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Cyproheptadine: Drug information

Cyproheptadine: Drug information
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For additional information see "Cyproheptadine: Patient drug information" and "Cyproheptadine: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Pharmacologic Category
  • Histamine H1 Antagonist;
  • Histamine H1 Antagonist, First Generation;
  • Piperidine Derivative
Dosing: Adult
Allergic conditions

Allergic conditions:

Note: Second-generation H1-antihistamines are preferred for treatment of allergic rhinitis and urticaria due to less sedating and anticholinergic effects. Avoid use of cyproheptadine in patients with high-risk occupations (eg, pilots, bus drivers) or who may be more prone to anticholinergic effects (eg, older adults) (Ref).

Oral : Initial: 4 mg three times daily; maintenance: 4 to 20 mg/day in divided doses; maximum: 0.5 mg/kg/day; some patients may require up to 32 mg/day for adequate control of symptoms.

Appetite, decreased secondary to chronic disease

Appetite, decreased secondary to chronic disease (off-label use): Oral: Initial: 2 mg 4 times per day for 1 week, then 4 mg 4 times per day (Ref).

Serotonin syndrome, moderate

Serotonin syndrome (serotonin toxicity), moderate (off-label use):

Note: Reserve for patients with agitation despite discontinuation of serotonergic agent(s), adequate sedation (eg, with a benzodiazepine), and supportive care (Ref).

Oral: Initial: 12 mg once followed by 2 mg every 2 hours until clinical response. Maintenance: 4 to 8 mg every 6 hours as needed. Maximum dose: 32 mg/day (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, elimination is diminished in renal insufficiency.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Avoid use (Ref).

Dosing: Pediatric

(For additional information see "Cyproheptadine: Pediatric drug information")

Allergic conditions

Allergic conditions (nonacute):

Weight-directed or BSA-directed dosing: Children ≥2 years and Adolescents: Oral: 0.25 mg/kg/day or 8 mg/m2/day in 2 to 3 divided doses.

Fixed dosing:

2 to 6 years: Oral: 2 mg every 8 to 12 hours; maximum daily dose: 12 mg/day.

7 to 14 years: Oral: 4 mg every 8 to 12 hours; maximum daily dose: 16 mg/day.

≥15 years: Initial: Oral: 4 mg every 8 hours; titrate to effect; usual range: 12 to 16 mg/day although some patients may require up to 32 mg; maximum daily dose: 0.5 mg/kg/day.

Appetite stimulation

Appetite stimulation: Limited data available; dosing regimens variable (Ref):

Weight-directed dosing: Children ≥2 years and Adolescents: Oral: 0.25 mg/kg/day divided twice daily; age-dependent maximum daily dose: ≤6 years: 12 mg/day; 7 to 14 years: 16 mg/day; ≥15 years: 32 mg/day. Dosing based on an open-label trial of 66 pediatric cancer patients (median age: 11.7 years; range: 3 to 19 years) which reported 76% response rate (either weight gained or stabilized); mean weight gain: 2.6 kg (range: −0.1 to 10 kg); in a subset analysis, patients >9 years showed a greater response than younger patients as did patients with hematologic malignancies (Ref). In malnourished patients (n=77, ages 2 to 5 years), use was associated with significantly higher BMI compared to controls after 8 weeks of therapy (Ref). In patients with multifactorial feeding problems (eg, cleft palate, neurodevelopmental disorders), cyproheptadine improved mealtime and feeding behaviors as well as weight for age z-scores (Ref).

Fixed dosing: Children ≥5 years and Adolescents: Oral: Initial: 2 mg every 6 hours (4 times daily) for 1 week; if tolerated, increase dose to 4 mg every 6 to 8 hours; one trial did not titrate dosing and started with target maintenance dose (4 mg three times daily) (Ref). Dosing based on a short-term (12-week) double-blind, placebo-controlled trial (n=8 treatment group) and a long-term (1-year) open-label trial (n=12) in patients with cystic fibrosis (CF); results showed significant increases in weight gain (3.4 kg vs 1.1 kg in placebo); long-term results showed a generally sustained effect (eg, no further weight loss or some additional weight gain) over study duration (Ref). A placebo-controlled trial including 25 patients with CF (age ≥5 years) utilized a 12 mg/day dose (4 mg 3 times daily); after 12 weeks of therapy, use was associated with significant increase in weight compared to placebo (1.61 kg vs 0.67 kg) (Ref).

