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      Drugs & Diseases

      cyproheptadine (Rx)

      Brand and Other Names:
      • Print

      Dosing & Uses

      AdultPediatric

      Dosage Forms & Strengths

      tablet

      • 4mg

      oral solution

      • 2mg/5mL

      Hypersensitivity Reaction

      4 mg PO q8hr initially; maintenance: 4-20 mg/day, up to 32 mg/day divided q8hr in some patients; not to exceed 0.5 mg/kg/day  

      Spasticity Associated With Spinal Cord (Off-label)

      2-4 mg PO q8hr initially; not to exceed 24 mg/day

      Migraine Headache Prophylaxis (Off-Label)

      2 mg PO q12hr with or without propanol

      Decreased Appetite Secondary to Chronic Disease (Off-label)

      2 mg PO q6hr for one week; THEN 4 mg PO q6hr

      Drug-Induced Sexual Dysfunction (Off-label)

      4-12 mg PO 1-2 hours before anticipated coitus or 1-16 mg/day

      Serotonin Syndrome (Off-Label)

      12 mg initially PO, followed by 2 mg q2hr or 4-8 mg PO q6hr as needed to control symptoms

      Dosing Modifications

      Nonanticholinergic antihistamines should be considered first when treating allergic reactions (Beers Criteria)

      Advanced age is associated with reduced clearance and greater risk of confusion, dry mouth, constipation, and other anticholinergic effects and toxicity; use lower end of dosage range (4 mg PO q12hr) for elderly patients, or administer less frequently

      Renal impairment: Elimination is reduced in renal insufficiency; administer lower doses, and monitor closely

      Dosage Forms & Strengths

      tablet

      • 4mg

      oral solution

      • 2mg/5mL

      Hypersensitivity Reaction

      <2 years old: Safety and efficacy not established

      2-6 years old: 2 mg PO q8-12hr; not to exceed 12 mg/day

      7-14 years old: 4 mg PO q8-12hr; not to exceed 16 mg/day

      Alternatively, total daily dose of 0.25 mg/kg or 8 mg/m²

      Migraine

      Prophylaxis

      < 3 years: Safety and efficacy not established

      >3 years and adolescents: 0.2-0.4 mg/kg/day PO divided BID; not to exceed 0.5 mg/kg/day

      Loss of Appetite (Including Anorexia Nervosa; Off-label)

      Stimulation of appetite

      <13 years: Safety and efficacy not established

      >13 years: 2 mg PO q6hr initially; increased to up to 8 mg q6hr over 3 weeks

      Dosing Modifications

      Renal impairment: Elimination is reduced in renal insufficiency; administer lower doses, and monitor closely

      Next:

      Interactions

      Interaction Checker

      and cyproheptadine

      No Results

         activity indicator 
        No Interactions Found
        Interactions Found

        Contraindicated

          Serious - Use Alternative

            Significant - Monitor Closely

              Minor

                All Interactions Sort By:
                 activity indicator 

                Contraindicated (12)

                • isocarboxazid

                  isocarboxazid, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • linezolid

                  linezolid, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • methylene blue

                  methylene blue, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • metyrapone

                  cyproheptadine decreases effects of metyrapone by pharmacodynamic antagonism. Contraindicated.

                • phenelzine

                  phenelzine, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • procarbazine

                  procarbazine, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • rasagiline

                  rasagiline, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • safinamide

                  safinamide, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • selegiline

                  selegiline, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • selegiline transdermal

                  selegiline transdermal, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • tedizolid

                  tedizolid, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                • tranylcypromine

                  tranylcypromine, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

                Serious - Use Alternative (6)

                • calcium/magnesium/potassium/sodium oxybates

                  cyproheptadine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                • eluxadoline

                  cyproheptadine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions.

