Cyproheptadine: Difference between revisions

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{{MedTemplate

| generic = Cyproheptadine

| generic = Cyproheptadine (hydrochloride)

| brand = Periactin

| brand = Periactin (US brand discontinued; generic widely available)

| classes = ~~Antihistamine~~

| structure =

| mechanism = H1 and 5-~~HT2~~ receptor ~~antagonist~~

| classes = [[:Category:Antihistamines|First-generation antihistamine]], [[:Category:Serotonin antagonists|Serotonin 5-HT2 antagonist]], [[:Category:Orexigenics|Appetite-promoting medicine (orexigenic)]]

| uses = <vote slug="allergic-conditions-use">Allergic conditions including urticaria and seasonal allergies (FDA)</vote>, <vote slug="serotonin-syndrome-antidote-use">Serotonin syndrome (off-label; the standard pharmacological antidote alongside supportive care and benzodiazepines)</vote>, <vote slug="appetite-stimulation-cachexia-use">Appetite stimulation in failure to thrive, cachexia, and anorexia (off-label, evidence-supported in pediatric and adult populations)</vote>, <vote slug="migraine-prophylaxis-pediatric-use">Pediatric migraine prophylaxis (off-label)</vote>, <vote slug="ssri-sexual-dysfunction-adjunct-use">SSRI-induced sexual dysfunction (off-label adjunct, modest evidence)</vote>

| starting_dose = Allergy: 4 mg PO TID. Serotonin syndrome: 12 mg loading dose PO or by nasogastric tube, then 2 mg every 2 hours until clinical improvement. Appetite stimulation: 2-4 mg PO TID-QID

| preparations = Tablets 4 mg; oral syrup 2 mg/5 mL

| fda_max = 32 mg/day adult; weight-based pediatric ceiling

| pill_id =

| routes = Oral

| onset = 30-60 minutes

| duration = 6-8 hours

| halflife = 8-16 hours<ref name="periactin-label">FDA Prescribing Information, Periactin (cyproheptadine hydrochloride), Merck/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/010407s058lbl.pdf</ref>

| bioavailability = ~95% (oral)<ref name="periactin-label" />

| pregnancy = Limited human data; older agent with substantial use experience.{{citation needed}}

| legal = [[USLegal:Prescription only|Rx-only]] in US

| mechanism = <vote slug="cyproheptadine-mech-claim">First-generation H1 histamine receptor antagonist with substantial additional '''5-HT2A and 5-HT2C serotonin receptor antagonism'''. The 5-HT2A antagonism is the basis of its role as the first-line pharmacological antidote for serotonin syndrome; the 5-HT2C antagonism underlies the appetite stimulation effect (the same receptor mechanism that drives weight gain with mirtazapine and olanzapine).</vote> Anticholinergic and sedating, with the standard first-generation antihistamine Beers-list concerns in elderly patients<ref name="periactin-label" />.

}}

== References ==

[[Category:Antihistamines]]

[[Category:Serotonin antagonists]]

[[Category:Orexigenics]]

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