Cyclic vomiting syndrome, prophylaxis

Cyclic vomiting syndrome, prophylaxis: Limited data available:

Note: Prophylaxis is recommended for patients experiencing frequent symptoms (eg, monthly) or severe symptoms (eg, requiring hospitalization, lasting >2 days, resulting in significant school/work absences). Cyproheptadine is a first-line choice for prophylaxis in children <5 years of age; however, it is less commonly used for older children and adolescents due to adverse effects (eg, appetite stimulation, weight gain); other drugs are more likely to be effective (Ref).

Children ≥2 years and Adolescents: Oral: 0.25 to 0.5 mg/kg/day in 1 to 3 divided doses; maximum daily dose: 12 mg/day. Note: Lower starting doses followed by titration have also been reported; some experts have used a once-daily dose at bedtime to prevent daytime sedation (Ref).

Functional abdominal pain; refractory

Functional abdominal pain (dyspeptic syndrome); refractory: Limited data available: Infants ≥9 months, Children, and Adolescents ≤14 years: Oral: Reported range: 0.04 to 0.6 mg/kg/day in divided doses 2 to 3 times daily (Ref); age-dependent maximum daily doses: Infants and Children 2 to 6 years: 12 mg/day; Children and Adolescents 7 to 14 years: 16 mg/day (Ref). Dosing based on prospective and retrospective trials. In a prospective, double-blind, placebo-controlled trial including 29 patients with functional abdominal pain (age range: 2 to 14 years; n= 15 treatment group), results showed significant improvement in pain frequency and intensity with 2 weeks of cyproheptadine (0.25 to 0.5 mg/kg/day divided twice daily) compared to placebo (Ref). A retrospective, open-label trial of 80 pediatric patients (median age: 9.8 years; range: 9 months to 20 years) with dyspeptic symptoms (eg, nausea, early satiety, abdominal pain, retching after fundoplication and vomiting) which failed to respond to conventional therapy received 0.04 to 0.6 mg/kg/day of cyproheptadine (median effective dose: 0.22 mg/kg/day); the observed response rate was 55%; a higher response rate (86%) was seen with patients who experienced retching post-Nissen fundoplication (Ref).

Migraine, prevention

Migraine, prevention: Limited data available: Children ≥3 years and Adolescents: Oral: Usual range: 0.2 to 0.4 mg/kg/day divided twice daily; doses up to 1.5 mg/kg/day in divided doses 2 to 3 times daily have also been reported (Ref); age-dependent maximum daily doses: Children 3 to 6 years: 12 mg/day; Children ≥7 years and Adolescents: 16 mg/day (Ref); experience suggests younger patients more tolerant of common cyproheptadine side effects (ie, sedation, increased appetite) (Ref).

Spasticity associated with spinal cord damage

Spasticity associated with spinal cord damage: Limited data available; efficacy results variable: Oral: Children ≥12 years and Adolescents: 4 mg at bedtime; increase by a 4 mg dose every 3 to 4 days; mean daily dose: 16 mg/day in divided doses; maximum daily dose: 36 mg/day (Ref). In the most rigorous evaluation, a double-blind, placebo-controlled, crossover trial of 16 hemiplegic pediatric patients (age range: 4 to 18 years), cyproheptadine (relatively low dose: 1 to 2 mg/day) had no statistical evidence of an effect on gait nor improvement in spasticity parameters (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling; however, elimination is diminished in renal insufficiency.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified. Reactions listed are based on reports for other agents in this same pharmacologic class (antihistamines) and may not be specifically reported for cyproheptadine.

Postmarketing:

Cardiovascular: Extrasystoles, hypotension, palpitations, tachycardia

Dermatologic: Diaphoresis, skin photosensitivity

Endocrine & metabolic: Weight gain

Gastrointestinal: Anorexia, cholestasis (Larrey 1987), constipation, diarrhea, epigastric pain, increased appetite, nausea, vomiting, xerostomia

Genitourinary: Difficulty in micturition, early menses, urinary frequency, urinary retention

Hematologic & oncologic: Agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenia

Hepatic: Hepatic failure (Chertoff 2014), hepatic impairment, hepatitis (Larrey 1987), jaundice (Henry 1978)

Hypersensitivity: Anaphylactic shock, hypersensitivity reaction

Nervous system: Ataxia, chills, confusion, dizziness, drowsiness, euphoria, excitement, fatigue, hallucination, headache, hysteria, insomnia, irritability, nervousness, neuritis, paresthesia, restlessness, sedated state, seizure, tightness in chest or throat, tremor, vertigo

Ophthalmic: Blurred vision, diplopia

Otic: Labyrinthitis (acute), tinnitus

Respiratory: Dry nose, dry throat, nasal congestion, thickening of bronchial secretions, wheezing

Contraindications

Use in newborn or premature infants or breastfeeding mothers; hypersensitivity to cyproheptadine or any component of the formulation; monoamine oxidase inhibitor therapy; angle-closure glaucoma; stenosing peptic ulcer; symptomatic prostatic hypertrophy; bladder neck obstruction; pyloroduodenal obstruction; elderly, debilitated patients.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with cardiovascular disease (including hypertension and ischemic heart disease).

