II. Indications

  1. Allergic Rhinitis
  2. Urticaria
  3. Serotonin Syndrome (not FDA approved)
  4. Appetite Stimulant (not FDA approved)

III. Mechanism

  1. See Antihistamine
  2. H1 Receptor Antagonist (First Generation Antihistamine)
  3. Cyproheptadine is an synthetic methyl-piperidine derivative with moderate Anticholinergic activity
  4. Cyproheptadine also has antiserotinergic activity

IV. Precautions

  1. Although FDA approved for children, FDA does not recommend routine Antihistamine use age <4 years
    1. Deaths have occurred in younger children related to Anticholinergic Toxicity

V. Dosing: Allergic Rhinitis or Urticaria

  1. Adult (age >14 years): Start 4 mg orally three times daily (maximum 32 mg/day)
  2. Child (age 7 to 14 years): Start 4 mg orally three times daily (maximum 16 mg/day)
  3. Child (age 2 to 6 years): Start 2 mg orally three times daily

VI. Dosing: Serotonin Syndrome

  1. See Serotonin Syndrome
  2. Start 12 mg orally for first dose
  3. Next: 2 mg orally every 2 hours until symptoms resolve
  4. Next 8 mg every 6 hours until syndrome completes

VII. Adverse Effects

VIII. Safety

  1. Pregnancy category B
  2. Avoid in Lactation

X. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 146-7
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

cyproheptadine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CYPROHEPTADINE 2 MG/5 ML SOLN Generic $0.05 per ml
CYPROHEPTADINE 2 MG/5 ML SYRUP Generic $0.05 per ml