Oxiracetam

Oxiracetam at a Glance

Oxiracetam is a synthetic racetam — a water-soluble relative of piracetam, dosed in the high hundreds of milligrams to a gram or two.

It is the “stimulating” member of the family, and its clinical work has focused on cognitive recovery after brain injury and in vascular cognitive impairment, where it was used as a medicine in Italy and elsewhere from the 1980s.

What It’s Used For

Traumatic brain injury recovery — supports cognitive recovery after head injury.
Vascular cognitive impairment — improves cognition where blood supply is the cause.
Dementia & degenerative decline — used in degenerative cognitive decline.
Healthy cognitive enhancement — the popular use, for memory and focus.

How It Works

Oxiracetam positively modulates AMPA and NMDA receptors, facilitating long-term potentiation — the synaptic process behind memory consolidation, and the mechanistic signature the racetam family shares. It also increases high-affinity choline uptake and acetylcholine turnover, which is why racetams are traditionally paired with a choline source.

It is water-soluble and short-acting, so it is split across the day rather than taken once, and usually dosed earlier because it is mildly stimulating.

The full trial record is in Pharmacology & Research below.

Pharmacology & Research

Oxiracetam is a synthetic, water-soluble racetam — a structural derivative of piracetam built on the same 2-pyrrolidinone ring — developed in the 1970s–80s (as ISF-2522 / CGP 21690E) and studied almost entirely as a treatment for impaired cognition rather than enhancement in healthy people. That distinction is the key to reading its evidence: the compound has a real, if modest, signal in acquired cognitive injury — a large modern phase 3 trial found it improved cognition after traumatic brain injury ^{1Reference 1Efficacy et al. · 2025RCTSignal Transduction and Targeted TherapyView study →} — but the most rigorous prevention trial in post-stroke patients was flatly negative — a result whose authors note supports South Korea’s regulatory decision to suspend its use ^{2Reference 2Oxiracetam et al. · 2026RCTOxiracetam and physical activity in preventing cognitive decline after stroke: a multicenter, randomized controlled trial (2026) — [randomised controlled trial]. European Stroke Journal. https://pubmed.ncbi.nlm.nih.gov/41614470/View study →}.

The popular use as a general “study aid” in healthy adults rests on almost no direct evidence. Pharmacologically it is unusual for a nootropic in being barely metabolized — the great majority is excreted unchanged by the kidneys — so renal function, not liver metabolism, governs its clearance ^{3,4Reference 3Gschwind HP et al. · 1992AnimalAbsorption and disposition of 14C-labelled oxiracetam in rat, dog and manView study →Reference 4Oxiracetam pharmacokinetics following si et al. · 1987Oxiracetam pharmacokinetics following single and multiple dose administration in the elderly (1987) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/3691580/View study →}.

Best-supported:Cognitive recovery after traumatic brain injury — a multicenter phase 3 RCT (n = 590) found both oxiracetam (6 g/day) and its L-enantiomer beat placebo on a cognitive battery ^{1Reference 1Efficacy et al. · 2025RCTSignal Transduction and Targeted TherapyView study →}.

Emerging / cautiously endorsed:Vascular cognitive impairment, mostly from older trials and adjunctive use (e.g. combined with nicergoline); it is used clinically for this in China ^{5,6Reference 5Clinical efficacy et al. · 2020RCTClinical efficacy and safety of nicergoline combined with oxiracetam in the treatment of vascular cognitive impairment (2020) — [randomised controlled trial]. Pakistan Journal of Pharmaceutical Sciences. https://pubmed.ncbi.nlm.nih.gov/32173636/View study →Reference 6Oxiracetam in the treatment of primary d et al. · 1989RCTOxiracetam in the treatment of primary degenerative and multi-infarct dementia: a double-blind, placebo-controlled study (1989) — [randomised controlled trial]. Neuropsychobiology. https://pubmed.ncbi.nlm.nih.gov/2693996/View study →}.

Popular but thin / overhyped:Cognitive enhancement in healthy people — the reason most supplement buyers take it — has essentially no real-world trial support; the closest human data is a scopolamine “chemical amnesia” challenge model, not everyday cognition ^{7Reference 7Effects of acute doses of oxiracetam in · 1993RCTEffects of acute doses of oxiracetam in the scopolamine model of human amnesia (1993) — [randomised controlled trial]. Psychopharmacology. https://pubmed.ncbi.nlm.nih.gov/7870912/View study →}.

