Periactin (cyproheptadine, generic) for Migraine & Allergies: Side Effects & Dosage

What is cyproheptadine, and how does it work (mechanism of action)?

Cyproheptadine (Periactin) is an oral antihistamine used for treating allergic reactions. It works by blocking the effects of histamine and is classified as a first generation antihistamine. Histamine is released by cells of the body during several types of allergic reactions and, to a lesser extent, during some viral infections, such as the common cold. When the histamine binds to receptors on other cells, it stimulates changes within the cells that lead to the release of chemicals that cause sneezing, itching, and increased production of mucus. Antihistamines compete with histamine for cell receptors and bind to the receptors without stimulating the cells. In addition, they prevent histamine from binding and stimulating the cells. Cyproheptadine also blocks the action of acetylcholine (anticholinergic effect) and serotonin, two neurotransmitters that nerves and muscles use to communicate with one another, and it causes drowsiness.

Is cyproheptadine available as a generic drug?

Yes, cyproheptadine is available in generic form.

Do I need a prescription for cyproheptadine?

Yes, you need a prescription for cyproheptadine from your doctor or other health care professional.

What are the uses for cyproheptadine?

Cyproheptadine is used for treating various types of allergic reactions and the skin manifestations of allergic reactions.

It's off-label uses (non-FDA approved) include:

• Spasticity associated with spinal cord injury
• Prevention of migraine headaches

What are the side effects of cyproheptadine?

Side effects of include:

• Drowsiness
• Sedation
• Dizziness
• Restlessness
• insomnia
• Tremors
• Euphoria
• Nervousness
• Irritability
• Delirium
• Seizures
• Psychosis
• Paresthesia
• Weakness
• Palpitation
• Fast heart beat
• Palpitation
• High or low blood pressure
• Anorexia
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Cholestasis
• Hepatitis
• Eczema
• Itching
• Blurred vision
• Double Vision
• Ringing in the ears
• Urinary retention
• Wheezing
• Nasal stuffiness

Other side effects that have been reported include:

• Vertigo
• Sweating
• Chills
• Early menses
• Headache
• impotence
• Dryness of mouth, nose, and throat
• Facial dyskinesia
• Tightness of chest

Antihistamines may reduce mental alertness, however, they may occasionally produce excitation in children.

Patients should be warned about driving a car or operating machinery and participating in other activities that require mental alertness and motor coordination.

Antihistamines may add to the sedative effects of alcohol, hypnotics, sedatives, tranquilizers, and anti-anxiety drugs.

Antihistamines are more likely to cause dizziness, sedation, and hypotension (low blood pressure) in elderly patients.

What is the dosage for cyproheptadine, and how should I take it?

• The recommended starting dose for adults is 4 mg every 8 hours.
• The dose range is 4 mg to 20 mg daily.
• Some patients may require up to 32 mg day. The dose should not exceed 0.5 mg/kg daily.
• The dosage for children 7 to 14 years of age should receive 4 mg 3 times daily. The maximum dose is 16 mg daily.
• Children 2 to 6 years old are treated with 2 mg three times daily and the maximum dose is 12 mg a day.
• The total daily dose may also be calculated by weight (0.25 mg/kg/day) or surface area (8 mg/m2).

Which drugs or supplements interact with cyproheptadine?

Cyproheptadine adds to the sedating effects of alcohol and other drugs like benzodiazepines, narcotics, tricyclic antidepressants, and high blood pressure (hypertension) medications, that can cause sedation.

1. Benzodiazepines is a class of drugs of anti-anxiety medications, for example:

• diazepam (Valium)
• lorazepam (Ativan)
• clonazepam (Klonopin)
• alprazolam (Xanax)

2. Narcotics is a drug class of drugs of pain medications and its derivatives, for example:

• oxycodone and acetaminophen (Percocet)
• hydrocodone and acetaminophen (Vicodin)
• guaifenesin with hydromorphone (Dilaudid)
• codeine, propoxyphene (Darvon)

3. Tricyclic's is a class of drugs of antidepressants, for example:

• amitriptyline (Elavil, Endep)
• imipramine (Tofranil)
• desipramine (Norpramin)

4. Certain antihypertensive medications, for example:

• clonidine (Catapres)
• propranolol (Inderal)

Cyproheptadine also can intensify the drying effects on moist tissues (such as the eye or mouth) of other medications with anticholinergic properties, for example, dicyclomine (Bentyl) and bethanechol (Urecholine), and probanthine.

Is cyproheptadine safe to use during pregnancy or while breastfeeding?

• Studies in women who are pregnant have not shown that cyproheptadine harms the fetus during the first, second and third trimesters of pregnancy. However, these studies do not exclude the possibility of harm. Cyproheptadine should be used during pregnancy only if it is clearly needed.
• It is not known whether cyproheptadine is excreted in human milk.

What else should I know about cyproheptadine?

• This drug is available in the following preparations: Tablets: 4 mg; Oral Solution: 2 mg/5 ml
• Store this medication should at room temperature, 15 C – 30 C (59 F – 86 F).
• The FDA approved cyproheptadine in October 1961.