                • metoclopramide intranasal

                  cyproheptadine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

                • olopatadine intranasal

                  cyproheptadine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

                • pitolisant

                  cyproheptadine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

                • sodium oxybate

                  cyproheptadine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                Monitor Closely (232)

                • 5-HTP

                  cyproheptadine decreases effects of 5-HTP by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of 5-HTP.

                • acrivastine

                  acrivastine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • albuterol

                  cyproheptadine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • alfentanil

                  cyproheptadine and alfentanil both increase sedation. Use Caution/Monitor.

                • almotriptan

                  cyproheptadine decreases effects of almotriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • alprazolam

                  cyproheptadine and alprazolam both increase sedation. Use Caution/Monitor.

                • amifampridine

                  cyproheptadine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

                • amisulpride

                  amisulpride and cyproheptadine both increase sedation. Use Caution/Monitor.

                • amitriptyline

                  cyproheptadine and amitriptyline both increase sedation. Use Caution/Monitor.

                • amobarbital

                  cyproheptadine and amobarbital both increase sedation. Use Caution/Monitor.

                • amoxapine

                  cyproheptadine and amoxapine both increase sedation. Use Caution/Monitor.

                • apomorphine

                  cyproheptadine and apomorphine both increase sedation. Use Caution/Monitor.

                • arformoterol

                  cyproheptadine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • aripiprazole

                  cyproheptadine and aripiprazole both increase sedation. Use Caution/Monitor.

                • armodafinil

                  cyproheptadine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • asenapine

                  asenapine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • asenapine transdermal

                  asenapine transdermal and cyproheptadine both increase sedation. Use Caution/Monitor.

                • avapritinib

                  avapritinib and cyproheptadine both increase sedation. Use Caution/Monitor.

                • azelastine

                  azelastine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • baclofen

                  cyproheptadine and baclofen both increase sedation. Use Caution/Monitor.

                • belladonna and opium

                  cyproheptadine and belladonna and opium both increase sedation. Use Caution/Monitor.

                • benperidol

                  cyproheptadine and benperidol both increase sedation. Use Caution/Monitor.

                • benzhydrocodone/acetaminophen

                  benzhydrocodone/acetaminophen and cyproheptadine both increase sedation. Use Caution/Monitor.

                • benzphetamine

                  cyproheptadine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • brexanolone

                  brexanolone, cyproheptadine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

                • brexpiprazole

                  brexpiprazole and cyproheptadine both increase sedation. Use Caution/Monitor.

                • brimonidine

                  brimonidine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • brivaracetam

                  brivaracetam and cyproheptadine both increase sedation. Use Caution/Monitor.

                • brompheniramine

                  brompheniramine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • buprenorphine

                  cyproheptadine and buprenorphine both increase sedation. Use Caution/Monitor.

                • buprenorphine buccal

                  cyproheptadine and buprenorphine buccal both increase sedation. Use Caution/Monitor.

                • buprenorphine subdermal implant

                  buprenorphine subdermal implant and cyproheptadine both increase sedation. Use Caution/Monitor.

                • buprenorphine transdermal

                  buprenorphine transdermal and cyproheptadine both increase sedation. Use Caution/Monitor.

                • buprenorphine, long-acting injection

                  buprenorphine, long-acting injection and cyproheptadine both increase sedation. Use Caution/Monitor.

                • butabarbital

                  cyproheptadine and butabarbital both increase sedation. Use Caution/Monitor.

                • butalbital

                  cyproheptadine and butalbital both increase sedation. Use Caution/Monitor.

                • butorphanol

                  cyproheptadine and butorphanol both increase sedation. Use Caution/Monitor.

                • caffeine

                  cyproheptadine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • carbinoxamine

                  carbinoxamine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • carisoprodol

                  cyproheptadine and carisoprodol both increase sedation. Use Caution/Monitor.

                • cenobamate

                  cenobamate, cyproheptadine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • chloral hydrate

                  cyproheptadine and chloral hydrate both increase sedation. Use Caution/Monitor.