The honest miss / caveat:It was ineffective in Alzheimer’s disease in a controlled trial ^{8Reference 8Treatment trial of oxiracetam in Alzheim · 1992Clinical trialTreatment trial of oxiracetam in Alzheimer’s disease (1992) — [clinical trial, negative]. Archives of Neurology. https://pubmed.ncbi.nlm.nih.gov/1444879/View study →}, and failed to prevent post-stroke cognitive decline in a 500-patient RCT whose findings the authors say support South Korea’s regulatory decision to suspend its use ^{2Reference 2Oxiracetam et al. · 2026RCTOxiracetam and physical activity in preventing cognitive decline after stroke: a multicenter, randomized controlled trial (2026) — [randomised controlled trial]. European Stroke Journal. https://pubmed.ncbi.nlm.nih.gov/41614470/View study →}. It is not approved as a drug or dietary supplement in the US.

Evidence by IndicationStrength of support · Beta

Support is an experimental score I’m building — a composite weighted by study type (human > animal > in vitro > review) and study volume. It’s a beta: a fast way to rank strength of evidence at a glance, not a validated metric. Each application links down to its write-up.

The largest body of oxiracetam data is in vascular/multi-infarct cognitive impairment, but it is uneven. Older double-blind trials from the 1980s–90s reported benefits on scales such as the IPSC-E, Blessed Dementia Scale and MMSE in mixed degenerative/multi-infarct dementia ^{6,9Reference 6Oxiracetam in the treatment of primary d et al. · 1989RCTOxiracetam in the treatment of primary degenerative and multi-infarct dementia: a double-blind, placebo-controlled study (1989) — [randomised controlled trial]. Neuropsychobiology. https://pubmed.ncbi.nlm.nih.gov/2693996/View study →Reference 9Oxiracetam in dementia: a double-blind · 1992RCTOxiracetam in dementia: a double-blind, placebo-controlled study (1992) — [randomised controlled trial]. Acta Neurologica Scandinavica. https://pubmed.ncbi.nlm.nih.gov/1414239/View study →}.

In modern practice (mainly China), it is often used adjunctively — a 120-patient trial found nicergoline plus oxiracetam improved MoCA more than nicergoline alone ^{5Reference 5Clinical efficacy et al. · 2020RCTClinical efficacy and safety of nicergoline combined with oxiracetam in the treatment of vascular cognitive impairment (2020) — [randomised controlled trial]. Pakistan Journal of Pharmaceutical Sciences. https://pubmed.ncbi.nlm.nih.gov/32173636/View study →}.

A 2024 Bayesian network meta-analysis of 194 vascular-dementia RCTs placed oxiracetam among the drugs with a favorable safety profile, but not among the most effective ^{10Reference 10Pharmacological treatments for vascular et al. · 2024Meta-analysisPharmacological treatments for vascular dementia: a systematic review and Bayesian network meta-analysis (2024) — [systematic review / meta-analysis]. Frontiers in Pharmacology. https://pubmed.ncbi.nlm.nih.gov/39239652/View study →}.

Critically, the best modern trial — a 500-patient Korean RCT testing whether oxiracetam could prevent post-stroke cognitive impairment — found no difference from placebo on MMSE or CDR-SB over 36 weeks ^{2Reference 2Oxiracetam et al. · 2026RCTOxiracetam and physical activity in preventing cognitive decline after stroke: a multicenter, randomized controlled trial (2026) — [randomised controlled trial]. European Stroke Journal. https://pubmed.ncbi.nlm.nih.gov/41614470/View study →}.

Gap: Treatment-of-established-impairment trials are old and mostly positive; the one rigorous modern prevention trial was null, so the benefit may be confined to already-impaired patients.

Mechanisms

Target / pathway	Effect	Relevant to
Cholinergic signaling	Increases high-affinity choline uptake and acetylcholine turnover	Memorylearning; rationale for pairing with a choline source
Glutamatergic AMPA/NMDA receptors	Positive modulation; facilitates long-term potentiation	Memory consolidationTBI/VCI recovery
Membrane phospholipid / PKC signaling	Modulation (preclinical)	Proposed neuroprotection
Cerebral energy metabolism	Enhanced glucose/ATP utilization (older preclinical claims)	Age-related and vascular cognitive decline

