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cyproheptadine

R06AX02

Forms & Strengths

Tablet: 4 mg
Syrup: 2 mg/5 mL

Adult Dosing

Allergic conditions: 4 to 20 mg daily in divided doses (typically 4 mg three times daily), maximum 32 mg/day
Appetite stimulation (off-label): 4 mg three to four times daily

Pediatric Dosing

Children 2 to 6 years: 2 mg two to three times daily, maximum 12 mg/day
Children 7 to 14 years: 4 mg two to three times daily, maximum 16 mg/day

Indications

Perennial and seasonal allergic rhinitis
Vasomotor rhinitis
Allergic conjunctivitis
Urticaria and angioedema
Pruritus of allergic dermatoses
Serotonin syndrome management (off-label)
Appetite stimulation in failure to thrive or cachexia (off-label)

Mechanism of Action

First-generation antihistamine with potent H1-receptor antagonist activity
Possesses significant antiserotonergic (5-HT2 receptor antagonist), anticholinergic, and local anesthetic properties

Contraindications

Hypersensitivity to cyproheptadine or structurally related drugs
Neonates and premature infants
Nursing mothers
Narrow-angle glaucoma
Symptomatic prostatic hypertrophy
Stenosing peptic ulcer
Pyloroduodenal obstruction
Concurrent use with monoamine oxidase inhibitors (MAOIs)

Adverse Reactions

Central nervous system depression, sedation, somnolence, dizziness
Anticholinergic effects: dry mouth, blurred vision, urinary retention, constipation
Paradoxical excitation in children (restlessness, insomnia, tremors)
Weight gain, increased appetite
Hypotension, palpitations, tachycardia
Thickening of bronchial secretions

Drug Interactions

Central nervous system depressants (alcohol, opioids, sedatives, hypnotics): enhanced sedation
Anticholinergic drugs (tricyclic antidepressants, atropine): additive anticholinergic toxicity
Monoamine oxidase inhibitors (MAOIs): prolonged and intensified anticholinergic effects
Serotonergic agents: may attenuate or reverse the clinical efficacy of SSRIs or serotonin syndrome treatments

Curated Content: Needs Vetting Before Put to Clinical Use