                • chlordiazepoxide

                  cyproheptadine and chlordiazepoxide both increase sedation. Use Caution/Monitor.

                • chlorpheniramine

                  chlorpheniramine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • chlorpromazine

                  cyproheptadine and chlorpromazine both increase sedation. Use Caution/Monitor.

                • chlorzoxazone

                  cyproheptadine and chlorzoxazone both increase sedation. Use Caution/Monitor.

                • cinnarizine

                  cinnarizine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • citalopram

                  cyproheptadine decreases effects of citalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

                • clemastine

                  clemastine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • clobazam

                  cyproheptadine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

                • clomipramine

                  cyproheptadine and clomipramine both increase sedation. Use Caution/Monitor.

                • clonazepam

                  cyproheptadine and clonazepam both increase sedation. Use Caution/Monitor.

                • clorazepate

                  cyproheptadine and clorazepate both increase sedation. Use Caution/Monitor.

                • clozapine

                  cyproheptadine and clozapine both increase sedation. Use Caution/Monitor.

                • codeine

                  cyproheptadine and codeine both increase sedation. Use Caution/Monitor.

                • cyclizine

                  cyclizine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • cyclobenzaprine

                  cyproheptadine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

                • dantrolene

                  cyproheptadine and dantrolene both increase sedation. Use Caution/Monitor.

                • daridorexant

                  cyproheptadine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

                • desflurane

                  desflurane and cyproheptadine both increase sedation. Use Caution/Monitor.

                • desipramine

                  cyproheptadine and desipramine both increase sedation. Use Caution/Monitor.

                • desvenlafaxine

                  cyproheptadine decreases effects of desvenlafaxine by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SNRIs.

                • deutetrabenazine

                  cyproheptadine and deutetrabenazine both increase sedation. Use Caution/Monitor.

                • dexchlorpheniramine

                  cyproheptadine and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

                • dexfenfluramine

                  cyproheptadine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • dexmedetomidine

                  cyproheptadine and dexmedetomidine both increase sedation. Use Caution/Monitor.

                • dexmethylphenidate

                  cyproheptadine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • dextroamphetamine

                  cyproheptadine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • dextromoramide

                  cyproheptadine and dextromoramide both increase sedation. Use Caution/Monitor.

                • diamorphine

                  cyproheptadine and diamorphine both increase sedation. Use Caution/Monitor.

                • diazepam

                  cyproheptadine and diazepam both increase sedation. Use Caution/Monitor.

                • diazepam intranasal

                  diazepam intranasal, cyproheptadine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

                • diethylpropion

                  cyproheptadine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • difelikefalin

                  difelikefalin and cyproheptadine both increase sedation. Use Caution/Monitor.

                • difenoxin hcl

                  cyproheptadine and difenoxin hcl both increase sedation. Use Caution/Monitor.

                • dimenhydrinate

                  cyproheptadine and dimenhydrinate both increase sedation. Use Caution/Monitor.

                • diphenhydramine

                  cyproheptadine and diphenhydramine both increase sedation. Use Caution/Monitor.

                • diphenoxylate hcl

                  cyproheptadine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

                • dipipanone

                  cyproheptadine and dipipanone both increase sedation. Use Caution/Monitor.

                • dobutamine

                  cyproheptadine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • donepezil transdermal

                  donepezil transdermal, cyproheptadine. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

                • dopamine

                  cyproheptadine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • dopexamine

                  cyproheptadine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • dosulepin

                  cyproheptadine and dosulepin both increase sedation. Use Caution/Monitor.

                • doxepin

                  cyproheptadine and doxepin both increase sedation. Use Caution/Monitor.

                • doxylamine

                  cyproheptadine and doxylamine both increase sedation. Use Caution/Monitor.

                • droperidol

                  cyproheptadine and droperidol both increase sedation. Use Caution/Monitor.

                • duloxetine

                  cyproheptadine decreases effects of duloxetine by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SNRIs.