Pharmacokinetics

Oxiracetam is absorbed rapidly after oral dosing, with peak plasma levels at roughly 1–2 hours ^{4,12Reference 4Oxiracetam pharmacokinetics following si et al. · 1987Oxiracetam pharmacokinetics following single and multiple dose administration in the elderly (1987) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/3691580/View study →Reference 12Pharmacokinetics of oxiracetam following et al. · 1984Pharmacokinetics of oxiracetam following intravenous and oral administration in healthy volunteers (1984) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/6519128/View study →}. Oral bioavailability in humans is intermediate — about 56% — sitting between poor absorption in rats (28–42%) and high absorption in dogs (81–90%) ^{3Reference 3Gschwind HP et al. · 1992AnimalAbsorption and disposition of 14C-labelled oxiracetam in rat, dog and manView study →}. The defining feature is that it is not appreciably metabolized: more than 80–90% of a dose is recovered unchanged in the urine, so the kidneys, not the liver, clear it ^{3,4,12Reference 3Gschwind HP et al. · 1992AnimalAbsorption and disposition of 14C-labelled oxiracetam in rat, dog and manView study →Reference 4Oxiracetam pharmacokinetics following si et al. · 1987Oxiracetam pharmacokinetics following single and multiple dose administration in the elderly (1987) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/3691580/View study →Reference 12Pharmacokinetics of oxiracetam following et al. · 1984Pharmacokinetics of oxiracetam following intravenous and oral administration in healthy volunteers (1984) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/6519128/View study →}. The terminal elimination half-life is short in people with normal kidneys — about 3–6 hours after an 800 mg dose — which is why it is dosed 2–3 times daily and shows little accumulation on twice-daily maintenance ^{4Reference 4Oxiracetam pharmacokinetics following si et al. · 1987Oxiracetam pharmacokinetics following single and multiple dose administration in the elderly (1987) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/3691580/View study →}. Two clinically important modifiers: renal impairment dramatically prolongs the half-life (from ~3–6 h up to 10–68 h as creatinine clearance falls), so the dose must be reduced in kidney disease ^{11Reference 11Pharmacokinetics of oxiracetam in patien · 1990Clinical trialPharmacokinetics of oxiracetam in patients with renal impairment after a 800 mg single oral dose (1990) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2253654/View study →}; and the antiepileptics carbamazepine and valproate shorten its half-life, requiring more frequent dosing in patients taking them ^{13Reference 13Pilot study to determine the interaction · 1990Pilot study to determine the interaction of oxiracetam with antiepileptic drugs (1990) — [pharmacokinetics]. Clinical Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2108837/View study →}. Oxiracetam has a chiral center, and its S-(L-)enantiomer is the pharmacologically active form now being developed separately in China ^{1,14Reference 1Efficacy et al. · 2025RCTSignal Transduction and Targeted TherapyView study →Reference 14Safety et al. · 2024RCTSafety, tolerability, and pharmacokinetics of oral (S)-oxiracetam in Chinese healthy volunteers: a randomized, double-blind, controlled phase I study (2024) — [randomised controlled trial]. European Journal of Pharmaceutical Sciences. https://pubmed.ncbi.nlm.nih.gov/37898393/View study →}.

Clinical trials

Oxiracetam is off-patent and decades old, so there is little Western pharmaceutical trial activity — Western registries list essentially one recent study, while contemporary trials are registered on Chinese and Korean registries. The two largest modern trials (a positive phase 3 in TBI and a null prevention trial in post-stroke patients) were both conducted in East Asia.

Completed	Planned	Terminated	Preclinical
~20+(mostly 1980s–90s + 3 modern)	0–1	0	Many(rodent/dog)

Last checked: July 2026.

Intake & Dosage

Because oxiracetam is not a nutrient, there is no RDA, no AI, and no Tolerable Upper Intake Level — the concept of correcting a deficiency does not apply. The doses to reference are those studied in research, not a personal recommendation.

