From the Guidelines
Cyproheptadine is recommended at a dosage of 12 to 24 mg over 24 hours, typically starting with 12 mg, followed by 2 mg every 2 hours for continuing symptoms, and a maintenance dose of 8 mg every 6 hours, given orally, for the treatment of serotonin syndrome. This dosage is based on the most recent and highest quality study available, which suggests that cyproheptadine is effective in treating serotonin syndrome, a condition characterized by excessive serotonin levels in the body 1. The study, published in the journal Pediatrics in 2016, provides guidance on the evaluation and management of children with acute mental health or behavioral problems, including the use of cyproheptadine for serotonin syndrome.
Key Points to Consider
- The pediatric dosage of cyproheptadine is usually 0.25 mg/kg per day, as stated in the study 1.
- There is no parenteral form of cyproheptadine, but tablets can be crushed and administered via a nasogastric tube if necessary.
- Cyproheptadine works by blocking serotonin receptors, which explains its effectiveness in treating serotonin syndrome.
- The medication should be used with caution, as it can cause side effects such as drowsiness, dry mouth, and increased appetite.
Important Considerations for Treatment
- Treatment of serotonin syndrome often involves discontinuing the precipitating agent and providing supportive care, including treatment of agitation, hyperthermia, and autonomic instability 1.
- In severe cases of serotonin syndrome, emergency sedation, neuromuscular paralysis, and intubation may be considered.
- Physical restraints should be avoided, as they can exacerbate isometric contractions and worsen hyperthermia and lactic acidosis.
From the Research
Recommended Use of Cyproheptadine
- Cyproheptadine is used as an appetite stimulant in patients with poor appetite, including children and adults with various chronic illnesses, such as cystic fibrosis 2 and the malignant carcinoid syndrome 3.
- It is also used to treat allergic-type symptoms, such as those associated with colds 4.
Dosage of Cyproheptadine
- The recommended dosage of cyproheptadine varies depending on the condition being treated and the patient's age and weight.
- In adults with poor appetite, a dosage of 4-8 mg per day has been shown to be effective in stimulating appetite and promoting weight gain 5.
- In children with cystic fibrosis, a dosage of 4 mg up to four times a day has been used to stimulate appetite and promote weight gain 2.
- In patients with the malignant carcinoid syndrome, an initial total daily dose of 0.4 mg/kg divided into three fractions has been recommended, with prompt modification to produce minimal and tolerable side effects 3.
Safety and Tolerability
- Cyproheptadine is generally considered to be a safe and well-tolerated medication, with mild side effects such as somnolence, dry mouth, and nausea being commonly reported 6, 5, 2, 3.
- However, rare but serious side effects, such as hepatotoxicity and liver failure, have been reported 6, 4.
- Patients taking cyproheptadine should be monitored for potential side effects and liver function should be assessed regularly 6.