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By Dr. James Howenstine, MD.
February 2, 2010

What Are Smart Drugs (Nootropics)?

While smart drugs are not needed to heal Alzheimer’s Disease, having knowledge of this interesting therapy can be advantageous to elderly individuals who are often in a constant battle to preserve their ability to think and remember. Much disability in the elderly is caused by unrecognized side effects of drugs. Tragically, many seniors live out their lives in confusion because of excessive doses or unrecognized side effects of pharmaceutical drugs. A classic example of this problem is the mental confusion, transient global amnesia (total temporary loss of awareness lasting up to 12 hours) and peripheral neuritis commonly caused by the widely prescribed statin drugs, which lower cholesterol values. Because the attending physicians often do not know that these problems relate to the cholesterol lowering therapy, many seniors are forced to cope with drug side effects interfering with brain function during their final years.

Smart drugs are substances that promote optimal brain function. Any drug that increases the amount of acetylcholine in the brain by blocking the action of the enzyme cholinesterase has the potential to improve memory, alertness, verbal fluency, and creative thinking. Therapies that increase the activity of cholinesterase will tend to lower the amount of acetylcholine in the brain. This tends to decrease alertness and impair memory, creative thinking and verbal fluency. If these changes occur, the guilty therapy might be considered a “dumb drug.” for that particular individual. A variety of drugs and nutrients make up the smart drug portfolio.

Evaluation of these therapies is quite complex, as not everyone reacts to each of these substances in the same way. Preexisting moodiness can cause a depressed result with decreased productivity subsequent to the increased cholinergic effect of a smart drug. Additionally, cholinergic smart drug therapy in patients who are under considerable stress may lead to a changed person who becomes less responsive to reward, unable to maintain sustained effort, and who exhibits suppressed – instead of enhanced – performance. The possibility exists that in the future AMPA-type glutamate receptors may even be able to increase intellectual performance in healthy young adults.

Alzheimer’s Disease (AD) patients, because of adverse effects from aluminum, mercury, and electromagnetic energy exposure, have suffered a progressive disproportionate loss of cholinergic neurons. A combination of organic vitamin B complex (a natural product called Supreme B), silica, and magnesium can heal AD. Increasing the level of acetylcholine in AD patients with a smart drug (pramiracetam, galantamine, piracetam, and vinpocetine) can increase blood flow to the brain, increase ATP energy production, increase the brain uptake of glucose and oxygen, and improve brain performance.

Pramiracetam (Neupramir) is similar chemically to piracetam, but pramiracetam is seven times more potent. This appears to be the most effective of the Smart Drugs used to treat Alzheimer’s Disease. The dosage used is about 1500 mg daily. Therapeutic results with Pramiracetam take about 1 month to become noticeable and may increase over the second month of therapy. Combining other nootropic drugs often improves the therapeutic result. A combination may permit the dose of Pramiracetam, which is expensive, to be reduced.

Pramiracetam can produce the following results in patients with AD:

Improve intelligence and memory
Reduce anxiety and aggressive behavior
Improve learning capability
Increase will power
Improve long term memory
Enhance the function of neurotransmitters
Increase the number of receptors for acetylcholine

Steroid Hormones enhance the function of Pramiracetam. Availability of steroid hormones is essential for Pramiracetam to be effective. Patients with low levels of steroid hormones or their precursors cannot derive therapeutic benefits from Pramiracetam. The needed steroid hormones include the following: aldosterone, corticosterone, dihydroepiandrosterone (DHEA), estrogens, pregnanediol, progesterone, and testosterone.


There is generally little toxicity and few to no side effects in patients taking Pramiracetam therapy. The usual dose is 1200 to 1500 mg daily in divided doses. Uremic patients need reduced dosages. Pramiracetam can improve attention span, learning capacity, memory, time-space orientation, and mental performance. Rare side effects have been seen including heartburn, mild nervousness, dizziness, nausea, anorexia, insomnia, trembling, dry mouth, and incontinence of urine and stool.

Pramiracetam seems to be available in China, South Africa, Australia, and Europe. I do not know whether it can be brought into the USA. The product is expensive.


Vinpocetine significantly decreases the decline in the release of dopamine [1] that normally occurs in tandem with the progression of the aging process. Persistence of dopamine prevents depression from developing, along with aiding in preservation of cholinergic nerve cell membranes.

Vinpocetine improves blood circulation to the brain and thereby prevents and alleviates cerebral insufficiency symptoms caused by strokes and narrowed arteries.

A middle-aged employee at Smart Nutrition had suffered from poor vision (myopia) all her life and had worn contact lenses for many years. She took a 20 mg Vinpocetine capsule one day. Later that day when standing behind the owner of the company, she remarked that she could read the monitor on his computer. Previously, she had been unable to read anything from that distance. The next day she mentioned that in driving home on the same familiar route she visualized many things she had never seen before. She was confident that her vision had improved from one capsule of Vinpocetine.

Vinpocetine was given to 100 elderly arteriosclerotic patients to improve circulation to the eyes. Visual acuity improved in 88 persons by an average of 73%. Improvement was most striking in patients who had already experienced retinal changes from occlusion of the central retinal artery. The 20 mg dosage of vinpocetine was administered by drop infusion three times daily or was given by intravenous infusion 10 mg three times daily. The improvement in vision paralleled blood pressure increases in the central retinal artery.


Piracetam is derived from the neurotransmitter gamma-aminobutyric acid (GABA). Because of a wide variety of favorable effects, Piracetam has become widely used in:

improving cell membrane fluidity
protecting nerves, along with anti-convulsant properties
moderating neurotransmission of the cholinergic and glutaminergic systems
improving neuroplasticity
reducing adhesion to the endothelium, blocking vasospasm, and improving microcirculation in vessels

Piracetam also has value in the treatment of cognitive disorders, dementia, vertigo, cortical myoclonus, dyslexia and sickle cell anemia.

The dosage used is 800 mg, three times daily.

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Nootropic drugs have a role to play in improving brain performance. Patients may wish to try these drugs. It would be worthwhile if a spouse or close friend could help evaluate potential improvement. Several of these drugs have shown unexpected benefits in other areas such as improvement in vision. Supreme B, Vinpocetine, and Piracetam are available from The Natural Health Team (, 800-416-2806).


1- Kahan, A. & Olah, M. Arzneimittelforschung 26(10a) 1969-72, 1976

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Dr. James A. Howenstine is a board certified specialist in internal medicine. The Second Edition of his book A Physicians Guide To Natural Health Products That Work is available.

Dr. Howenstine can be reached by phoning 001-506-2262-7504.

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Smart drugs are substances that promote optimal brain function. Any drug that increases the amount of acetylcholine in the brain by blocking the action of the enzyme cholinesterase has the potential to improve memory, alertness, verbal fluency, and creative thinking.