What is the use of cyproheptadine (antihistamine) for pruritus (itching) in pediatric patients?

From the Guidelines

Cyproheptadine is a recommended treatment for pruritus in pediatric patients, with a typical dosage of 0.25 mg/kg/day divided into 2-3 doses, as it has been shown to be effective in decreasing pruritus, flushing, urticaria, and tachycardia 1. When considering the treatment of pruritus in pediatric patients, it is essential to weigh the potential benefits and risks of cyproheptadine. The medication works by blocking histamine H1 receptors and serotonin receptors, reducing the itch sensation.

• The dosage of cyproheptadine for pediatric patients is typically 0.25 mg/kg/day, with a maximum of 0.5 mg/kg/day or 32 mg/day 1.
• For children 2-6 years old, a starting dose of 2 mg twice daily is recommended, while for those 7-14 years, 4 mg twice daily is appropriate.
• Common side effects of cyproheptadine include drowsiness and increased appetite, so administering the larger portion of the daily dose at bedtime may be beneficial.
• It is crucial to identify and address the underlying cause of the pruritus, as cyproheptadine provides symptomatic relief rather than treating the root condition.
• Before starting treatment, ensure there are no contraindications such as glaucoma, urinary retention, or concurrent MAO inhibitor use.
• The medication should be used for the shortest duration needed to control symptoms, typically reassessing after 2-4 weeks.
• Cyproheptadine has been shown to be effective in combination with H2 antihistamines for controlling severe pruritus and wheal formation 1.

From the FDA Drug Label

Safety and effectiveness in pediatric patients below the age of two have not been established Pediatric Use Patients should be warned about engaging in activities requiring mental alertness and motor coordination, such as driving a car or operating machinery. The answer to using cyproheptadine for pruritus in pediatric patients is that safety and effectiveness have not been established in patients below the age of two 2.

• Key considerations for pediatric patients include the potential for diminished mental alertness or excitation.
• Caution is advised when using cyproheptadine in pediatric patients due to the potential for adverse effects.

From the Research

Cyproheptadine for Pruritus in Pediatric Patients

• Cyproheptadine is an antihistamine that has been used to treat pruritus in various conditions, including atopic dermatitis and functional gastrointestinal disorders 3, 4.
• In pediatric patients, cyproheptadine has been shown to be effective in improving symptoms of functional abdominal pain, functional dyspepsia, and irritable bowel syndrome 4.
• A study on the use of cyproheptadine in children with feeding difficulties and poor growth found that it was safe and effective in improving weight gain and feeding behaviors 5.
• However, the evidence for the use of antihistamines, including cyproheptadine, in the treatment of atopic dermatitis is inconclusive, and more clinical trials are needed to elucidate their role in the treatment of this condition 3.
• In the treatment of chronic pruritus associated with dermatologic diseases in pediatric patients, the use of cyproheptadine is not specifically recommended, and instead, basic skin therapy and topical medications are suggested as first-line treatments 6.

Dosage and Safety

• The dosage of cyproheptadine used in pediatric patients varies depending on the condition being treated, but a common dose is 0.14 mg/kg/day 4.
• Adverse effects of cyproheptadine in pediatric patients include sleepiness and weight gain, but it is generally considered to be safe and well-tolerated 4, 5.
• The safety profile of cyproheptadine in pediatric patients is considered to be good, with no significant differences in adverse effects compared to adults 4.

Clinical Trials and Evidence

• More clinical trials are needed to evaluate the efficacy and safety of cyproheptadine in pediatric patients with pruritus and other conditions 3, 7.
• The current evidence for the use of cyproheptadine in pediatric patients is largely based on retrospective studies and case reports, and more prospective studies are needed to confirm its effectiveness and safety 4, 5.
• The use of cyproheptadine in pediatric patients should be guided by the available evidence and clinical experience, and patients should be closely monitored for adverse effects and response to treatment 6.