• Increased intraocular pressure: Use with caution in patients with increased intraocular pressure.

• Respiratory disease: Use with caution in patients with asthma or other chronic breathing disorders.

• Thyroid dysfunction: Use with caution in patients with thyroid dysfunction.

Special populations:

• Older adults: Antihistamines are more likely to cause dizziness, sedation, and hypotension and other anticholinergic effects in older adults; avoid use (Beers Criteria [AGS 2019]; manufacturer's labeling).

• Pediatric: Antihistamines may cause excitation in young children.

Warnings: Additional Pediatric Considerations

Excessive dosages of antihistamine in infants and young children may cause hallucinations, CNS depression, seizures, and death. Use with caution and use the lowest effective dose in children ≥2 years of age and avoid concomitant use with other medications having respiratory depressant effects.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Syrup, Oral, as hydrochloride:

Generic: 2 mg/5 mL (473 mL, 946 mL)

Tablet, Oral, as hydrochloride:

Generic: 4 mg

Generic Equivalent Available: US

Yes

Pricing: US

Syrup (Cyproheptadine HCl Oral)

2 mg/5 mL (per mL): $0.14 - $0.76

Tablets (Cyproheptadine HCl Oral)

4 mg (per each): $0.15 - $1.61

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Pediatric

Oral: Administer liquid preparations with an accurate measuring device.

Use: Labeled Indications

Allergic conditions: Perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis caused by inhalant allergens and foods; mild, uncomplicated allergic skin manifestations of urticaria and angioedema; amelioration of allergic reactions to blood or plasma; cold urticaria; dermatographism; adjunctive anaphylactic therapy (following epinephrine and other standard measures).

Use: Off-Label: Adult

Appetite, decreased secondary to chronic disease; Serotonin syndrome (serotonin toxicity)

Medication Safety Issues
Sound-alike/look-alike issues:

Cyproheptadine may be confused with cyclobenzaprine

Periactin may be confused with Percodan, Persantine

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (pediatric liquid medications requiring measurement) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).

Older Adult: High-Risk Medication:

Beers Criteria: Cyproheptadine, a first-generation antihistamine, is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (independent of diagnosis or condition) due to its potent anticholinergic properties resulting in increased risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity; use should also be avoided due to reduced clearance with advanced age and tolerance associated with use as a hypnotic. Exposure to concurrent anticholinergic drugs also increases risk of falls, delirium, and dementia; consider total anticholinergic burden when conducting medication reviews (Beers Criteria [AGS 2023]).

International issues:

Periactin brand name for cyproheptadine [US, multiple international markets] may be confused with Perative brand name for an enteral nutrition preparation [multiple international markets] and brand name for ketoconazole [Argentina]

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Acetylcholinesterase Inhibitors. Risk C: Monitor

Aclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Acrivastine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amantadine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Amezinium: Antihistamines may increase stimulatory effects of Amezinium. Risk C: Monitor

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Benperidol. Risk C: Monitor

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Benztropine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Benztropine. Risk C: Monitor

Benzylpenicilloyl Polylysine: Coadministration of Antihistamines and Benzylpenicilloyl Polylysine may alter diagnostic results. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. Risk D: Consider Therapy Modification

Betahistine: Antihistamines may decrease therapeutic effects of Betahistine. Betahistine may decrease therapeutic effects of Antihistamines. Risk C: Monitor

Biperiden: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Biperiden. Risk C: Monitor

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Bornaprine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Bornaprine. Risk C: Monitor

Botulinum Toxin-Containing Products: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Buclizine. Risk C: Monitor

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of Cannabinoid-Containing Products. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Certoparin: Antihistamines may increase therapeutic effects of Certoparin. Risk C: Monitor

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Chlorprothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Chlorprothixene. Risk C: Monitor

Cimetropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Cimetropium. Risk X: Avoid

CloZAPine: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider Therapy Modification

CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Cyclizine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Darifenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Darifenacin. Risk C: Monitor

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Dicyclomine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dicyclomine. Risk C: Monitor

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dimethindene (Systemic). Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor

DroNABinol: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of DroNABinol. Risk X: Avoid

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Eluxadoline: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Eluxadoline. Risk X: Avoid

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Fenfluramine: Cyproheptadine may decrease therapeutic effects of Fenfluramine. Fenfluramine may increase CNS depressant effects of Cyproheptadine. Risk C: Monitor

Fesoterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Fesoterodine. Risk C: Monitor

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification

FluPHENAZine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Gastrointestinal Agents (Prokinetic): Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Gastrointestinal Agents (Prokinetic). Risk C: Monitor

Gepotidacin: May decrease anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Glucagon: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor

Glycopyrrolate (Oral Inhalation): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Oral Inhalation). Risk X: Avoid

Glycopyrrolate (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Systemic). Risk C: Monitor

Glycopyrronium (Topical): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Hyaluronidase: Antihistamines may decrease therapeutic effects of Hyaluronidase. Risk C: Monitor

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Ipratropium (Nasal): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Ipratropium (Oral Inhalation): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Itopride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Itopride. Risk C: Monitor

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Levosulpiride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Levosulpiride. Risk X: Avoid

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Maprotiline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Maprotiline. Risk C: Monitor

Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Melperone: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification

Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methscopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methscopolamine. Risk C: Monitor

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyraPONE: Coadministration of Cyproheptadine and MetyraPONE may alter diagnostic results. Management: Consider alternatives to the use of the metyrapone test in patients taking cyproheptadine. Risk D: Consider Therapy Modification

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mirabegron: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Mirabegron. Risk C: Monitor

Monoamine Oxidase Inhibitors: Cyproheptadine may decrease serotonergic effects of Monoamine Oxidase Inhibitors. Monoamine Oxidase Inhibitors may increase anticholinergic effects of Cyproheptadine. Risk X: Avoid

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nitroglycerin: Agents with Clinically Relevant Anticholinergic Effects may decrease absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

OLANZapine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OLANZapine. Risk C: Monitor

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opipramol: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxatomide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification

OxyBUTYnin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OxyBUTYnin. Risk C: Monitor

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Perazine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Perphenazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Perphenazine. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Pitolisant: Antihistamines may decrease therapeutic effects of Pitolisant. Risk X: Avoid

Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Potassium Chloride: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid

Potassium Citrate: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Pramlintide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. These effects are specific to the GI tract. Risk X: Avoid

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Promethazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Promethazine. Risk C: Monitor

Propantheline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Propantheline. Risk C: Monitor

Propiverine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

QuiNIDine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Ramosetron: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Ramosetron. Risk C: Monitor

Revefenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Revefenacin. Risk X: Avoid

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Rivastigmine: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Rivastigmine. Rivastigmine may decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider Therapy Modification

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Scopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Scopolamine. Risk C: Monitor

Secretin: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider Therapy Modification

Selective Serotonin Reuptake Inhibitor: Cyproheptadine may decrease therapeutic effects of Selective Serotonin Reuptake Inhibitor. Risk C: Monitor

Sofpironium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Sofpironium. Risk X: Avoid

Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

Thiazide and Thiazide-Like Diuretics: Agents with Clinically Relevant Anticholinergic Effects may increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Thiothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Thiothixene. Risk C: Monitor

Tiapride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Tiapride. Risk C: Monitor

Tiotropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tiotropium. Risk X: Avoid

Tolterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tolterodine. Risk C: Monitor

Topiramate: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Topiramate. Risk C: Monitor

Tranylcypromine: May increase anticholinergic effects of Antihistamines, First Generation. Risk X: Avoid

Tricyclic Antidepressants: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tricyclic Antidepressants. Risk C: Monitor

Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Trimethobenzamide: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trimethobenzamide. Risk C: Monitor

Trospium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trospium. Risk C: Monitor

Umeclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zuclopenthixol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Zuclopenthixol. Risk C: Monitor

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Pregnancy Considerations

Outcome data following maternal use of cyproheptadine during pregnancy are limited (Heinonen 1977; Kasperlik-Załuska 1980; Khir 1982; Sadovsky 1972). Per the product labeling, based on two studies, an increased risk of congenital abnormalities was not observed following maternal use of cyproheptadine during the first, second, or third trimesters in two studies of pregnant patients; however, the possibility of harm cannot be ruled out.

