Racetam

Oxiracetam

4-Hydroxy-2-oxo-1-pyrrolidineacetamide

Evidence TierCWADA NOT PROHIBITED

tuneTypical Dose

1200–2400 mg per day in 2–3 divided doses

watchEffect Window

Acute (1–3 hours) for focus. Weeks for neuroprotective/memory baselines.

check_circleCompliance

WADA NOT PROHIBITED

Overview

Clinical Summary

Oxiracetam is a racetam-class compound investigated for cognitive impairment and post-stroke deficits. It is used for memory and attention goals, but modern high-quality trial evidence is limited.

Limited studies suggest possible improvements in memory and attention in dementia or post-stroke cognitive deficits. Proposed mechanisms include cholinergic and glutamatergic modulation, but evidence quality varies and many trials are older. Minority claims include learning enhancement in healthy users, which lacks robust support. Net benefit remains uncertain without contemporary well-powered randomized trials.

Positively modulates AMPA and NMDA receptors, enhances acetylcholine and glutamate release, and increases high-affinity choline uptake (HACU) and neuronal ATP production.

Outcomes

What This Is Expected To Influence

Primary Outcomes

  • Improves memory and concentration in elderly populations with dementia or cognitive decline

Secondary Outcomes

  • Anecdotally regarded as the 'logic nootropic' for mild stimulatory enhancement of analytical thinking

Safety

Contraindications and Interactions

Contraindications

  • Severe renal impairment
  • Pregnancy
  • Lactation

Side effects

  • Headache (choline-demand mechanism)
  • Insomnia
  • GI upset

Interactions

  • May potentiate anticoagulants
  • May potentiate stimulants

Avoid if

  • Severe renal impairment
  • Concurrent high-dose stimulant use without physician oversight

Evidence

Study-level References

oxiracetam-SRC-001RCT
Sourceopen_in_new

Baumel B, et al. "Oxiracetam in the treatment of multi-infarct dementia." Clin Neuropharmacol. 1989.

Population: Patients with multi-infarct dementia

Key findings: Oxiracetam (800 mg twice daily) resulted in statistically significant improvements in memory and global clinical impression compared to placebo.

Paper content

Oxiracetam (800 mg twice daily) resulted in statistically significant improvements in memory and global clinical impression compared to placebo.

oxiracetam-SRC-002Multicenter, double-blind, placebo-controlled randomized trial.
Sourceopen_in_new

Lim JS, Rha JH, Park JH, et al. Oxiracetam and physical activity in preventing cognitive decline after stroke: A multicenter, randomized controlled trial. Eur Stroke J. 2026;11(1):23969873251350141. doi:10.1093/esj/23969873251350141. PMID:41614470.

Population: High-risk post-stroke patients at risk for cognitive decline.

Dose protocol: Oxiracetam vs placebo for 36 weeks in 457 post-stroke patients

Key findings: No significant difference from placebo on MMSE (P=0.49) or CDR-SB (P=0.38). No drug-exercise interaction found.

Notes: Large well-powered negative trial. Supported regulatory suspension in South Korea.

Paper content

This large multicenter double-blind randomized trial tested oxiracetam versus placebo over 36 weeks in 457 post-stroke patients at high risk for cognitive decline. Neither MMSE nor CDR-SB scores showed significant differences between groups. There was no interaction between drug and physical activity. The authors concluded that oxiracetam did not demonstrate benefit in preventing post-stroke cognitive impairment, and noted that these findings supported the regulatory decision to suspend its use in South Korea.

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