                • eletriptan

                  cyproheptadine decreases effects of eletriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • encorafenib

                  encorafenib, cyproheptadine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

                • ephedrine

                  cyproheptadine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • epinephrine

                  cyproheptadine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • epinephrine racemic

                  cyproheptadine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • escitalopram

                  cyproheptadine decreases effects of escitalopram by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

                • esketamine intranasal

                  esketamine intranasal, cyproheptadine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

                • estazolam

                  cyproheptadine and estazolam both increase sedation. Use Caution/Monitor.

                • ethanol

                  cyproheptadine and ethanol both increase sedation. Use Caution/Monitor.

                • etomidate

                  etomidate and cyproheptadine both increase sedation. Use Caution/Monitor.

                • fenfluramine

                  cyproheptadine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  cyproheptadine decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

                • fentanyl

                  fentanyl, cyproheptadine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

                • fentanyl intranasal

                  fentanyl intranasal, cyproheptadine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

                • fentanyl transdermal

                  fentanyl transdermal, cyproheptadine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

                • fentanyl transmucosal

                  fentanyl transmucosal, cyproheptadine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

                • flibanserin

                  cyproheptadine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

                  cyproheptadine decreases effects of flibanserin by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • fluoxetine

                  cyproheptadine decreases effects of fluoxetine by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

                • fluphenazine

                  cyproheptadine and fluphenazine both increase sedation. Use Caution/Monitor.

                • flurazepam

                  cyproheptadine and flurazepam both increase sedation. Use Caution/Monitor.

                • fluvoxamine

                  cyproheptadine decreases effects of fluvoxamine by pharmacodynamic antagonism. Use Caution/Monitor. May deminish serotonergic effect of SSRIs.

                • formoterol

                  cyproheptadine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • frovatriptan

                  cyproheptadine decreases effects of frovatriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • gabapentin

                  gabapentin, cyproheptadine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

                • gabapentin enacarbil

                  gabapentin enacarbil, cyproheptadine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

                • ganaxolone

                  cyproheptadine and ganaxolone both increase sedation. Use Caution/Monitor.

                • glycopyrronium tosylate topical

                  glycopyrronium tosylate topical, cyproheptadine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

                • gotu kola

                  gotu kola increases effects of cyproheptadine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

                • haloperidol

                  cyproheptadine and haloperidol both increase sedation. Use Caution/Monitor.

                • hawthorn

                  hawthorn increases effects of cyproheptadine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

                • hops

                  hops increases effects of cyproheptadine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

                • hyaluronidase

                  cyproheptadine decreases effects of hyaluronidase by Other (see comment). Use Caution/Monitor. Comment: Antihistamines, when given in large systemic doses, may render tissues partially resistant to the action of hyaluronidase. Patients may require larger amounts of hyaluronidase for equivalent dispersing effect.

                • hydromorphone

                  cyproheptadine and hydromorphone both increase sedation. Use Caution/Monitor.

                • hydroxyzine

                  cyproheptadine and hydroxyzine both increase sedation. Use Caution/Monitor.

                • iloperidone

                  cyproheptadine and iloperidone both increase sedation. Use Caution/Monitor.

                • imipramine

                  cyproheptadine and imipramine both increase sedation. Use Caution/Monitor.

                • isoproterenol

                  cyproheptadine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • kava

                  kava increases effects of cyproheptadine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

                • ketamine

                  ketamine and cyproheptadine both increase sedation. Use Caution/Monitor.

                • ketotifen, ophthalmic

                  cyproheptadine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

                • lasmiditan

                  lasmiditan, cyproheptadine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

                • lemborexant

                  lemborexant, cyproheptadine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

                • levalbuterol

                  cyproheptadine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • levomilnacipran

                  cyproheptadine decreases effects of levomilnacipran by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SNRIs.

                • levorphanol

                  cyproheptadine and levorphanol both increase sedation. Use Caution/Monitor.

