Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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 (220)
- 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.
- 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.
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
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
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.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%)
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 - | 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 - | 2 mg/5 mL syrup |  | |
| cyproheptadine oral - | 4 mg tablet |  | |
| cyproheptadine oral - | 4 mg tablet |  | |
| cyproheptadine oral - | 2 mg/5 mL syrup |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
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 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 March 2022. Copyright(c) 2022 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.
Formulary
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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.
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- Compare formulary status to other drugs in the same class.
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