Periactin

Periactin is used to treat sneezing, runny nose, itching, watery eyes, hives, rashes, and other symptoms of allergies and the common cold.

Product dosage: 4mg
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Synonyms Apetamin-p Apeton Apitup Arictin Axoprol Cipla-actin Ciplactin Cipractin Cipractine Ciproeptadina Ciproheptadina Ciprolisina Ciprovit Ciptadine Complamin Covitasa b12 Cuplactin Cyproatin Cyprodin Cyprogin Cyproheptadin Cyproheptadinum Cypromin Cyprotol Dronactin Dynamogen Ennamax Esprocy Glocyp Glutodina Heptagyl Heptasan Ifrasal Kulinet Lexahist Lupactin Nuran Oractine Pangavit Periactine Periactinol Poncohist Practin Prakten Prohessen Pronicy Sipraktin Triactin Trimetabol Viternum

Periactin (cyproheptadine hydrochloride) is a prescription antihistamine and serotonin antagonist clinically indicated for the management of allergic conditions and, more notably, as a potent appetite stimulant. Its unique dual mechanism of action not only blocks histamine receptors but also inhibits serotonin, a neurotransmitter known to suppress appetite. This makes it a valuable therapeutic option for healthcare providers addressing clinically significant weight loss, cachexia, and failure to thrive in both pediatric and adult populations under careful medical supervision. Its efficacy is supported by decades of clinical use and a well-understood pharmacological profile.

Features

• Active Ingredient: Cyproheptadine Hydrochloride
• Drug Class: First-generation Piperidine Antihistamine, Serotonin Antagonist
• Available Formulations: 4 mg scored tablets and a 2 mg/5 mL oral syrup
• Mechanism of Action: Competitive antagonist of histamine H1 receptors and serotonin (5-HT2) receptors
• Prescription Status: Rx-only medication requiring diagnosis and ongoing monitoring
• Onset of Appetite Effects: Typically observed within 1-3 weeks of initiating therapy

Benefits

• Promotes clinically significant weight gain by effectively stimulating appetite and increasing caloric intake.
• Addresses the underlying physiological mechanisms of appetite suppression, particularly those mediated by serotonin.
• Provides a well-established treatment option with a long history of safe and effective use in both children and adults.
• Offers a dual therapeutic benefit for patients experiencing concurrent allergic symptoms and poor appetite.
• Can improve quality of life and nutritional status in conditions associated with cachexia and wasting.
• Available in multiple formulations (tablet, syrup) to accommodate different patient needs and age groups.

Common use

Periactin is primarily prescribed for its appetite-stimulating effects in cases of unexplained, significant weight loss or a failure to achieve expected weight gain. Its use is common in clinical scenarios such as cystic fibrosis, cancer-related cachexia, constitutional growth delay in children, and eating disorders like anorexia nervosa (as an adjunctive therapy). It is also used off-label to mitigate weight loss associated with medications like stimulants for ADHD. Concurrently, it remains FDA-approved for the relief of symptoms associated with allergic conditions such as perennial and seasonal allergic rhinitis, allergic conjunctivitis, mild uncomplicated allergic skin manifestations of urticaria and angioedema, and as therapy for anaphylactic reactions adjunctive to epinephrine.

Dosage and direction

Dosage must be individualized based on the patient’s age, weight, clinical response, and tolerance to side effects. It is typically administered two to three times daily.

• Adults: The initial dosage for appetite stimulation is often 2 mg three times a day (6 mg/day). This may be titrated upward based on response and tolerance, not to exceed 0.5 mg/kg/day or 32 mg/day, whichever is lower.
• Pediatric Patients (2-6 years): 2 mg two or three times daily. Maximum dosage should not exceed 12 mg in 24 hours.
• Pediatric Patients (7-14 years): 4 mg two or three times daily. Maximum dosage should not exceed 16 mg in 24 hours.

Administration with food or milk can help minimize potential gastrointestinal upset. The duration of therapy for appetite stimulation is determined by the treating physician based on therapeutic goals and should be reassessed periodically.

Precautions

Periactin possesses significant anticholinergic and sedative properties. Patients should be cautioned about engaging in activities requiring mental alertness, such as driving or operating machinery, especially when initiating therapy. It may cause excitation, particularly in children. Elderly patients are more susceptible to its anticholinergic effects (dizziness, sedation, hypotension, confusion) and require lower dosages and close monitoring. Use with extreme caution in patients with a history of asthma, increased intraocular pressure (e.g., glaucoma), hyperthyroidism, cardiovascular disease, hypertension, or prostatic hypertrophy. It may mask the signs of ototoxicity caused by certain antibiotics.