                • lisdexamfetamine

                  cyproheptadine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • lofepramine

                  cyproheptadine and lofepramine both increase sedation. Use Caution/Monitor.

                • lofexidine

                  cyproheptadine and lofexidine both increase sedation. Use Caution/Monitor.

                • loprazolam

                  cyproheptadine and loprazolam both increase sedation. Use Caution/Monitor.

                • lorazepam

                  cyproheptadine and lorazepam both increase sedation. Use Caution/Monitor.

                • lormetazepam

                  cyproheptadine and lormetazepam both increase sedation. Use Caution/Monitor.

                • loxapine

                  cyproheptadine and loxapine both increase sedation. Use Caution/Monitor.

                • loxapine inhaled

                  cyproheptadine and loxapine inhaled both increase sedation. Use Caution/Monitor.

                • lurasidone

                  lurasidone, cyproheptadine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

                • maprotiline

                  cyproheptadine and maprotiline both increase sedation. Use Caution/Monitor.

                • marijuana

                  cyproheptadine and marijuana both increase sedation. Use Caution/Monitor.

                • melatonin

                  cyproheptadine and melatonin both increase sedation. Use Caution/Monitor.

                • meperidine

                  cyproheptadine and meperidine both increase sedation. Use Caution/Monitor.

                • meprobamate

                  cyproheptadine and meprobamate both increase sedation. Use Caution/Monitor.

                • metaproterenol

                  cyproheptadine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • metaxalone

                  cyproheptadine and metaxalone both increase sedation. Use Caution/Monitor.

                • methadone

                  cyproheptadine and methadone both increase sedation. Use Caution/Monitor.

                • methamphetamine

                  cyproheptadine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • methocarbamol

                  cyproheptadine and methocarbamol both increase sedation. Use Caution/Monitor.

                • methylenedioxymethamphetamine

                  cyproheptadine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • midazolam

                  cyproheptadine and midazolam both increase sedation. Use Caution/Monitor.

                • midazolam intranasal

                  midazolam intranasal, cyproheptadine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

                • midodrine

                  cyproheptadine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • milnacipran

                  cyproheptadine decreases effects of milnacipran by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SNRIs.

                • mipomersen

                  mipomersen, cyproheptadine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

                • mirtazapine

                  cyproheptadine and mirtazapine both increase sedation. Use Caution/Monitor.

                • modafinil

                  cyproheptadine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • morphine

                  cyproheptadine and morphine both increase sedation. Use Caution/Monitor.

                • motherwort

                  cyproheptadine and motherwort both increase sedation. Use Caution/Monitor.

                • moxonidine

                  cyproheptadine and moxonidine both increase sedation. Use Caution/Monitor.

                • nabilone

                  cyproheptadine and nabilone both increase sedation. Use Caution/Monitor.

                • nalbuphine

                  cyproheptadine and nalbuphine both increase sedation. Use Caution/Monitor.

                • naratriptan

                  cyproheptadine decreases effects of naratriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • norepinephrine

                  cyproheptadine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • nortriptyline

                  cyproheptadine and nortriptyline both increase sedation. Use Caution/Monitor.

                • olanzapine

                  cyproheptadine and olanzapine both increase sedation. Use Caution/Monitor.

                • opium tincture

                  cyproheptadine and opium tincture both increase sedation. Use Caution/Monitor.

                • orphenadrine

                  cyproheptadine and orphenadrine both increase sedation. Use Caution/Monitor.

                • oxazepam

                  cyproheptadine and oxazepam both increase sedation. Use Caution/Monitor.

                • oxycodone

                  cyproheptadine and oxycodone both increase sedation. Use Caution/Monitor.

                • oxymorphone

                  cyproheptadine and oxymorphone both increase sedation. Use Caution/Monitor.

                • paliperidone

                  cyproheptadine and paliperidone both increase sedation. Use Caution/Monitor.

