to doctors.

The main question looks like this:

- Is it normal or not at our age (insert the desired age) not... - then something is said that the child does not yet know how to do - sit, stand, roll over, crawl, walk, pick up, throw, talk, go to the toilet, sleep all night without waking up , obey your parents, read, count, sing, draw, etc., etc.?

Any answer “normal” actually means that the doctor has no doubt that the child is healthy and that he does not need any treatment.

And here, in fact, a situation is simulated when society experiences a huge need for drugs that “improve the functioning of the nervous system.” I emphasize once again: this is not a need for a child or a doctor, this is a need existing model human relationships in the doctor-parent-child system.

Humiliated by the state and legally defenseless, the doctor does not have the slightest desire to take responsibility.

The doctor knows for sure that without prescribing medication, he automatically becomes, on the one hand, an “inattentive and indifferent specialist,” and on the other, a potential culprit for all theoretically possible neurological troubles in the future. “We are 15, we have headaches every day, but at 6 months we visited a neurologist, complained of a trembling lip, and he said that everything was fine...”

Parents are convinced that there are some magic drops, thanks to which the child will learn to sit, talk, obey his mother and go to the potty.

Parents, as a rule, have no doubt that neurological problems in general and various “delays and deviations” are easy to cure: the main thing is to prescribe the right medicine in time (!!!).

Parents are not able to understand that the metabolism in the child’s nervous tissue occurs so intensely that it is practically impossible to accelerate it pharmacologically.

There are medications that have been experimentally shown to have a positive effect on the nervous system and have proven their safety—numerous nootropic drugs.

Medicines are prescribed, and some time after the prescription, the vast majority of children actually begin to sit, stand, roll over, crawl, walk, pick up, throw, talk, go to the toilet, sleep all night without waking up, obey their parents, read, count, sing, draw and etc., etc. They start, of course, not because the medicines were prescribed, but because the time has come, because it was so conceived by great Nature (God, Evolution). But it is very difficult to agree that “after the medicine” does not mean “thanks to the medicine”...

Thus, nootropic drugs can solve many problems because:

  • ease the burden of responsibility on doctors;
  • reassure parents;
  • improve the financial situation of their producers and sellers;
  • in most cases they do not harm patients.

It is not surprising that all the problems described do not concern the real owner of the insurance company at all. Where it is the private insurance company that pays for treatment, and not the patient or a corrupt official, well, there (in the world of private capital) no one wants to pay for relief, reassurance and “no-harm”. They pay for effective treatment, confirmed by evidence-based medicine. But there are problems with this...

I would like, however, to emphasize that the ability of nootropic drugs to positively influence metabolic processes in nervous tissue is not at all an invention of greedy pharmacists, it is a real fact.

Nootropics are truly capable of:

  • intensify energy metabolism in neurons;
  • enhance protein synthesis;
  • increase the speed of impulse transmission in the central nervous system;
  • improve glucose uptake by nerve cells;
  • strengthen cell membranes.

These properties are actually revealed in experiments. It is these properties that allow scientists to consider nootropic drugs as a very (!!!) promising group of drugs and continue their intensive study. It is on the basis of these properties that indications for the use of nootropics are formulated.

That is, given the ability of nootropics to activate, enhance, increase, improve and strengthen, it is assumed that they will help with delayed speech development or mental retardation. And then the saddest thing - the theoretical assumption does not find its practical confirmation when using drugs in real patients.

Not surprising in this regard two facts:

  • manufacturers of nootropic drugs do not promise anyone quick and meaningful action: - it is strongly emphasized that the effectiveness, firstly, is moderate and, secondly, to obtain the effect it is necessary long-term use- a few months;
  • An increasing number of pharmacologists propose to consider nootropic drugs not as drugs, but as biological active additives, potentially capable of improving the quality of life.

So, you left the office of the pediatrician or neurologist and in your hands you have a list of prescribed medications, and on this list are nootropic drugs.

You know that nootropic drugs, if used, are used for a reason, but for very specific indications. And this means that if you are prescribed a drug from the group of nootropic drugs, it is because your child has been given a specific diagnosis (see the list of indications and diagnoses above).

No diagnosis - no indications. That is the prescription of nootropic drugs has nothing to do with muscle hypertonicity, minimal brain dysfunction, pyramidal insufficiency and other fashionably popular domestic diagnoses.

Again, you already know that the effectiveness of nootropics has not been proven, but you also know that in most cases they are safe, and you have neither the strength nor the special desire to argue with the doctor and take responsibility for “not treating” yourself. So, we will be treated... And the main thing here is to do no harm. Therefore, in the subsequent consideration of the main nootropic drugs, we will put the safety of use at the forefront.