Algorithms are available for the treatment of acute rhinitis and urticaria. First-generation oral antihistamines are generally not recommended for use in pregnant patients due to side effects (AAAAI/ACAAI [Dykewicz 2020]; EAACI [Zuberbier 2022]).

Breastfeeding Considerations

It is not known if cyproheptadine is present in breast milk.

Drowsiness and irritability have been reported in breastfed infants exposed to antihistamines (Ito 1993).

Antihistamines may decrease maternal serum prolactin concentrations when administered prior to the establishment of nursing (Messinis 1985).

Use of a second-generation antihistamine is preferred when an oral antihistamine is needed in lactating patients (Butler 2014). Cyproheptadine is contraindicated in patients who are breastfeeding.

Mechanism of Action

A potent antihistamine and serotonin antagonist with anticholinergic effects; competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract (Paton 1985).

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Well absorbed (Graudins 1998)

Metabolism: Primarily by hepatic glucuronidation to metabolites (Hintze 1975)

Half-life elimination: Metabolites: ~16 hours (Paton 1985)

Time to peak, plasma: Metabolites: 6 to 9 hours (Paton 1985)

Excretion: Urine (~40% primarily as metabolites); feces (2% to 20%, <6% as unchanged drug)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Elimination is diminished in renal insufficiency.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Periactin;
  • (AR) Argentina: Azulina;
  • (AT) Austria: Periactin;
  • (AU) Australia: Periactin;
  • (BD) Bangladesh: Arictin;
  • (BE) Belgium: Periactin;
  • (BF) Burkina Faso: Nurabol;
  • (BG) Bulgaria: Cyprotol | Peritol;
  • (BR) Brazil: Periatin | Preptin;
  • (CH) Switzerland: Periactin;
  • (CI) Côte d'Ivoire: Nurabol;
  • (CL) Chile: Ciproactin | Viternum;
  • (CN) China: Cyproheptadine;
  • (CO) Colombia: Ciproheptadina | Periactin | Viternum;
  • (CZ) Czech Republic: Peritol;
  • (DE) Germany: Peritol;
  • (DO) Dominican Republic: Prolyn;
  • (EC) Ecuador: Ciproheptadina | Complamin | Periactin;
  • (EE) Estonia: Periactin | Peritol;
  • (EG) Egypt: Cyptadine | Triactin;
  • (ES) Spain: Periactin;
  • (FI) Finland: Anarexol;
  • (FR) France: Periactine;
  • (GB) United Kingdom: Periactin;
  • (GR) Greece: Adekin | Periactin;
  • (HK) Hong Kong: Appetin | C.h. | Ciprodin | Cyprodin | Cyprogin | Cyproheptadine | Periact | Periactin | Qualiactin | U eatin | Uni-Heptadine | Uni-heptadine;
  • (HU) Hungary: Peritol;
  • (ID) Indonesia: Alphahist | Apeton | Arsigran | Cylat | Ennamax | Erphacyp | Esprocy | Glocyp | Graperide | Heptasan | Kensip | Lexahist | Nebor | New cypromin | Omesip | Poncohist | Procydin | Profut | Prohessen | Pronam | Pronicy | Pronimax;
  • (IE) Ireland: Periactin;
  • (IN) India: Abitol | Add app | Afdigrow | Anabol | Anorexin | Apeat | Apectin | Apenorm | Apetamin | Apetone | Apetox | Apitol | App Up | Appetin pl | Appodin g | Appri | Aptivin | Bal Riactin | Cadictin | Cadlactin | Ciplactin | Cipron | Cym | Cyphoden | Cyprollion | Cyprotol | Cyptan | Cyptol | Eptocol | Hepdine | Heptadine | Heptidin | Hungree | Ibiapt | Ioplex | Lupactin | Lycip | Normatone | Osactin | Pepon | Peritol | Practin | Rarritol | Sp lysin | Toractin;
  • (IQ) Iraq: Afractin | Cibtaden | Citadine | Cyproctin | Cyprodad | Cyprodine | Cyprosaf | Periahist;
  • (IT) Italy: Periactin;
  • (JO) Jordan: Periactin;
  • (JP) Japan: Cyproatin | Cyproatin taiyo | Cyproatin towa | Cypromin | Cyptazin | Ifrasarl | Ifrasarl showa | Periactin;
  • (KE) Kenya: Ciplactin | Plactinic | Uniactin;
  • (KR) Korea, Republic of: Cyprodin | Periactin | Pratin | Prohethin;
  • (KW) Kuwait: Periactin | Triactin;