                • papaveretum

                  cyproheptadine and papaveretum both increase sedation. Use Caution/Monitor.

                • papaverine

                  cyproheptadine and papaverine both increase sedation. Use Caution/Monitor.

                • paroxetine

                  cyproheptadine decreases effects of paroxetine by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

                • passion flower

                  passion flower increases effects of cyproheptadine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

                • pentazocine

                  cyproheptadine and pentazocine both increase sedation. Use Caution/Monitor.

                • pentobarbital

                  cyproheptadine and pentobarbital both increase sedation. Use Caution/Monitor.

                • perphenazine

                  cyproheptadine and perphenazine both increase sedation. Use Caution/Monitor.

                • phendimetrazine

                  cyproheptadine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • phenobarbital

                  cyproheptadine and phenobarbital both increase sedation. Use Caution/Monitor.

                • phentermine

                  cyproheptadine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • phenylephrine

                  cyproheptadine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • phenylephrine PO

                  cyproheptadine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

                • pholcodine

                  cyproheptadine and pholcodine both increase sedation. Use Caution/Monitor.

                • pimozide

                  cyproheptadine and pimozide both increase sedation. Use Caution/Monitor.

                • pirbuterol

                  cyproheptadine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • pregabalin

                  pregabalin, cyproheptadine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

                • primidone

                  cyproheptadine and primidone both increase sedation. Use Caution/Monitor.

                • prochlorperazine

                  cyproheptadine and prochlorperazine both increase sedation. Use Caution/Monitor.

                • promethazine

                  cyproheptadine and promethazine both increase sedation. Use Caution/Monitor.

                • propofol

                  propofol and cyproheptadine both increase sedation. Use Caution/Monitor.

                • propylhexedrine

                  cyproheptadine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • protriptyline

                  cyproheptadine and protriptyline both increase sedation. Use Caution/Monitor.

                • quazepam

                  cyproheptadine and quazepam both increase sedation. Use Caution/Monitor.

                • quetiapine

                  cyproheptadine and quetiapine both increase sedation. Use Caution/Monitor.

                • ramelteon

                  cyproheptadine and ramelteon both increase sedation. Use Caution/Monitor.

                • risperidone

                  cyproheptadine and risperidone both increase sedation. Use Caution/Monitor.

                • rizatriptan

                  cyproheptadine decreases effects of rizatriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • salmeterol

                  cyproheptadine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • scullcap

                  cyproheptadine and scullcap both increase sedation. Use Caution/Monitor.

                • secobarbital

                  cyproheptadine and secobarbital both increase sedation. Use Caution/Monitor.

                • sertraline

                  cyproheptadine decreases effects of sertraline by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

                • sevoflurane

                  sevoflurane and cyproheptadine both increase sedation. Use Caution/Monitor.

                • shepherd's purse

                  cyproheptadine and shepherd's purse both increase sedation. Use Caution/Monitor.

                • stiripentol

                  stiripentol, cyproheptadine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

                • sufentanil

                  cyproheptadine and sufentanil both increase sedation. Use Caution/Monitor.

                • sumatriptan

                  cyproheptadine decreases effects of sumatriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • sumatriptan intranasal

                  cyproheptadine decreases effects of sumatriptan intranasal by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • tapentadol

                  cyproheptadine and tapentadol both increase sedation. Use Caution/Monitor.

                • temazepam

                  cyproheptadine and temazepam both increase sedation. Use Caution/Monitor.

                • terbutaline

                  cyproheptadine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • thioridazine

                  cyproheptadine and thioridazine both increase sedation. Use Caution/Monitor.

                • thiothixene

                  cyproheptadine and thiothixene both increase sedation. Use Caution/Monitor.

                • topiramate

                  cyproheptadine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

                • tramadol

                  cyproheptadine and tramadol both increase sedation. Use Caution/Monitor.

