Cyproheptadine

Mechanism :

Cyproheptadine is serotonin and histamine antagonist with anticholinergic and sedative effects. Antiserotonin and antihistamine drugs appear to compete with serotonin and histamine, respectively, for receptor sites.

Indication :

Hypersensitivity reactions
Migraine
Loss of appetite (including Anorexia Nervosa) (off-label)

Contraindications :

Should not be used in new born or premature infants. Because of the higher risk of antihistamines for infants generally and for new-borns and premature ones in particular, antihistamine therapy is contraindicated in nursing mothers. Hypersensitivity to cyproheptadine and other drugs of similar chemical structure, monoamine oxidase inhibitor therapy, angle-closure glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction, pyloroduodenal obstruction, elderly, debilitated patients are contraindications to treatment.

Dosing :

Hypersensitivity Reaction:

<2 years:

Safety and efficacy not established.

2 to 6 years:

2 mg 2-3 times a day, (Max: 12 mg a day).

7 to 14 years:

4 mg 2-3 times a day, (Max: 16 mg a day).

Migraine:

Prophylaxis:

<3 years: Safety and efficacy not established.

>3 years: 0.2-0.4 mg/kg/day PO in twice daily divided doses (Maximum dose: 0.5 mg/kg/day).

Loss of Appetite (Including Anorexia Nervosa):

<13 years: Safety and efficacy not established.

>13 years: Initially 2 mg PO 4 times a day (increase upto 8 mg 6 hourly over three weeks).

Adverse Effect :

Sedation, dizziness, disturbed coordination, confusion, restlessness, excitation, nervousness, tremor, irritability, paraesthesia, neuritis, convulsions, euphoria, hallucinations, hysteria, faintness, excessive perspiration, urticaria, photosensitivity, blurred vision, diplopia, vertigo, tinnitus, hypotension, palpitation, tachycardia, extrasystoles, anaphylactic shock.

Interaction :

MAO inhibitors: Prolong and intensify the anticholinergic effects of antihistamines.
Antihistamines: May have additive effects with alcohol and other CNS depressants, e.g., hypnotics, sedatives, tranquilizers, antianxiety agents.

Hepatic Dose :

No dosage adjustments are recommended.