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Cyproheptadine in ADHD


Cyproheptadine in ADHD

1. Mechanisms of action of cyproheptadine

Cyproheptadine is a1

  • H1 antihistamine
  • Serotonin antagonist
  • anticholinergic
  • blocks hypothalamic centers
    • thereby inhibits the release of cortisol

Plasma half-life: 6 to 9 hours

2. Indications for cyproheptadine

Cyproheptadine is used:

  • Loss of appetite (only in veterinary medicine and without veterinary drug approval)
  • Anorexia nervosa (no drug approval)
  • Hives (cold urticaria) (drug approval in Germany only for this, and only if conventional antihistamines are not sufficient)
  • Antiallergic (USA only)
    • seasonal allergic or vasomotor rhinitis
    • allergic conjunctivitis
    • allergic skin symptoms
    • Improvement of allergic reaction to blood or plasma
    • Dermographism (“made hives”, urticaria factitia)

3. Side effects and contraindications of cyproheptadine

Side effects of Cyproheptadine21

  • Tiredness, drowsiness
  • central disturbances
  • Visual disturbances
  • Digestive disorders
  • Urinary retention
  • dry mucous membranes
  • increased appetite
  • Hypersensitivity
  • Pain, headache
  • Cramps
  • Shock, shivering, dizziness, sweating
  • allergic skin reactions, exanthema
  • Drowsiness, somnolence, hallucinations
  • Mydriasis, narrow-angle glaucoma, visual disturbances
  • Dry mouth
  • Micturition disorders
  • Cardiac arrhythmias, tachycardia
  • Blood count changes
  • Gastrointestinal tract disorders

Contraindications to cyproheptadine21

  • Hypersensitivity to cyproheptadine
  • Bladder voiding disorders
  • Narrow-angle glaucoma
  • acute asthma attack
  • Pregnancy, lactation
  • Children
  • Babies
  • Infants
  • Lactation
  • Concurrent treatment with an MAO inhibitor
  • Stomach or intestinal ulcer
  • Prostate enlargement
  • Urinary retention
  • Intestinal obstruction

4. Cyproheptadine for weight gain in humans

A systematic review of the use of cyproheptadine for weight gain found significant weight gain in 39 of 46 studies evaluated. In contrast, little benefit of cyproheptadine was found in malignant/progressive diseases, such as HIV and cancer. The most common side effect was transient mild to moderate sedation. The review concluded that cyproheptadine is a safe and generally well-tolerated drug for weight gain.3
A recent bigger RCT also found cyproheptadine to be an effective and safe medication for weight gain in adults.4

Another systematic review on the safety of cyproheptadine found a total of 93 adverse effects (adults 81.7%, children 18.3%) in the French pharmacovigilance database from 1985 to 2020.5
Primarily these were

  • neurological symptoms (n = 38, adults 71%, children 28.9%)
  • hepatic complications (n = 15, adults 86.7%, children 13.3%; 0.27 to 1.4/1000, independent of age)

Cyproheptadine was thus classified as a safe drug. Use in young children was discouraged as a precaution. Liver values should be monitored.

5. Cyproheptadine for weight gain in ADHD

An ADHD sufferer (36 kg) reported that her appetite reduction caused by stimulants was successfully resolved by 10 ml of cyproheptadine.

The presentation here is only for the sake of completeness, since many sufferers have problems with loss of appetite. The use of cyproheptadine to increase appetite in ADHD should only be done under close medical supervision. When using cyproheptadine, liver values should be monitored, as very rare cases of liver failure have been reported.

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