Common supplement range: 750–1,600 mg/day, typically split into 2–3 doses 6–8 hours apart. The short (~3–6 h) half-life is the reason for split dosing ^{4Reference 4Oxiracetam pharmacokinetics following si et al. · 1987Oxiracetam pharmacokinetics following single and multiple dose administration in the elderly (1987) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/3691580/View study →}.
Research doses run much higher: the modern TBI phase 3 trial used 6 g/day of racemic oxiracetam (4 g/day of the L-enantiomer), and vascular-impairment trials commonly used 1,600 mg/day ^{1,6Reference 1Efficacy et al. · 2025RCTSignal Transduction and Targeted TherapyView study →Reference 6Oxiracetam in the treatment of primary d et al. · 1989RCTOxiracetam in the treatment of primary degenerative and multi-infarct dementia: a double-blind, placebo-controlled study (1989) — [randomised controlled trial]. Neuropsychobiology. https://pubmed.ncbi.nlm.nih.gov/2693996/View study →}.
Renal impairment: clearance is almost entirely renal, and half-life lengthens dramatically as kidney function falls — doses should be reduced in kidney disease ^{3,11Reference 3Gschwind HP et al. · 1992AnimalAbsorption and disposition of 14C-labelled oxiracetam in rat, dog and manView study →Reference 11Pharmacokinetics of oxiracetam in patien · 1990Clinical trialPharmacokinetics of oxiracetam in patients with renal impairment after a 800 mg single oral dose (1990) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2253654/View study →}.
Enzyme-inducing antiepileptics (carbamazepine, valproate) shorten its half-life, so more frequent dosing may be needed in those patients ^{13Reference 13Pilot study to determine the interaction · 1990Pilot study to determine the interaction of oxiracetam with antiepileptic drugs (1990) — [pharmacokinetics]. Clinical Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2108837/View study →}.
With food / choline: many users pair it with a choline donor to offset racetam-associated headache; this is a practical convention, not a trial-validated protocol.

These are doses studied in research, not a personal recommendation.

Safety

Oxiracetam’s trial record is mild — headache is the usual complaint — so the things worth actually knowing are how it is cleared and what it is taken with: kidneys do nearly all the work, and two common antiepileptics change its kinetics.

Safety at a Glance

Low / no toxicityDrug interactions

Generally well tolerated. Adverse events were mild, dose-independent, and often no more frequent than placebo, with no excess of serious events in the large TBI trial.
Avoid in pregnancy and breastfeeding. No safety data at all — see the box below.
Renal impairment raises exposure and prolongs the half-life several-fold. A dose reduction is warranted.
Carbamazepine and valproate shorten its half-life. Not contraindicated, but dosing frequency may need adjusting.
Headache is the common complaint. It is the reason for the choline-pairing convention; restlessness or insomnia can follow a late dose.
Not an approved drug or supplement in the US, and suspended in South Korea. A genuine regulatory caveat, not a formality.

Full Safety & Interactions Detail

Across the trial record oxiracetam has been generally well tolerated, with adverse events that were mild, dose-independent, and often no more frequent than placebo ^{1,6,14Reference 1Efficacy et al. · 2025RCTSignal Transduction and Targeted TherapyView study →Reference 6Oxiracetam in the treatment of primary d et al. · 1989RCTOxiracetam in the treatment of primary degenerative and multi-infarct dementia: a double-blind, placebo-controlled study (1989) — [randomised controlled trial]. Neuropsychobiology. https://pubmed.ncbi.nlm.nih.gov/2693996/View study →Reference 14Safety et al. · 2024RCTSafety, tolerability, and pharmacokinetics of oral (S)-oxiracetam in Chinese healthy volunteers: a randomized, double-blind, controlled phase I study (2024) — [randomised controlled trial]. European Journal of Pharmaceutical Sciences. https://pubmed.ncbi.nlm.nih.gov/37898393/View study →}.

The most commonly reported issues are headache (the reason for the choline-pairing convention), mild gastrointestinal upset (loose stools were the main finding in canine toxicology), and — consistent with its mildly stimulating quality — occasional restlessness, agitation or insomnia if taken late in the day. Serious adverse events were not elevated versus placebo in the large modern TBI trial ^{1Reference 1Efficacy et al. · 2025RCTSignal Transduction and Targeted TherapyView study →}.

Two safety points deserve emphasis. First, oxiracetam is cleared almost entirely by the kidneys, so renal impairment both raises exposure and prolongs the half-life several-fold — a dose reduction is warranted ^{3,11Reference 3Gschwind HP et al. · 1992AnimalAbsorption and disposition of 14C-labelled oxiracetam in rat, dog and manView study →Reference 11Pharmacokinetics of oxiracetam in patien · 1990Clinical trialPharmacokinetics of oxiracetam in patients with renal impairment after a 800 mg single oral dose (1990) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2253654/View study →}.

