Both noopept and piracetam modulate acetylcholine and glutamate (AMPA) function. These may underlie most of the cognitive enhancing effects seen with both substances.
Both increase sensitivity to Nerve Growth Factor (NGF) . Noopept actually increases NGF levels, and NGF has long been linked to healthy brain function and repair.
Both may help mitochondrial function; piracetam by modulating amyloidal toxicity and noopept by increasing membrane potential. Benefits to the endoplasmic reticulum and other cell structures remain theoretical.
Both noopept and piracetam appear to broadly increase cognitive functions in the elderly and sleep- or nutrient-deprived, with more narrow benefits to cognition in the young and healthy. While both appear to benefit recovering alcoholics, noopept may be especially helpful according to studies. In young healthy volunteers, the differences in effect between the two compounds have yet to be exactly determined. Both appear to increase working and verbal memory, without yielding much improvement in spatial or eidetic memory.
Overall there are many similarities in mechanism and in effect between these two popular nootropics. Noopept may be more potent and powerful, but especially in the elderly piracetam is still a good choice as a base nootropic. For very healthy, young subjects seeking a dramatic effect, noopept may be a better choice. As far as price goes, both noopept and piracetam are very affordable.
Piracetam is much more active on the cardiovascular system than noopept, while noopept is more active on the nervous system (and at lower doses). Within the central nervous system, piracetam promotes an increase in mean capillary diameter and a decrease in the number of non-functioning capillaries (which the pressure is too high to activate) . In modest doses, piracetam increases oxygen consumption in the brain. Enhancing cerebral blood flow may add another layer of nootropic and neuroprotective functions that noopept alone may not have.
Piracetam appears to improve membrane function in a way noopept does not . This interesting effect is due to its affinity with the polar heads of the outside phospholipid membrane. The interaction with the membrane includes reorienting and promoting even dispersion of cholesterol molecules. This effect may be synergistic with phosphatidylcholine or -serine.
Piracetam may deplete choline stores, while noopept may be more likely to replenish them. Low acetylcholine may associated with headache and brain fog but unfortunately, these may also be signs of too much piracetam. For this reason, it is oft cited that combining piracetam with a choline source is recommended. Combining choline with noopept appears to confer a less impressive synergy. It is not recommended to combine noopept with piracetam (to attempt to replenish choline stores). They may be combined in a low dose, 5 mg Noopept and 600 mg piracetam, again combined with a few weekly eggs or tiny booster dose of supplemental choline.
While both noopept and piracetam may increase the effects of NGF, only noopept has BDNF effects . Piracetam has no known effects on neuroprotective neurotrophins, other than NGF. Noopept’s effect on neurogenesis, learning, recovery after induced stroke or Parkinsonism is much more dramatic than piracetam’s effect  according to one study. The positive effects piracetam has in these cases is likely due to its positive effects on cerebral blood-flow. Unlike the pro-oxidative concerns raised with large doses of piracetam (studied in combination with ALCAR), no similar concerns have been raised with similarly effective doses of piracetam.
Although Noopept has fewer side effects and safety concerns, there are more tolerance concerns. It also does not synergize as well with choline sources (probably due to increased saturation of muscarinic and neurotrophic sites). Both noopept and piracetam can cause allergic reactions or rare negative side effects. While both are considered widely tolerable, their use should not be without considerable warning.
Common Side effects
- Brain fog
 Piracetam elevates muscarinic cholinergic receptor density in the frontal cortex of aged but not of young mice.
 The metabolic enhancer piracetam ameliorates the impairment of mitochondrial function and neurite outgrowth induced by ß-amyloid peptide
 Mechanism of action of piracetam on cerebral circulation.
 Piracetam: novelty in a unique mode of action.
 On the mechanism of noopept action: decrease in activity of stress-induced kinases and increase in expression of neutrophines