  • (LB) Lebanon: Periactin;
  • (LT) Lithuania: Ciplactin | Peritol;
  • (LU) Luxembourg: Periactin;
  • (LV) Latvia: Ciplactin | Peritol;
  • (MA) Morocco: Antinorex | Apetine | Aractine | Nurabol | Periactine | Pernabol;
  • (MX) Mexico: Viternum;
  • (MY) Malaysia: Cyproheptadine | Cyproheptadine HCL;
  • (NG) Nigeria: Curegold | Cyprigold | Cyproheptadine | Cypropek | Garylong | Rich apetie syrup | Vema tone;
  • (NL) Netherlands: Periactin;
  • (NO) Norway: Cyproheptadine HCL | Peritol;
  • (NZ) New Zealand: Periactin;
  • (PK) Pakistan: Cyprodin | Periactin | Stanzar;
  • (PL) Poland: Peritol | Protadina;
  • (PR) Puerto Rico: Cyproheptadine HCL | Periactin;
  • (PT) Portugal: Ciproral | Periactin | Supersan | Viternum;
  • (QA) Qatar: Periactin | Triactin;
  • (RO) Romania: Biohept | Ciproheptadina arena;
  • (RU) Russian Federation: Peritol;
  • (SA) Saudi Arabia: Periactin;
  • (SE) Sweden: Periactin;
  • (SG) Singapore: Cyproheptadine | Cyprotin | Periactin | Pilian;
  • (SK) Slovakia: Peritol;
  • (SR) Suriname: Abitol | Appe actin | Proactin;
  • (TH) Thailand: Anpro | Appedine | Baby | Bozo | Cycodine | Cyheptine | Cypro | Cyprodine | Cyprogin | Cyproheptadin | Cyproheptadine | Cypromed p | Cypromide | Cyprono | Cypropicco | Cyprosian | Cyprotec | Cyprotin | Kentidine | Mano | Periactin | Perry | Polytab | Pondnaheptin | Proretin | Star;
  • (TN) Tunisia: Cipractine | Ciptadine;
  • (TR) Turkey: Prakten | Sipraktin;
  • (TW) Taiwan: Antimin | Antisemin | Appitamine | Ceriatin | Chilieanzin | Cyhepdin | Cyllermin | Cypro | Cyprodin | Cyprodine | Cyproh | Cyprohepatadine | Cyproheptadine | Cyproheptadine HCL | Cypromin | Cypromine | Cytadine | Dariactin | Dechimin | Earmin | Feri | Fulimin | Huavine | Komian | Nekmin | Outallergin | Pelion | Periactin | Perian | Pilian | Piminton | Prozine | Serodine | Showmin | Synmin;
  • (UA) Ukraine: Peritol | Peritonil;
  • (UG) Uganda: Cypolive | Procip | Toractin;
  • (UY) Uruguay: Ciprogal;
  • (VE) Venezuela, Bolivarian Republic of: Cyprodin | Periactin;
  • (ZA) South Africa: Cipla-actin | Periactin;
  • (ZM) Zambia: Apectine | Ciplactin | Cyproheptadine | Power apetite | Prodin | Super apeti
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Andersen JM, Sugerman KS, Lockhart JR, et al, "Effective Prophylactic Therapy for Cyclic Vomiting Syndrome in Children Using Amitriptyline or Cyproheptadine," Pediatrics, 1997, 100(6):977-81. [PubMed 9374568]
  3. Badihian N, Saneian H, Badihian S, Yaghini O. Prophylactic therapy of cyclic vomiting syndrome in children: comparison of amitriptyline and cyproheptadine: a randomized clinical trial. Am J Gastroenterol. 2018;113(1):135-140. doi:10.1038/ajg.2017.194 [PubMed 28719594]
  4. Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133(5):1270-1277. doi:10.1016/j.jaci.2014.02.036 [PubMed 24766875]
  5. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112-1120. doi:10.1056/NEJMra041867 [PubMed 15784664]
  6. Brenner M, Lewis D. The treatment of migraine headaches in children and adolescents. J Pediatr Pharmacol Ther. 2008;13(1):17-24. [PubMed 23055860]
  7. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: part II. Lactation. J Am Acad Dermatol. 2014;70(3):417. doi:10.1016/j.jaad.2013.09.009 [PubMed 24528912]
  8. Chertoff J, Alam S, Clark V. Cyproheptadine-induced acute liver failure. ACG Case Rep J. 2014;1(4):212-213. doi:10.14309/crj.2014.56 [PubMed 25580444]
  9. Couluris M, Mayer JL, Freyer DR, Sandler E, Xu P, Krischer JP. The effect of cyproheptadine hydrochloride (Periactin) and megestrol acetate (Megace) on weight in children with cancer/treatment-related cachexia. J Pediatr Hematol Oncol. 2008;30(11):791-797. [PubMed 18989154]
