Cyproheptadine

Registered South African indications:

• Symptomatic treatment of seasonal and perennial rhinitis
• Symptomatic relief of pruritus

Registered South African contraindications

• Hypersensitivity to the active ingredient or any of it excipients
• Hypersensitivity to other medicines of similar chemical structure
• Breastfeeding
• Elderly
• Debilitated patients
• Acute asthmatic attack
• Closed-angle glaucoma
• Pyloroduodenal obstruction
• Stenosing peptic ulcer
• Symptomatic prostatic hypertrophy
• Bladder neck obstruction
• Children below 2 years
• Coadministration with monoamine oxidase inhibitors

South African recommendations

• Pregnancy
• History of bronchial asthma
• Increased intraocular pressure
• Hyperthyroidism
• Cardiovascular disease
• Hypertension
• Simultaneous intake of alcohol or other CNS depressant agents
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: tab

South African registered indications and dosages

Symptomatic treatment of seasonal and perennial rhinitis
Symptomatic relief of pruritus

• Oral (tab): Initial: 4mg, 3 times a day; Adjust according to size and response of the patient; Therapeutic range: 4-20mg/day in divided doses; Majority of patients require 12-16mg/day

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Dosage must be individualised. Since the antiallergic effect of a single dose usually lasts 4-6 hours, the daily requirement should be given  in divided doses 3 times a day or as often as necessary to provide continuous relief

Paed. forms avail. in SA and covered in this monograph: tab

South African registered indications and dosages

Symptomatic treatment of seasonal and perennial rhinitis
Symptomatic relief of pruritus

Younger than 2 years

• Contraindicated

Between 2-6 years

• Oral (tab): Initial: 2mg, 2-3 times a day; Adjust as needed according to the size and response; If an additional dose is required, it should be taken at bedtime; Max: 8mg/24hrs

Between 7-14 years

• Oral (tab): 4mg, 2-3 times a day; Adjust as needed according to the size and response; If an additional dose is required, it should be taken at bedtime; Max: 16mg/24hrs

Older than 14 years

• See adult dosage

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Dosage must be individualised. Since the antiallergic effect of a single dose usually lasts 4-6 hours, the daily requirement should be given  in divided doses 3 times a day or as often as necessary to provide continuous relief

Pregnancy

South African recommendations

• Caution
• Safety in pregnant women has not been established

Breastfeeding

South African recommendations

• Contraindicated
  Because of the higher risk of antihistamines for infants generally, and for newborns and prematures in particular, cyproheptadine is contraindicated in nursing mothers

Fertility

South African recommendations

• No information available

South African recommendations

• Caution; no information available

South African recommendations

• Caution; no information available

South African recommendations

• Contraindicated

Central Nervous System Disorders

• Sedation
• Sleepiness
• Dizziness
• Disturbed coordination
• Tremor
• Paraesthesia
• Neuritis
• Convulsions
• Faintness
• Headache
• Confusion
• Restlessness
• Excitation
• Irritability
• Nervousness
• Insomnia
• Aggressive behaviour
• Hallucination
• Hysteria
• Euphoria
• Fatigue

Cardiovascular Disorders

• Palpitation
• Tachycardia
• Extrasystoles
• Hypotension

Respiratory Disorders

• Thickening of bronchial secretions
• Dryness of nose and throat
• Tightness of chest and wheezing
• Nasal stuffiness
• Epistaxis

Gastrointestinal Disorder

• Dryness of mouth
• Epigastric distress
• Nausea and vomiting
• Diarrhoea
• Constipation

Hepatobiliary Disorders

• Cholestasis
• Hepatic failure
• Hepatitis
• Hepatic function abnormality
• Jaundices

Genitourinary Disorders

• Frequency and difficulty of micturition
• Urinary retention

Endocrine and Metabolic Disorders

• Anorexia
• Increased appetite
• Early menses
• Increased weight

Skin and Subcutaneous Tissue Disorders

• Urticaria
• Photosensitivity
• Excessive perspiration

Immune, Blood and Lymphatic System Disorders

• Haemolytic anaemia
• Leucopenia
• Agranulocytosis
• Thrombocytopenia
• Rash
• Oedema
• Anaphylactic shock

Sensory Disorders

• Blurred vision
• Diplopia
• Acute labyrinthitis
• Tinnitus
• Vertigo

Other Disorders

• Rigors

• Monoamine oxidase inhibitors
• Alcohol
• Central nervous system depressants
• Serotonin-enhancing antidepressants 

None routine

Cyproheptadine competes with free histamine for binding at histamine-receptor sites. This leads to a reduction of the negative symptoms brought on by histamine binding to the receptor. Cyproheptadine also competes with serotonin at receptor sites in intestinal smooth muscle and in other locations.

Tablet 4mg

• Cipla-Actin (Cipla Medpro) 
• Periactin (MC Pharma) originator