                • trazodone

                  cyproheptadine and trazodone both increase sedation. Use Caution/Monitor.

                • triazolam

                  cyproheptadine and triazolam both increase sedation. Use Caution/Monitor.

                • triclofos

                  cyproheptadine and triclofos both increase sedation. Use Caution/Monitor.

                • trifluoperazine

                  cyproheptadine and trifluoperazine both increase sedation. Use Caution/Monitor.

                • trimipramine

                  cyproheptadine and trimipramine both increase sedation. Use Caution/Monitor.

                • triprolidine

                  cyproheptadine and triprolidine both increase sedation. Use Caution/Monitor.

                • valerian

                  valerian increases effects of cyproheptadine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

                • venlafaxine

                  cyproheptadine decreases effects of venlafaxine by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SNRIs.

                • xylometazoline

                  cyproheptadine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • yohimbine

                  cyproheptadine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • ziconotide

                  cyproheptadine and ziconotide both increase sedation. Use Caution/Monitor.

                • ziprasidone

                  cyproheptadine and ziprasidone both increase sedation. Use Caution/Monitor.

                • zolmitriptan

                  cyproheptadine decreases effects of zolmitriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.

                • zotepine

                  cyproheptadine and zotepine both increase sedation. Use Caution/Monitor.

                Minor (6)

                • ashwagandha

                  ashwagandha increases effects of cyproheptadine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

                • brimonidine

                  brimonidine increases effects of cyproheptadine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

                • eucalyptus

                  cyproheptadine and eucalyptus both increase sedation. Minor/Significance Unknown.

                • nettle

                  nettle increases effects of cyproheptadine by pharmacodynamic synergism. Minor/Significance Unknown. (High dose nettle; theoretical interaction) May enhance CNS depression.

                • sage

                  cyproheptadine and sage both increase sedation. Minor/Significance Unknown.

                • Siberian ginseng

                  Siberian ginseng increases effects of cyproheptadine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

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                Adverse Effects

                Frequency Not Defined

                Psychiatric/neurologic: CNS depression, drowsiness, sedation ranging from mild drowsiness to deep sleep (most frequent), dizziness, lassitude, disturbed coordination; less commonly, restlessness, insomnia, tremors, euphoria, nervousness, irritability, delirium, seizures, toxic psychosis, paresthesia

                Muscular: Weakness

                Cardiovascular: Palpitation, tachycardia, palpitation, ECG changes (eg, widened QRS), arrhythmias (eg, extrasystole, heart block), hypotension, hypertension, dizziness, sedation, hypotension

                GI: Epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation

                Hepatic: Cholestasis, hepatitis, hepatic failure, hepatic function abnormality, jaundice (rare)

                Skin: Eczema, pruritus, inflammation, papular rash, erythema on exposed skin

                Sensory: Visual disturbances, blurred vision, diplopia, tinnitus, acute labyrinthitis

                Renal: Dysuria, urinary retention

                Respiratory: Thickening of bronchial secretions, wheezing, nasal stuffiness

                Other: Vertigo, sweating, chills, early menses, headache, impotence, dryness of mouth, nose, and throat, facial dyskinesia, tightness of chest, faintness

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                Warnings

                Contraindications

                Documented hypersensitivity

                Premature infants and neonates

                Nursing women

                Concomitant monoamine oxidase inhibitor therapy

                Narrow-angle glaucoma

                Stenosing peptic ulcer, pyloroduodenal obstruction

                Symptomatic prostatic hypertrophy

                Bladder neck obstruction

                Elderly, debilitated patients

                Cautions

                Elimination reduced in renal insufficiency

                Use with caution in cardiovascular disease, including hypertension

                Elderly patients: Avoid use in elderly because of high incidence of anticholinergic effects; may exacerbate existing lower urinary conditions or benign prostatic hyperplasia; if used, administer at low end of dosage range

                May cause CNS depression, which may impair mental abilities; use caution when operating heavy machinery

