cyproheptadine

BEERS REMS

Relief of allergic symptoms caused by histamine release including:
- Seasonal and perennial allergic rhinitis,
- Chronic urticaria,
- Cold urticaria.

Unlabeled Use:

Stimulation of appetite.

Action ⬆ ⬇

Antagonizes the effects of histamine at H₁-receptor sites; does not bind to or inactivate histamine.
Also blocks the effects of serotonin, which may result in increased appetite.

Therapeutic effects:

Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and redness).
Decreased cold urticaria.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Unknown.

Metabolism/Excretion: Mostly metabolized by the liver.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(antihistaminic effects)

ROUTE	ONSET	PEAK	DURATION
PO	15–60 min	1–2 hr	8 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Acute attacks of asthma;
Known alcohol intolerance (syrup only).
Lactation: Lactation;

Use Cautiously in:

Angle-closure glaucoma;
Hepatic impairment;
OB: Safety not established in pregnancy; .
Geri: Appears on Beers list. risk of anticholinergic adverse reactions in older adults, including falls, delirium, and dementia. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias, hypotension, palpitations

Derm: photosensitivity, rash

EENT: blurred vision

GI: dry mouth, constipation

GU: urinary hesitancy, urinary retention

Metab: weight gain

Neuro: drowsiness, excitation (increased in children)

Interactions ⬆ ⬇

Drug-drug:

Additive CNS depression with other CNS depressants, including alcohol, opioid analgesics, and sedative/hypnotics.
MAO inhibitors may intensify and prolong the anticholinergic effects of antihistamines.

Route/Dosage ⬆ ⬇

PO (Adults ): 4 mg every 8 hr (range 4–20 mg/day in 3 divided doses; up to 0.5 mg/kg/day).
PO (Children 6–14 yr): 2–4 mg every 8–12 hr (not to exceed 16 mg/day).
PO (Children 2–6 yr): 2 mg every 8–12 hr (not to exceed 12 mg/day).

Availability ⬆ ⬇

(Generic available)

Tablets: 4 mg
Syrup: 2 mg/5 mL

Assessment ⬆ ⬇

Geri: Assess for adverse anticholinergic effects (delirium, acute confusion, dizziness, dry mouth, blurred vision, urinary retention, constipation, tachycardia).
Allergy: Assess symptoms (rhinitis, conjunctivitis, hives) prior to and periodically throughout therapy.
- Assess lung sounds and respiratory function prior to and periodically during therapy. May cause thickening of bronchial secretions. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions.
Appetite Stimulant: Monitor food intake and weight routinely.

Lab Test Considerations:

May cause false-negative reactions on allergy skin tests; discontinue 72 hr prior to testing.
- ↑serum amylase and prolactin concentrations may occur when cyproheptadine is administered with a thyrotropin-releasing hormone.

Implementation ⬆ ⬇

PO: Administer with food, water, or milk to minimize gastric irritation.
- Administer syrup with an accurate measuring device.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take cyproheptadine exactly as directed. Take missed dose as soon as remembered. Do not double doses. Syrup should be accurately measured using calibrated medication cup or measuring device.
Medication may cause drowsiness. Advise patient to avoid driving or other activities requiring alertness until response to the drug is known.
Advise patient to use sunscreen and protective clothing to prevent a photosensitivity reaction.
Caution patient to avoid concurrent use of alcohol and other CNS depressants, including opioids.
Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dry mouth. Patient should notify dentist if dry mouth persists for >2 wk.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding. Monitor infants exposed to cyproheptadine through breast milk for irritability or drowsiness.
Geri: Teach patient and family about anticholinergic effects and to contact a health care provider if such effects persist.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