OxiracetamvsPramiracetam

Oxiracetam enhances glutamatergic neurotransmission through positive allosteric modulation of AMPA receptors, increasing the amplitude and duration of excitatory postsynaptic potentials. It increases the release of excitatory neurotransmitters glutamate and D-aspartic acid from hippocampal presynaptic terminals, acting as a glutamate analog. Oxiracetam stimulates protein kinase C (PKC) isoforms, particularly PKC-α and PKC-γ, which phosphorylate substrates involved in memory consolidation, long-term potentiation (LTP), and synaptic plasticity. PKC activation enhances NMDA receptor function and AMPA receptor trafficking to the synapse. Its mild stimulatory effect derives from cholinergic system enhancement via increased acetylcholine release and nicotinic α7 receptor potentiation in the cortex.

Pramiracetam increases high-affinity choline uptake (HACU) in the hippocampus via potentiation of the choline transporter (CHT1), similar to but 15-30x more potent than coluracetam — dramatically increasing acetylcholine synthesis and release. It modulates AMPA glutamate receptors through positive allosteric modulation, enhancing excitatory neurotransmission. Pramiracetam increases neuronal nitric oxide synthase (nNOS) activity, elevating nitric oxide (NO) production and inducing cerebral vasodilation via cGMP-dependent pathways, thereby enhancing cerebral blood flow and oxygen delivery. The emotional flattening effect suggests significant modulation of prefrontal cortex activity, possibly through excessive cholinergic tone in limbic-prefrontal circuits or reduced dopaminergic/emotional salience signaling. It may also modulate sigma-1 receptor activity.