Cyproheptadine dosing

Fat-soluble vitamin supplementation is usually required in pancreatic insufficiency. Specially-formulated products for CF patients (ADEKs and Vitamax ) are usually sufficient to attain normal serum vitamin levels at a dose of 1 tablet daily for younger children and 2 tablets daily for teenagers and adults. Additional supplementation may be needed in uncontrolled malabsorption or for replacement of severe vitamin deficiency.5,15 Appetite stimulants such as cyproheptadine may be an option for promoting nutrition and weight gain, but efficacy has not been established. 

Cyproheptadine is not an addictive or habit-forming substance. In the study referenced above, it was administered three times per day with a total daily dose from 12 to 32mg/day. Common side effects of this medication include drowsiness, dry mouth, and drying of the nasal passages and airways. Caution should be exercised when administering cyproheptadine with other sedating medications. 

Fixed dose combination of cyproheptadine with lysine or peptone. 

The major clinical applications of cyproheptadine are in the treatment of the smooth muscle manifestations of carcinoid tumor and in cold-induced urticaria. The usual dosage in adults is 12-16 mg/d in three or four divided doses. It is of some value in serotonin syndrome, but because it is available only in tablet form, cyproheptadine must be crushed and administered by stomach tube in unconscious patients. 

Serotonin syndrome after a single dose of sertraline 100 mg has been reported in a 16-year-old girl (6). It responded to a single 4 mg dose of the serotonin antagonist cyproheptadine. 

Treatment of tardive dyskinesia is often unsatisfactory, especially in severe cases. A large number of treatments have been proposed (SEDA-20,40), including antiparkinsonian drugs, benzodiazepines, baclofen, hormones, calcium channel blockers, valproate, propranolol, opiates, cyproheptadine, tryptophan, lithium, manganese, niacin, botulinum toxin, ECT, dietary control, and biofeedback training. In an open study, 20 patients (mean age 65 years) with severe unresponsive tardive dyskinesia (mean duration 44 months, mean exposure 52 months) were treated with tetrabenazine (mean dose 58 mg/day) (310). The mean score on the AIMS motor subset, determined from videotapes, improved by 54%. Sedation was the only subjective complaint. 

Watemberg NM, Roth KS, Alehan FK, Epstein CE. Central anticholinergic syndrome on therapeutic doses of cyproheptadine. Pediatrics 1999 103(l) 158-60. 

PARACETAMOL ANTIHISTAMINES Chlorphenamine, cyproheptadine and hydroxyzine may slow the onset of action of intermittent-dose paracetamol Anticholinergic effects delay gastric emptying and absorption Warn patients that the action of paracetamol may be delayed. This will not be the case when paracetamol is taken regularly... 

After a single oral dose of 5 mg to 2 subjects, peak plasma concentrations of cyproheptadine metabolites of 0.036 and 0.05 ig/ml were attained in 6 to 9 hours unchanged drug was not detected (K. L. Hintze et al.. Drug Met. Disp., 1975, 5, 1-9). 

Dose. 12 to 16 mg of anhydrous cyproheptadine hydrochloride daily maximum of 32 mg daily. 

In 23 patients who took an overdose of Sleep-Qik (valerian dry extract 75 mg, mean dose 2.5 g, hyoscine hydrobromide 0.25 mg, and cyproheptadine hydrochloride 2 mg) the main problems were central nervous system depression and anticholinergic poisoning (7). There was no evidence of liver damage, subclinical, acute, or delayed. It is unlikely that valerian contributed to the adverse effects in these cases. 

Sexual dysfunction, delayed or absent ejaculation in men, and anorgasmia in women, are common SSRI side effects. Decreased libido may also be caused by the SSRIs. These side effects often may be diminished by dose reduction, drug holidays, or the use of other medications as antidotes, such as yohimbine, cyproheptadine, or buproprion. 

Solutions of drugs were prepared in 145 mM aqueous NaCl, from which a dose series was prepared. dl-Octopamine, dl-synephrine, dopamine, tolazoline, clonidine, yohimbine, cyproheptadine, gramine, chlorpromazine, promethazine, propranolol, metoclopramide, and 3-isobutyl-l-methylxanthine were obtained from Sigma Chemical Co. naphazoline from Aldrich Chemical Co. chlordimeform and phentolamine from Ciba Geigy mianserin from Research Biochemicals Inc. and lofexidine, XAMI, and tramazoline were gifts from Dr. R. Hollingworth, Purdue Univ. 

Serotonin syndrome. Anecdotal case reports suggest benefit with cyproheptadine (Periactin ), 4 mg orally (PO) every hour for 3- doses (see p 430) or methysergide, 2 mg PO every 6 hours for 3-4 doses. 

B. Specific drugs and antidotes. For suspected serotonin syndrome, anecdotal reports claim benefit from cyproheptadine (Periactin), 4 mg orally every hour for 3 doses, or methysergide (Sansert), 2 mg orally every 6 hours for 3 doses, presumably because of the serotonin antagonist effects of these drugs. 

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