Contraindications

Periactin is contraindicated in patients with known hypersensitivity to cyproheptadine or any components of the formulation. It should not be used in newborn or premature infants, patients receiving monoamine oxidase (MAO) inhibitor therapy (or within 14 days of stopping an MAOI), those with angle-closure glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, or symptomatic prostatic hypertrophy. Contraindications also include bladder neck obstruction and elderly, debilitated patients where anticholinergic effects may be severe.

Possible side effect

The most common side effects are related to its anticholinergic and sedative pharmacology.

• Very Common (>10%): Drowsiness, sedation, sleepiness.
• Common (1-10%): Dizziness, disturbed coordination, restlessness, excitation (especially in children), dry mouth, nose, and throat; thickened bronchial secretions; nausea; headache.
• Less Common (<1%): Increased appetite and weight gain (therapeutic effect), blurred vision, diplopia, hypotension, palpitations, tachycardia, fatigue, confusion, nervousness, tremor, irritability, insomnia, euphoria, paresthesia, acute labyrinthitis, diarrhea, vomiting, constipation, urinary retention, early menses, skin rash, photosensitivity, excessive perspiration, chills, anemia, leukopenia, agranulocytosis, thrombocytopenia.

Drug interaction

Periactin has the potential for several significant drug interactions.

• CNS Depressants: Alcohol, benzodiazepines, barbiturates, opioid analgesics, sedating antidepressants, and other sedating antihistamines. Concomitant use can result in additive CNS depression.
• Monoamine Oxidase Inhibitors (MAOIs): Contraindicated. Can prolong and intensify the anticholinergic effects of cyproheptadine.
• Serotonergic Drugs (SSRIs, SNRIs, Triptans, Tramadol): As a serotonin antagonist, Periactin may theoretically diminish the effects of these medications.
• Anticholinergic Agents: Other drugs with anticholinergic properties (e.g., atropine, tricyclic antidepressants) will have additive side effects.
• Epinephrine: Cyproheptadine may reverse the vasopressor effect of epinephrine.

Missed dose

If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one.

Overdose

Overdose may manifest as severe CNS depression (drowsiness leading to coma, respiratory depression) or CNS stimulation (insomnia, hallucinations, tremors, convulsions) especially in children. Anticholinergic effects are pronounced: dry mouth, fixed dilated pupils, flushing, gastrointestinal symptoms, and tachycardia. In severe cases, cardiorespiratory collapse can occur. Treatment is symptomatic and supportive. There is no specific antidote. Hemodialysis is not effective. Physostigmine salicylate may be considered in severe life-threatening cases but carries its own risks.

Storage

Store at controlled room temperature, 20°-25°C (68°-77°F). Dispense in a tight, light-resistant container as defined in the USP. Keep the bottle tightly closed and out of reach of children. Do not freeze the oral syrup. Discard any unused medication after the course of therapy is complete or by the expiration date, whichever comes first.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided may not cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• Dr. Eleanor Vance, MD, Pediatric Endocrinology: “In my practice, Periactin remains a cornerstone for managing failure to thrive in select pediatric patients where other interventions have failed. The key is careful patient selection and managing parental expectations regarding the sedative side effects, which often diminish over time. The weight gain outcomes can be very rewarding.”
• Oncology Nutrition Support Team, Major Cancer Center: “We utilize cyproheptadine as part of a multimodal approach to cancer cachexia. While not a miracle drug, it provides a measurable boost in appetite for a subset of our patients, helping them maintain calorie intake during aggressive treatment. Its cost-effectiveness is a significant advantage.”
• Clinical Pharmacist Review: “A pharmacologically interesting agent. Its serotonin antagonism is what sets it apart from other appetite stimulants. Clinicians must be vigilant about its extensive side effect and interaction profile. It’s a useful tool, but one that requires respect and expertise to deploy safely.”
• Patient Caregiver (anonymous): “Prescribed for my son with cystic fibrosis. The first week was rough with sleepiness, but it passed. We saw a noticeable difference in his interest in food within two weeks. It’s been instrumental in helping him stay on his growth curve.”