cyproheptadine (Rx)

Brand and Other Names:
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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

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      Serious - Use Alternative

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            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 (5)

            • 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.

            • 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 (218)

            • 5-HTP

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

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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
            -
            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
            -
            4 mg tablet
            cyproheptadine oral
            -
            2 mg/5 mL syrup
            cyproheptadine oral
            -
            4 mg tablet
            cyproheptadine oral
            -
            2 mg/5 mL syrup

            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 persist or worsen, 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 laboratory tests (including allergy skin testing, metyrapone test), possibly causing false test results. Make sure laboratory 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 August 2021. Copyright(c) 2021 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.

            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.

            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.