Piracetam

It has been used for more than 40 years, being in fact the ancestor of nootropic drugs.

Available in a variety of dosage forms, intended for both enteral and parenteral use - tablets, capsules, granules, syrups, solutions for intramuscular and intravenous administration.

Possible side effects are abdominal pain, nausea, vomiting, constipation, diarrhea, dizziness, headache, mental agitation, motor disinhibition, irritability, imbalance, decreased ability to concentrate, anxiety, sleep disturbances.

Neuroamino acid preparations

Gamma -aminobutyric acid . Available in tablets. Taken orally before meals. Strengthens the effect of sleeping pills and anticonvulsants. Possible nausea, vomiting, insomnia, increased body temperature, feeling hot, shortness of breath, hypersensitivity reactions.

Hopanthenic acid . Available in tablets and syrup. Allergic reactions (rhinitis, conjunctivitis, rash) are possible during use. Not recommended in the first trimester of pregnancy.

Nicotinoyl gamma-aminobutyric acid . Used for enteral administration (tablets) and parenteral administration (i.m., intravenous solutions). Use may be accompanied by nausea, headache, dizziness, irritability, anxiety, and allergic reactions. Contraindicated for pregnant and lactating women.

Gamma-amino-beta-phenylbutyric acid hydrochloride - known by trade name phenibut , available in tablets. Irritates the mucous membranes of the gastrointestinal tract (therefore it is contraindicated for peptic ulcers). At the beginning of treatment, as a rule, it causes severe drowsiness. Irritability, agitation, anxiety, dizziness, headache, nausea, and allergic reactions are also possible. Not for use during pregnancy and breastfeeding.

Glycine . Available in tablets intended for resorption in the mouth. Very well tolerated - rare allergic reactions.

Glutamic acid . Release forms: tablets and granules. Adverse reactions — increased excitability, vomiting, diarrhea. At long-term use possible decrease in the level of leukocytes and hemoglobin, irritation of the oral mucosa, cracks on the lips. Contraindicated in febrile conditions, diseases of the liver, kidneys, gastrointestinal tract, hematopoietic organs. During treatment, clinical blood and urine tests should be performed periodically.

Neuropeptides

Neuropeptides are protein molecules produced in the nervous system that have biological activity. Medicines containing neuropeptides have a certain nootropic effect. Some drugs in this group are widely known and are actively used in countries where the concept of evidence-based medicine has not yet been adequately implemented. The most well-known neuropeptide drugs include cerebrolysin , cortexin , actovegin , solcoseryl .

Drugs are administered mainly intramuscularly. They are well tolerated, but allergic reactions are possible, sometimes very severe.

Pyritinol

Taken orally (suspension, tablets, dragees). It has impressive list possible side effects - sleep disturbances, increased excitability, headache, dizziness, fast fatiguability, loss of appetite, nausea, diarrhea, allergic reactions, stomatitis, joint pain, reactions from the hematopoietic system. Contraindicated in hypersensitivity, epilepsy, hepatic and renal failure. Not recommended for pregnant and lactating women. During treatment, laboratory monitoring is required (clinical blood and urine tests, liver tests).

Vinpocetine

It is considered as a drug with complex action. It has not only a nootropic effect, but also the ability to improve blood circulation in nervous tissue. However, numerous beneficial features Vinpocetine has not yet been confirmed by evidence-based medicine.

The drug is available in tablets and solutions for intravenous administration. It cannot be administered intramuscularly. Contraindicated for pregnant and lactating women. When taken orally, it is well tolerated (rare hypersensitivity reactions); when administered intravenously, a decrease in blood pressure, dizziness, nausea, and phlebitis are possible.

Due to the large number of side effects (drowsiness, fatigue, headache, trembling limbs, increased muscle tone, depression, dry mouth, abdominal pain, increased sweating, allergic reactions, lowering blood pressure) is currently not recommended either as a nootropic or as a vascular agent. The use is considered justified in the complex treatment of migraines, dizziness, and motion sickness.

The list of nootropics does not end there. The stimulating effect on metabolic processes in nervous tissue - that same nootropic effect - seems very, very attractive. It is not surprising that there are many (hundreds!) of a wide variety of medicines, in theory having a nootropic effect.

Even a cursory listing of these drugs may take more than a dozen pages, nevertheless all that can be prescribed to your child to “improve” the nervous system are medications with unproven effectiveness, located in the 4th phase clinical trials(so-called post-marketing research). Only you - moms and dads - have the right to decide whether your child will be a participant in these studies or not.

(This publication is a fragment of the book by E. O. Komarovsky adapted to the format of the article



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