  10. Cristofori F, Thapar N, Saliakellis E, et al. Efficacy of the neurokinin-1 receptor antagonist aprepitant in children with cyclical vomiting syndrome. Aliment Pharmacol Ther. 2014;40(3):309-317. doi:10.1111/apt.12822 [PubMed 24898244]
  11. Cyproheptadine hydrochloride oral solution syrup [prescribing information]. Congers, NY: Chartwell Rx LLC; July 2022.
  12. Cyproheptadine hydrochloride tablets, USP [prescribing information]. Congers, NY: Chartwell Rx LLC; January 2023.
  13. Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: a practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-767. doi:10.1016/j.jaci.2020.07.007 [PubMed 32707227]
  14. Epifanio M, Marostica PC, Mattiello R, et al. A randomized, double-blind, placebo-controlled trial of cyproheptadine for appetite stimulation in cystic fibrosis. J Pediatr (Rio J). 2012;88(2):155-160. [PubMed 22544046]
  15. Gracies JM, Nance P, Elovic E, et al, “Traditional Pharmacological Treatments for Spasticity. Part II: General and Regional Treatments,” Muscle Nerve Suppl, 1997, 6:S92-120. [PubMed 9826984]
  16. Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyproheptadine. J Emerg Med. 1998;16(4):615-619. doi:10.1016/s0736-4679(98)00057-2 [PubMed 9696181]
  17. Harrison ME, Norris ML, Robinson A, Spettigue W, Morrissey M, Isserlin L. Use of cyproheptadine to stimulate appetite and body weight gain: A systematic review. Appetite. 2019;137:62-72. [PubMed 30825493]
  18. Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. Publishing Sciences Group Inc. 1977.
  19. Henry DA, Lowe JM, Donnelly T. Jaundice during cyproheptadine treatment. Br Med J. 1978;1(6115):753. doi:10.1136/bmj.1.6115.753 [PubMed 630329]
  20. Hintze KL, Wold JS, Fischer LJ. Disposition of cyproheptadine in rats, mice, and humans and identification of a stable epoxide metabolite. Drug Metab Dispos. 1975;3(1):1-9. [PubMed 234828]
  21. Homnick DN, Homnick BD, Reeves AJ, Marks JH, Pimentel RS, Bonnema SK. Cyproheptadine is an effective appetite stimulant in cystic fibrosis. Pediatr Pulmonol. 2004;38(2):129-134. doi:10.1002/ppul.20043 [PubMed 15211696 ]
  22. Homnick DN, Marks JH, Hare KL, Bonnema SK. Long-term trial of cyproheptadine as an appetite stimulant in cystic fibrosis. Pediatr Pulmonol. 2005;40(3):251-256. doi:10.1002/ppul.20265 [PubMed 16015665 ]
  23. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168(5):1393-1399. doi:10.1016/s0002-9378(11)90771-6 [PubMed 8498418]
  24. Kacperski J, Kabbouche MA, O'Brien HL, Weberding JL. The optimal management of headaches in children and adolescents. Ther Adv Neurol Disord. 2016;9(1):53-68. [PubMed 26788131]
  25. Kardinal CG, Loprinzi CL, Schaid DJ, et al. A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer. 1990;65(12):2657-2662. doi:10.1002/1097-0142(19900615)65:12<2657::aid-cncr2820651210>3.0.co;2-s [PubMed 2187585]
  26. Kasperlik-Załuska A, Migdalska B, Hartwig W, et al. Two pregnancies in a woman with Cushing's syndrome treated with cyproheptadine. Case report. Br J Obstet Gynaecol. 1980;87(12):1171-1173. doi:10.1111/j.1471-0528.1980.tb04494.x [PubMed 7437385]
  27. Khir AS, How J, Bewsher PD. Successful pregnancy after cyproheptadine treatment for Cushing's disease. Eur J Obstet Gynecol Reprod Biol. 1982;13(6):343-347. doi:10.1016/0028-2243(82)90069-7 [PubMed 7128894]
  28. Khodadadeh S, Holstein H, Purushothaman S, et al, "A Study of the Effect of Cyproheptadine on Gait in Hemiplegic Children," Gait Posture, 1998, 8(3):205-213. [PubMed 10200409]
  29. Kliegman RM and St. Geme J, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Saunders Elsevier; 2020.
  30. Larrey D, Geneve J, Pessayre D, Machayekhi JP, Degott C, Benhamou JP. Prolonged cholestasis after cyproheptadine-induced acute hepatitis. J Clin Gastroenterol. 1987;9(1):102-104. doi:10.1097/00004836-198702000-00026 [PubMed 3559100]
