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Cyproheptadine

Class
Antihistamines
Subclass
First-generation H1-antihistamines
Substance name
Cyproheptadine hydrochloride
Brand names
Periactin®
Common formulations
Tablet
Dosage and administration
Adults patients
Symptomatic relief
Allergic rhinitis • Perennial
•
Start at: 12 mg PO daily, in 3 divided doses
•
Maintenance: 12-16 mg PO daily, in 3 divided doses
•
Maximum: 32 mg per day
Titrate up to 32 mg/day for adequate relief, with the total daily dose not exceeding 0.5 mg/kg/day.
Treatment
Cold urticaria
•
Start at: 12 mg PO daily, in 3 divided doses
•
Maintenance: 12-16 mg PO daily, in 3 divided doses
•
Maximum: 32 mg per day
Titrate up to 32 mg/day for adequate relief, with the total daily dose not exceeding 0.5 mg/kg/day.
Dermographism
•
Start at: 12 mg PO daily, in 3 divided doses
•
Maintenance: 12-16 mg PO daily, in 3 divided doses
•
Maximum: 32 mg per day
Titrate up to 32 mg/day for adequate relief, with the total daily dose not exceeding 0.5 mg/kg/day.
Urticaria • Mild, uncomplicated
•
Start at: 12 mg PO daily, in 3 divided doses
•
Maintenance: 12-16 mg PO daily, in 3 divided doses
•
Maximum: 32 mg per day
Titrate up to 32 mg/day for adequate relief, with the total daily dose not exceeding 0.5 mg/kg/day.
Adjunctive treatment
Adjunctive treatment for anaphylactic reactions
•
Start at: 12 mg PO daily, in 3 divided doses
•
Maintenance: 12-16 mg PO daily, in 3 divided doses
•
Maximum: 32 mg per day
Titrate up to 32 mg/day for adequate relief, with the total daily dose not exceeding 0.5 mg/kg/day.
Indications for use
Labeled indications
Adults
•
Symptomatic relief of allergic rhinitis (perennial)
•
Symptomatic relief of allergic rhinitis (seasonal)
•
Treatment of allergic conjunctivitis
•
Treatment of cold urticaria
•
Treatment of dermographism
•
Treatment of urticaria (mild, uncomplicated)
•
Treatment of vasomotor rhinitis
•
Adjunctive treatment for anaphylactic reactions
Safety risks
Contraindications
Receiving MAOIs therapy
Bladder obstruction, stenosing peptic ulcer disease, pyloroduodenal GI obstruction, and symptomatic prostatic hypertrophy
Pre-existing closed-angle glaucoma
Warnings and precautions
Arrhythmias
•
Use caution with a history of cardiac disease.
COPD
•
Use caution with a history of asthma.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Titrate slowly. Monitor for drowsiness.
eGFR 10-20 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Titrate slowly. Monitor for drowsiness.
eGFR < 10 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Titrate slowly. Monitor for drowsiness.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required. Titrate with caution.
Hepatic impairment
Any severity
•
Reduce dose. Monitor serum aminotransferases.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: A
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Do not use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Somnolence
Common 1-10%
•
Blurred vision, constipation, dry mouth, ↑ appetite, urinary retention, weight gain
Uncommon < 1%
•
Anaphylaxis, fatigue, skin rash, urticaria
Unknown frequency
•
Acute liver failure, agranulocytosis, cholestasis, cognitive impairment, ↓ WBC count, ↓ platelet count, hemolytic anemia, hyperhidrosis, hypotension, jaundice, neuritis, photosensitivity of skin, chills, confusion, diarrhea, diplopia, dizziness, dyspepsia, euphoria, ↑ appetite, insomnia, irritability, nasal congestion, nausea, paresthesia, restlessness, seizure, tinnitus, urinary frequency, vertigo, vomiting, sinus tachycardia, tremor, wheezing
Interactions
Drug(s)
Check Interactions
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