Cyproheptadine

Use

Allergic rhinitis and other allergic symptoms (urticaria); promote weight gain
and appetite stimulation; prevent episodes of cyclic vomiting; management of
dyspeptic symptoms; treatment of spasticity associated with spinal cord
damage; management of serotonin syndrome (after use of SSRI).

Safe Dose

Pediatric

!Allergic Conditions (Oral):

Children > 2 years and Adolescents: 0.25 mg/kg/day divided into 2-3 doses
Fixed dosing:
2-6 years: 2mg every 8-12 hours (maximum 12 mg/day)
7-14 years: 4mg every 8-12 hours (maximum dose 16 mg/day)
> 15 years: 12-16 mg/day (maximum dose 0.5 mg/kg/day)

Appetite Stimulation (Oral): weight directed dosing

Children > 2 years and Adolescents: 0.25 mg/kg/day divided into 2 doses
Maximum doses:
< 6 years: 12 mg/day
7-14 years: 16 mg/day
> 15 years: 32 mg/day

Cyclic vomiting syndrome prevention (Oral):

Children 2-5 years: 0.25-0.5 mg/kg/day divided into 2-3 doses (maximum 12
mg/day)

Dyspeptic Syndrome Refractory (Oral):

Infants > 9 months and Children < 12 years: 0.04-0.6 mg/kg/day divided
into 2-3 doses

!Migrane prophylaxis:

Children > 3 years and Adolescents: 0.2-0.4 mg/kg/day divided into two
doses (maximum 0.5 mg/kg/day)

!Spasticity associated with spinal cord damage (Oral):

Children > 12 years and Adolescents: 4 mg at bedtime; increased by a 4 mg

dose every 3-4 days (maximum 36 mg/day)

Action

Antihistamine and serotonin antagonist: binds to H1-receptor sites in the GI

tract, blood vessels, and respiratory tract to prevent histamine from binding to
them.

Route

PO

Adverse
Reactions

Cardiovascular: hypotension, palpitations, tachycardia

CNS: ataxia, chills, confusion, dizziness, drowsiness, euphoria, excitement,
fatigue, hallucination, headache, hysteria, insomnia, irritability, nervousness,
paresthesia, restlessness, sedation, seizure, vertigo
Dermatologic: diaphoresis, skin photosensitivity, skin rash, urticaria
GI: abdominal pain, anorexia, cholestasis, constipation, diarrhea, increased
appetite, nausea, vomiting, xerostomia
GU: difficulty urinating, urinary frequency, urinary retention
Hematology/Oncologic: agranulocytosis, hemolytic anemia, leukopenia,
thrombocytopenia
Hepatic: hepatic failure, hepatitis, jaundice
Hypersensitivity: anaphylactic shock, angioedema, hypersensitivity reaction
Neuromuscular & skeletal: tremor
Ophthalmic: blurred vision, diplopia
Otic: tinnitus
Respiratory: nasal congestion, pharyngitis, thickening of bronchial secretions

ContraHypersensitivity to cyproheptadine; narrow-angle glaucoma; bladder neck

indication obstruction; pyloroduodenal obstruction; peptic ulcer; concurrent use of
s
MAOIs; premature and term newborns (causes SIDS)
Nursing
Imp

1) Administration Oral: usually administered in 2-4 divided doses; for cyclic

vomiting syndrome, administer once daily at bedtime to improve
tolerability of sedative effects
2) Discuss specific use of drug and side effects with patient and how it relates
to the treatment
3) Have patient (or patient caretaker) report any side effects to the nurse or
prescriber
4) Educate about signs of severe reactions (ex: seizure, confusion,
hypotension, difficulty urinating, etc.)

Drug
Level

Metabolism: metabolized in the liver

Half-life: approx. 16 hours
Peak time: 6-9 hours
Excretion: urine and feces

Teaching

What is this drug used for? Ease allergy signs and prevent migraine headaches.

!Is it safe for my child to take?

1) Not if your child is allergic to cyproheptadine.

2) Inform doctor if the child has any allergies to food, drugs, or dyes.
Inform doctor about the type of allergy the child has.
3) Not safe if your child has asthma, glaucoma, bowel block, or trouble
passing urine.

!What are some side effects?

Blue skin; swollen face, lips, tongue; child feels weak, dizzy, nervous, excited;
rash formation; wheezing, chest tightness.

!How is the drug best given?

1) Most useful if administerd 2-3 hours before contact with allergen

2) Give with or without food; to reduce GI discomfort, give with food
3) There is a liquid form if the child can not swallow pills; measure
correctly
4) Feeding tubes: administer liquid form; flush tube before administering
medication