  31. Lewis D, Ashwal S, Hershey A, et al, "Practice Parameter: Pharmacological Treatment of Migraine Headache in Children and Adolescents: Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society," Neurology, 2004, 63(12):2215-24. [PubMed 15623677]
  32. Lewis DW, Diamond S, Scott D, et al, "Prophylactic Treatment of Pediatric Migraine," Headache, 2004a, 44(3):230-7. [PubMed 15012660]
  33. Lewis DW, Winner P. The pharmacological treatment options for pediatric migraine: an evidence-based appraisal. NeuroRx. 2006;3(2):181-191. [PubMed 16554256]
  34. Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008;47(3):379-393. doi:10.1097/MPG.0b013e318173ed39 [PubMed 18728540]
  35. Li BUK. Managing cyclic vomiting syndrome in children: beyond the guidelines. Eur J Pediatr. 2018;177(10):1435-1442. [PubMed 30076469]
  36. Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. [PubMed 26505932]
  37. Madani S, Cortes O, Thomas R. Cyproheptadine use in children with functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2016;62(3):409-413. [PubMed 26308312]
  38. Messinis IE, Souvatzoglou A, Fais N, et al, "Histamine H1 Receptor Participation in the Control of Prolactin Secretion in Postpartum," J Endocrinol Invest, 1985, 8(2):143-6. [PubMed 3928731]
  39. Najib K, Moghtaderi M, Karamizadeh Z, Fallahzadeh E. Beneficial effect of cyproheptadine on body mass index in undernourished children: a randomized controlled trial. Iran J Pediatr. 2014;24(6):753-758. [PubMed 26019782]
  40. Paton DM and Webster DR. Clinical Pharmacokinetics of H1-Receptor Antagonists (The Antihistamines). Clin Pharmacokinet. 1985;10(6):477-497. [PubMed 2866055]
  41. Raucci U, Borrelli O, Di Nardo G, et al. Cyclic vomiting syndrome in children. Front Neurol. 2020;11:583425. doi:10.3389/fneur.2020.583425 [PubMed 33224097]
  42. Refer to manufacturer's labeling.
  43. Rodriguez L, Diaz J, and Nurko S, "Safety and Efficacy of Cyproheptadine for Treating Dyspeptic Symptoms in Children," J Pediatr, 2013, Feb 16. [PubMed 23419589]
  44. Sadeghian M, Farahmand F, Fallahi GH, Abbasi A. Cyproheptadine for the treatment of functional abdominal pain in childhood: a double-blinded randomized placebo-controlled trial. Minerva Pediatr. 2008;60(6):1367-1374. [PubMed 18971897]
  45. Sadovsky E, Pfeifer Y, Polishuk WA, Sulman FG. The use of antiserotonin-cyproheptadine HCL in pregnancy: an experimental and clinical study. Adv Exp Med Biol. 1972;27:399-405. doi:10.1007/978-1-4684-3219-0_33 [PubMed 4680134]
  46. Sant'Anna AM, Hammes PS, Porporino M, Martel C, Zygmuntowicz C, Ramsay M. Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program. J Pediatr Gastroenterol Nutr. 2014;59(5):674-678. [PubMed 24941960]
  47. Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (revised edition 2017; first edition 2007). Clin Exp Allergy. 2017;47(7):856-889. doi:10.1111/cea.12953 [PubMed 30239057]
  48. Shaker MS, Wallace DV, Golden DBK, et al; Joint Task Force on Practice Parameters Reviewers. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017 [PubMed 32001253]
  49. Simons FE, Ebisawa M, Sanchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1):32. [PubMed 26525001]
  50. Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf. 2008;7(5):587-596. doi:10.1517/14740338.7.5.587 [PubMed 18759711]
  51. Wians FH, Norton JT, and Wirebaugh, “False-Positive Serum Tricyclic Antidepressant Screen With Cyproheptadine,” Clin Chem, 1993, 39(6):1355-6. [PubMed 8504557]
  52. Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77(3):734-766. doi:10.1111/all.15090 [PubMed 34536239]
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