Chronic Disease Support/Management/Chronic Twitching


QUESTION: Hello Doctor. I have chronic twitching of the muscles near my ear and eustachian tube. It feels like thumping in the ear and is very distressing. The proper word for it is Myoclonus. I wanted to know what you would recommend for this condition. I have tried muscle relaxant drugs like Baclofen but did not like its effects. I have heard of a drug called Piracetam which is a nootropic used for myoclonus. I don't know if it would help. Please let me know what you would recommend. Thank you.

ANSWER: The most common treatment for myoclonus (per the Mayo Clinic - which is as good as it gets) is Klonopin.  See the link provided.

Piracetam is not an approved drug in the US and because of that would be illegal to import from overseas by purchasing it online.  Piracetam was marketed in the US until 2010 when the FDA forced the stoppage of sales.  That means that Piracetam is not allowed for sale as a dietary supplement - neither is it allowable for sale as a prescription drug.  Many of the non-Rx otc drugs are grandfathered in to be sold in the US - new drugs to market must prove safety and efficacy (yes even new otc drugs) and no company has invested the time or effort to get this drug approved.  It is available online.  I don't recommend you buy this way for two reasons. First, it may be seized and you could be fined for the import of an unapproved drug into the US.  Second, and more importantly there are no regulations that ensure that you will get what you are supposed to get and not something that might be inert or even dangerous.

Hope that helps.


---------- FOLLOW-UP ----------

QUESTION: Wow thank you so much Doctor. I had no idea it was not an available drug here. I wonder why it has not been approved by the FDA? Do you know why the sales were stopped here? Based on your knowledge do you think Nootropics be dangerous?

It was stopped for sale because it is a drug and was illegally being sold as a dietary supplement.  Drugs - even over the counter drugs are required to be tested for efficacy and safety - this drug has no research data admissible and there are no American companies (or foreign based companies for that matter) that have gone to the time and effort required to have it sold as an over the counter drug or a prescription drug.

There is no was to give you a blanket statement on nootropics as there are drugs classified as nootropics that are already in use in the US. Examples are Aricept, Adderall and Namenda - but their efficacy seems to be limited by people with afflictions - EXCLUDING Adderall and other stimulants which will work for anyone but are habit forming and abusable.  

SO we are working from the same definition Nootropics (/noʊ.əˈtrɒpɨks/ noh-ə-TROP-iks), also referred to as smart drugs, memory enhancers, neuro enhancers, cognitive enhancers, and intelligence enhancers, are drugs, supplements, nutraceuticals, and functional foods that purportedly improve mental functions such as cognition, memory, intelligence, motivation, attention, and concentration.  The word nootropic was coined in 1972 by the Romanian Dr. Corneliu E. Giurgea,derived from the Greek words νους nous, or "mind," and τρέπειν trepein meaning "to bend/turn". Nootropics are thought to work by altering the availability of the brain's supply of neurochemicals (neurotransmitters, enzymes, and hormones), by improving the brain's oxygen supply, or by stimulating nerve growth.

"Smart drugs" are either completely untested and unavailable (and therefor potentially dangerous if sourced from unregulated sources like China and India) or they are strictly regulated.  Believe me - if a nootropic was available in the US readily I would have it for myself!

Have a great day.


Chronic Disease Support/Management

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Dr. Joshua Cappuccilli


I can answer most questions about chronic disease management with drug therapy and lifestyle changes.


Most commonly I deal with patients with the following disease states (not all inclusive) chronic cardiac issues, diabetes, hypothyroidism, hypogonadism, pain, and joint afflictions such as RA. I am also experienced in management of liver failure, renal failure and renal transplant patients. The most common issues with chronic disease state management that I see in my practice are drug therapy modifications as they relate to the progression of the particular disease state.

BA from University of South Florida 1999 Doctor of Pharmacy 2008 University of Florida College of Pharmacy

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