Can I start cyproheptadine with escitalopram (Lexapro) and clonazepam (Klonopin) for anxiety-related weight loss and loss of appetite with a normal Body Mass Index (BMI)?

Cyproheptadine with Escitalopram and Clonazepam for Anxiety-Related Weight Loss

Cyproheptadine can be safely added to your escitalopram and clonazepam regimen to address anxiety-related weight loss and appetite issues, especially since your BMI is normal.

Rationale for Adding Cyproheptadine

Cyproheptadine is an antihistamine with appetite-stimulating properties that can effectively counteract the weight loss sometimes associated with anxiety disorders and SSRI medications like escitalopram. Research supports its use for medication-induced weight loss:

• A retrospective chart review showed that cyproheptadine (4-8 mg nightly, mean dose 4.9 mg/day) successfully reversed weight loss in patients taking stimulant medications, with all patients gaining weight after adding cyproheptadine (mean gain of 2.2 kg) 1
• Cyproheptadine has demonstrated effectiveness for weight gain without interfering with the therapeutic effects of psychiatric medications

Medication Compatibility

The combination of cyproheptadine with escitalopram and clonazepam appears safe based on available evidence:

• No significant negative drug interactions between cyproheptadine and escitalopram or clonazepam are reported in the guidelines
• Escitalopram is an effective SSRI for anxiety disorders with good tolerability 2
• In some cases, cyproheptadine has been used to treat serotonin syndrome caused by excessive serotonergic activity, suggesting it may actually help balance serotonergic effects rather than cause problems when combined with SSRIs 3

Dosing Recommendations

• Start with a low dose of cyproheptadine (4 mg) at bedtime
• Can be gradually increased to 4-8 mg daily as needed for appetite stimulation
• Take at night to minimize daytime sedation
• Monitor for weight gain and appetite improvement over 2-4 weeks

Potential Benefits Beyond Weight Gain

• May help with anxiety-related insomnia due to its sedative properties
• Could potentially help with anxiety symptoms through its antihistamine and antiserotonergic effects
• Addresses both weight loss and poor appetite simultaneously

Potential Side Effects to Monitor

• Sedation/drowsiness (take at bedtime to minimize this effect)
• Dry mouth
• Increased appetite (desired effect in this case)
• Dizziness
• Blurred vision (uncommon at lower doses)

Important Considerations

1. Monitor weight gain carefully: Once you reach your target weight, the dose may need to be adjusted or discontinued to prevent excessive weight gain

2. Timing matters: Take cyproheptadine at night to minimize daytime sedation that could compound with clonazepam's sedative effects

3. Regular follow-up: Schedule follow-up appointments to monitor weight, appetite, and any side effects

4. Alternative options: If cyproheptadine is not effective or causes intolerable side effects, other options for weight gain include mirtazapine, which has both antidepressant and appetite-stimulating properties 4

5. Avoid common pitfalls: Don't stop any of your current medications abruptly, as this could worsen anxiety and cause withdrawal symptoms

While there are limited high-quality studies specifically examining cyproheptadine with escitalopram and clonazepam, the available evidence suggests this combination is reasonable for addressing anxiety-related weight loss with a normal BMI.