Despite small sample sizes in published studies and few randomized trials, clonidine, guanfacine, cyproheptadine
, topiramate, and gabapentin are reasonable alternatives to prazosin for reducing nightmares in patients with PTSD.
Of the remaining prophylactic agents, there is insufficient evidence to recommend cyproheptadine
, amitriptyline, divalproex sodium, topiramate, or levetiracetam, according to the guidelines.
treatment in neuroleptic-induced akathisia.
A recent review article15 recommends cyproheptadine
as an initial agent in children <10 years of age.
Halmi prefers to use cyproheptadine
rather than tricyclics to promote weight gain.
is the first choice for prophylaxis in young children.
TABLE Summary of treatment options for SSRI-induced sexual dysfunction Strategy Drugs considered RCT data Switch therapy Bupropion SR, bupropion, Nefazodone mirtazapine, nefazodone effective Augmentation Buspirone, amantadine, Small, transient bupropion, cyproheptadine
, effect with dextroamphetamine, granisetron, high-dose ginkgo biloba, methylphenidate, buspirone.
In 1997, Gillman reported a case of a woman with serotonin syndrome whose condition did not improve with supportive management, cyproheptadine
, and propranolol.
The standard drugs of prophylactic therapy include propanolol (Inderal) with a pediatric dose 0.5-1 mg/kg daily divided in two or three doses; cyproheptadine
(Periactin) with a pediatric dose of 0.25-0.5 mg/kg daily divided; and amitriptyline with a pediatric dose of 10-40 mg daily under 6 years, 30-60 mg for those aged 6-12 years, and 50-100 mg over 12 years.
Case reports also suggest using serotonin receptor antagonists--such as cyproheptadine
, methysergide, chlorpromazine, or propranolol--to clinically manage serotonin syndrome, although empiric support is limited.(9)
By contrast, most prophylactic agents, including [beta]-blockers, calcium channel antagonists, cyproheptadine
, tricyclic antidepressants, and methysergide, act through antagonistic activity at the 5-HT-2 receptor site.