Second, it has a documented pharmacokinetic interaction with the antiepileptics carbamazepine and valproate, which shorten its half-life; the interaction did not appear to change antiepileptic drug levels, and concurrent use was not judged contraindicated, but dosing frequency may need adjustment ^{13Reference 13Pilot study to determine the interaction · 1990Pilot study to determine the interaction of oxiracetam with antiepileptic drugs (1990) — [pharmacokinetics]. Clinical Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2108837/View study →}.

Regulatory status is a genuine caveat, not a formality: oxiracetam is not approved as a drug or dietary supplement in the United States, and its use is subject to a regulatory suspension in South Korea — a decision the authors of a 500-patient trial (which found no benefit for preventing post-stroke cognitive decline) say their findings support ^{2Reference 2Oxiracetam et al. · 2026RCTOxiracetam and physical activity in preventing cognitive decline after stroke: a multicenter, randomized controlled trial (2026) — [randomised controlled trial]. European Stroke Journal. https://pubmed.ncbi.nlm.nih.gov/41614470/View study →}.

Pregnancy & Lactation

Not established in pregnancy Not established in lactation

Verdict: avoid. There are no human pregnancy or lactation safety data for oxiracetam, and no basis to establish safety. In the absence of any studies, it should not be used during pregnancy or breastfeeding.

References

Efficacy and safety of L-oxiracetam on cognitive function in patients with traumatic brain injury: a multicentre, randomised, double-blind, phase 3 clinical trial (Year 2025) — [randomised controlled trial]. Signal Transduction and Targeted Therapy. https://pubmed.ncbi.nlm.nih.gov/41381424/
Oxiracetam and physical activity in preventing cognitive decline after stroke: a multicenter, randomized controlled trial (2026) — [randomised controlled trial]. European Stroke Journal. https://pubmed.ncbi.nlm.nih.gov/41614470/
Gschwind HP, Schütz H, Wigger N, et al. (1992). Absorption and disposition of 14C-labelled oxiracetam in rat, dog and man. Eur J Drug Metab Pharmacokinet. https://pubmed.ncbi.nlm.nih.gov/1499599/
Oxiracetam pharmacokinetics following single and multiple dose administration in the elderly (1987) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/3691580/
Clinical efficacy and safety of nicergoline combined with oxiracetam in the treatment of vascular cognitive impairment (2020) — [randomised controlled trial]. Pakistan Journal of Pharmaceutical Sciences. https://pubmed.ncbi.nlm.nih.gov/32173636/
Oxiracetam in the treatment of primary degenerative and multi-infarct dementia: a double-blind, placebo-controlled study (1989) — [randomised controlled trial]. Neuropsychobiology. https://pubmed.ncbi.nlm.nih.gov/2693996/
Effects of acute doses of oxiracetam in the scopolamine model of human amnesia (1993) — [randomised controlled trial]. Psychopharmacology. https://pubmed.ncbi.nlm.nih.gov/7870912/
Treatment trial of oxiracetam in Alzheimer’s disease (1992) — [clinical trial, negative]. Archives of Neurology. https://pubmed.ncbi.nlm.nih.gov/1444879/
Oxiracetam in dementia: a double-blind, placebo-controlled study (1992) — [randomised controlled trial]. Acta Neurologica Scandinavica. https://pubmed.ncbi.nlm.nih.gov/1414239/
Pharmacological treatments for vascular dementia: a systematic review and Bayesian network meta-analysis (2024) — [systematic review / meta-analysis]. Frontiers in Pharmacology. https://pubmed.ncbi.nlm.nih.gov/39239652/
Pharmacokinetics of oxiracetam in patients with renal impairment after a 800 mg single oral dose (1990) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2253654/
Pharmacokinetics of oxiracetam following intravenous and oral administration in healthy volunteers (1984) — [pharmacokinetics]. European Journal of Drug Metabolism and Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/6519128/
Pilot study to determine the interaction of oxiracetam with antiepileptic drugs (1990) — [pharmacokinetics]. Clinical Pharmacokinetics. https://pubmed.ncbi.nlm.nih.gov/2108837/
Safety, tolerability, and pharmacokinetics of oral (S)-oxiracetam in Chinese healthy volunteers: a randomized, double-blind, controlled phase I study (2024) — [randomised controlled trial]. European Journal of Pharmaceutical Sciences. https://pubmed.ncbi.nlm.nih.gov/37898393/

For half-lives, timing and stacking across the nootropics on this site, see the Nootropic Dosage Guide.