cyproheptadine hydrochloride

cy·pro·hept·a·dine hydrochloride (spr-hpt-dn)

n.

An antihistamine used to relieve the symptoms of various allergic reactions, such as itching and skin rash.

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cyproheptadine hydrochloride

[sī′prōhep′tədēn]

an antihistamine.

indications It is prescribed in the treatment of hypersensitivity reactions, including rhinitis, skin rash, and pruritus.

contraindications Asthma or known hypersensitivity to this drug prohibits its use. It is not given to newborns or lactating mothers.

adverse effects Among the more serious adverse reactions are skin rash, hypersensitivity, and tachycardia. Drowsiness and dry mouth commonly occur.

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cyproheptadine hydrochloride

Periactin (UK), Periactin, PMS-Cyproheptadine (CA)

Pharmacologic class: Piperidine (nonselective)

Therapeutic class: Antihistamine

Pregnancy risk category B

Action

Antagonizes effects of histamine at histamine₁-receptor sites, preventing histamine-mediated responses. Also blocks effects of serotonin, causing increased appetite.

Availability

Syrup: 2 mg/5 ml

Tablets: 4 mg

⊘Indications and dosages

➣ Allergy symptoms caused by histamine release (including seasonal and perennial allergic rhinitis); chronic urticaria; angioedema; dermographism; cold urticaria; adjunctive therapy for anaphylactic reactions

Adults: Initially, 4 mg P.O. q 8 hours. Maintenance dosage is 4 to 20 mg/day in three divided doses, to a maximum dosage of 0.5 mg/kg/day.

Children ages 7 to 14: 2 to 4 mg P.O. q 12 hours. Don't exceed 16 mg/day.

Children ages 2 to 6: 2 mg P.O. q 12 hours. Don't exceed 12 mg/day.

Off-label uses

• Vascular cluster headaches

Contraindications

• Hypersensitivity to drug
• Alcohol intolerance (syrup only)
• Bladder neck obstruction
• Angle-closure glaucoma
• Ulcer disease
• Symptomatic prostatic hypertrophy
• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:
• hepatic impairment
• elderly patients
• pregnant patients (safety not established)
• breastfeeding patients.

Administration

• Give with food or milk to decrease GI upset.

Route	Onset	Peak	Duration
P.O.	15-60 min	1-2 hr	8 hr

Adverse reactions

CNS: drowsiness, dizziness, excitation (especially in children), fatigue, sedation, hallucinations, disorientation, tremor

CV: palpitations, hypotension, arrhythmias

EENT: blurred vision, nasal dryness and congestion, dry throat

GI: constipation, dry mouth

GU: urinary retention, urinary frequency, ejaculatory inhibition, early menses

Respiratory: thickened bronchial secretions

Skin: rash, photosensitivity

Other: weight gain

Interactions

Drug-drug. CNS depressants (including opioid analgesics, sedative-hypnotics): increased CNS depression

MAO inhibitors: intensified, prolonged anticholinergic effects

Drug-diagnostic tests. Allergy skin tests: false-negative reactions

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor patient for excessive anticholinergic effects.
• Assess for excessive CNS depression.
• Discontinue drug 4 days before diagnostic skin testing.

Patient teaching

• Advise patient to take drug with food to minimize GI upset.
• Caution patient not to use other CNS depressants, sleep aids, or alcohol during therapy.
• Instruct patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.