<p>Piracetam is contra-indicated in patients with severe renal insufficiency (creatinine clearance &lt; 20 ml/min) and hepatic impairment. As the principal route of elimination for Piracetam is via the kidney, special care must be taken when treating patients known to suffer from renal insufficiency. Monitoring of renal function is recommended in such cases. The increase in half-life is directly related to the decrease in renal function and creatinine clearance. This is also true for the older patient in whom creatinine clearance is dependent on age. When the creatinine clearance is &lt; 60 ml/min, or serum creatinine is &gt;1.25 mg/100 ml, the dosage prescribed should be calculated as following:<br />
<br />
<strong>CrCl&nbsp;60-40&nbsp;ml/min</strong>:&nbsp;Dosage should be 1/2 of normal dose<br />
<strong>CrCl 40-20 ml/min</strong>:&nbsp;Dosage should be 1/4 of normal dose</p>