Question: My 2-year-old child with Down’s syndrome started piracetam on December 7th and broke out in hives on the 11th. I think its an allergic reaction to the piracetam because there were no other changes involved, no change in Nutrivene-D or diet, and I’ve seen this allergic reaction before. The piracetam is liquid, prescribed by our doctor, and made by a compounding pharmacy. I thought I should tell you. ——K

Answer: Piracetam allergy is extremely rare. It is much more likely that the allergic reaction was caused by the preservatives used in stabilizing liquid piracetam preparations against fungal contamination. Unlike piracetam, methylparaben and propylparaben are not uncommon triggers of allergic and intollerance reactions. You can check this out by having your physician change the prescription to capsules (or powder) and dissolving it into liquid as you use it (on an ongoing basis). There is no need for preservatives in dry piracetam preparations, or freshly prepared solutions. However, without preservatives, you should dissolve only the amount that can be used in a day — or two with refrigeration.

This may not be as convenient as preprepared liquid piracetam, but there are a few suggestions that I can offer that might be helpful. Assuming that you give piracetam three times per day, you can get the new piracetam capsules with three doses per capsule (a full days dosage) or six doses per capsule (two days worth). This will save you money over single-dose capsules (encapsulization is labor-intensive, especially in the small batches made by hand by compounding pharmacists). This can also save you time. You can dump the contents of a three- or six-dose capsule into three or six teaspoons of distilled water, and then measure out one teaspoon of the piracetam solution at a time for dosing. In other words, mix once a day (or every other day) and dose three times per day.

It might be helpful to ask the pharmacist for a few small glass vials with screw caps into which you can dump the capsule’s contents (throwing away the empty capsule), fill with water, and shake for quick disolution. Get at least two vials so you can wash one while the other is in use. If you put a piece of clear tape on the outside of the vial and mark it with a permanent marker at the three or six teaspoon level, you can save time by filling it with distilled water to the mark instead of having to carefully measure out three or six teaspoons of water each time. You can even put additional marks at each teaspoon level, if that would make dosing easier.

The measure of volume that you use is basically arbitrary. I mentioned teaspoons because they are likely to be in every kitchen, but you could just as easily use milliliters, cubic centimeters, fluid ounces, or drops. The only limitation is that the water volume be sufficient to dissolve the piracetam completely. This is not really a problem because piracetam is highly water soluble. One gram of piracetam (1000 mg) will readily dissolve in only two cubic centimeters of water (less than a half teaspoon).

Another technique that can be a big convenience is piracetam-sicles. You can take a plastic ice-cube tray with ten (or twelve) ice-cube compartments and fill it with piracetam solution containing ten (or twelve) doses of piracetam. You can find out exactly how much water to use if you fill the tray with plain water first, and then carefully pour it into a graduated kitchen measuring cup. The only trick to piracetam-sicles is having to fill each compartment in the ice-cube tray to approximately the same level to keep the doses even. A little practice may be needed.

Once the piracetam solution has frozen into ice cubes, a cube can be added to a beverage for dosing. Because the piracetam-sicles melt slowly, the bitter taste of piracetam is lowest with the first sip and gradually gets stonger. This can allow gradual taste desensitization in children who would otherwise object to a sudden bitter flavor. Piracetam can also be dissolved in fruit juices and frozen into piracetam-sicles to make taste more acceptable. Generally, citrus juices are best for masking bitter flavors. When children are old enough, they may appreciate an after-school piracetam-sicle on a stick. Just insert the popsicle sticks into piracetam-juice mixture in the ice-cube trays before it freezes. After it freezes, grab the stick and the piracetam-sickle will pop out in your hand. ——SWF