                Use caution in cardiovascular disease, including hypertension and ischemic heart disease

                Use with caution in patients with increased intraocular pressure, history of asthma or other chornic breathing disorders, or thyroid dysfunction

                Nonanticholinergic antihistamines should be considered first for treatment of allergic reaction in the elderly (Beers criteria)

                Antihistamines may cause excitation in young children

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                Pregnancy & Lactation

                Pregnancy category: B

                Lactation: Excretion in milk unknown; contraindicated

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Serotonin and histamine antagonist; competitively inhibits H1 receptor, mediating bronchial constriction, smooth-muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias; prevents histamine release in blood vessels and is more effective in preventing histamine response than in reversing it; may be useful in patients with syndromes sustained by histamine-producing tumors

                Moderate anticholinergic activity with low sedative effect

                May have anti-5HT2 effects

                May have some calcium-channel blocking activity

                Absorption

                Peak plasma time: 6-9 hr

                Metabolism

                Metabolized by glucuronidation via UGT1A

                Metabolites: Quaternary ammonium glucuronide conjugate

                Elimination

                Excretion: Urine (40%), feces (2-20%)

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		2 mg/5 mL syrup
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		2 mg/5 mL syrup
                cyproheptadine oral
                -
                		2 mg/5 mL syrup
                cyproheptadine oral
                -
                		2 mg/5 mL syrup
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		4 mg tablet
                cyproheptadine oral
                -
                		2 mg/5 mL syrup
                cyproheptadine oral
                -
                		4 mg tablet

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                cyproheptadine oral

                CYPROHEPTADINE - ORAL

                (SYE-proe-HEP-ta-deen)

                COMMON BRAND NAME(S): Periactin

                USES: Cyproheptadine is an antihistamine used to relieve allergy symptoms such as watery eyes, runny nose, itching eyes/nose, sneezing, hives, and itching. It works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction. This medication also blocks another natural substance in your body (serotonin).This medication should not be used in newborn or premature infants.

                HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually 2 to 3 times a day. If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your age, medical condition, and response to treatment. In children, the dosage may also be based on weight and body size. Do not increase your dose or take this medication more often than directed.Tell your doctor if your condition does not improve or if it worsens.

                SIDE EFFECTS: Drowsiness, dizziness, blurred vision, constipation, or dry mouth/nose/throat may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To relieve dry mouth, suck (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as restlessness, confusion, hallucinations), shaking (tremor), difficulty urinating, fast/irregular heartbeat.Get medical help right away if you have any very serious side effects, including: seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before taking cyproheptadine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing problems (such as asthma, emphysema), high pressure in the eye (glaucoma), heart disease, high blood pressure, kidney disease, seizures, stomach/intestine problems (such as ulcers, blockage), overactive thyroid (hyperthyroidism), difficulty urinating (for example, due to enlarged prostate).This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Liquid products may contain alcohol and/or sugar. Caution is advised if you have diabetes, liver disease, or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.Children may be more sensitive to the side effects of this drug. This drug can often cause excitement in young children instead of drowsiness.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, constipation, confusion, or trouble urinating. Drowsiness, dizziness, and confusion can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or other antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.Do not use with any other antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray) because increased side effects may occur.This medication may interfere with certain lab tests (such as allergy skin testing, metyrapone test), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, seizures, widened pupils. In children, mental/mood changes (such as restlessness, irritability, hallucinations) may occur before drowsiness.

                NOTES: Do not share this medication with others.

                MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

                STORAGE: Store at room temperature away from light and moisture. Do not freeze the liquid form of this medication. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

                Information last revised July 2023. Copyright(c) 2023 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

                To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                Create Your List of Plans

                Adding plans allows you to:

                • View the formulary and any restrictions for each plan.
                • Manage and view all your plans together – even plans in different states.
                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                View explanations for tiers and restrictions
                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.
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