Periactin (cyproheptadine hydrochloride) is a versatile prescription medication with dual therapeutic applications. Primarily recognized as a first-generation antihistamine, it effectively manages allergic conditions such as hay fever, urticaria, and allergic dermatitis. Additionally, it is uniquely indicated as an appetite stimulant, particularly useful in cases of unintended weight loss or failure to thrive. Its mechanism involves antagonism of histamine H1 receptors and serotonin, contributing to both its anti-allergic and orexigenic effects. This product card provides a comprehensive overview for healthcare professionals and informed patients.

Features

• Active ingredient: Cyproheptadine hydrochloride 4mg per tablet
• Pharmaceutical form: Oral tablets
• Classification: First-generation antihistamine with antiserotonergic properties
• Half-life: Approximately 8-9 hours in adults
• Metabolism: Hepatic, primarily via CYP3A4
• Excretion: Renal (approximately 40% as metabolites)
• Available in packages of 30, 60, and 100 tablets
• White, scored tablets with identification markings
• Prescription-only medication in most jurisdictions

Benefits

• Effectively reduces histamine-mediated allergic reactions including itching, sneezing, and rhinorrhea
• Promotes measurable weight gain in patients experiencing appetite suppression or cachexia
• Provides relief from migraine headache prophylaxis through serotonin antagonism
• Demonstrates rapid onset of action, typically within 20-30 minutes for allergic symptoms
• Offers flexible dosing regimen adaptable to individual patient needs and tolerance
• Cost-effective therapeutic option compared to newer generation alternatives

Common use

Periactin is commonly prescribed for the management of various allergic conditions including seasonal allergic rhinitis, chronic urticaria, angioedema, and allergic conjunctivitis. Its appetite-stimulating properties make it valuable in clinical scenarios involving weight management challenges, such as in patients with cancer-related cachexia, HIV-associated wasting syndrome, or failure to thrive in pediatric and geriatric populations. Off-label uses include management of serotonin syndrome symptoms, migraine prophylaxis, and treatment of night sweats associated with various conditions.

Dosage and direction

For allergic conditions in adults: 4mg three times daily, not to exceed 0.5mg/kg/day. Maximum daily dose: 32mg.
For appetite stimulation in adults: 4mg three times daily, with possible titration based on response and tolerance.
Pediatric dosing (2-6 years): 2mg two to three times daily, not to exceed 12mg/day.
Pediatric dosing (7-14 years): 4mg two to three times daily, not to exceed 16mg/day.
Administration with food may reduce gastrointestinal discomfort. Dosage adjustments required for hepatic impairment. Elderly patients may require lower initial doses due to increased sensitivity.

Precautions

Exercise caution in patients with angle-closure glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, or bladder neck obstruction. Use with care in patients with hypertension, cardiovascular disease, or hyperthyroidism. May impair mental and physical abilities required for potentially hazardous tasks including driving or operating machinery. Avoid alcohol and other CNS depressants during therapy. Regular monitoring of weight and nutritional status recommended when used for appetite stimulation. Periodic liver function tests advised during prolonged therapy.

Contraindications

Hypersensitivity to cyproheptadine or any component of the formulation. Concurrent monoamine oxidase inhibitor therapy or within 14 days of discontinuing MAOI treatment. Neonates and premature infants. Patients with narrow-angle glaucoma. Severe hypertension. Acute asthma attacks. Prostatic hypertrophy with urinary retention. Breastfeeding is contraindicated due to secretion in milk and potential adverse effects on infants.

Possible side effect

Common: Drowsiness (affects approximately 20-50% of patients), dizziness, dry mouth, nausea, appetite increase.
Less common: Headache, excitation (especially in children), blurred vision, diplopia, hypotension, tachycardia, weight gain.
Rare: Blood dyscrasias including leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia; cholestatic jaundice; seizures; allergic reactions including anaphylaxis.
Paradoxical reactions including agitation, hallucinations, and insomnia may occur, particularly in pediatric patients.

Drug interaction

MAO inhibitors: Risk of severe hypertensive crisis.
CNS depressants: Enhanced sedative effects with alcohol, barbiturates, benzodiazepines, opioids.
Anticholinergic agents: Additive effects with atropine, tricyclic antidepressants, phenothiazines.
Serotonergic drugs: Possible attenuation of effects of SSRIs, SNRIs, triptans.
Hepatic enzyme inducers: Rifampin, carbamazepine may decrease cyproheptadine levels.
Hepatic enzyme inhibitors: Ketoconazole, erythromycin may increase cyproheptadine levels.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule to ensure consistent therapeutic effect. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.

Overdose

Symptoms may include severe CNS depression (coma), CNS stimulation (hallucinations, convulsions), anticholinergic effects (dry mouth, fixed dilated pupils, flushing), cardiovascular collapse. Children may experience paradoxical excitation. Treatment is supportive and symptomatic. Gastric lavage may be beneficial if performed soon after ingestion. Activated charcoal may be administered. Physostigmine may be considered for severe central anticholinergic effects under careful monitoring. Hemodialysis is not effective due to high protein binding.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep container tightly closed. Do not store in bathroom or near kitchen sink. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly discard any unused medication after treatment completion.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Dosage and treatment decisions should be made based on individual patient assessment by a licensed medical practitioner. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions.

Reviews

Clinical studies demonstrate Periactin’s efficacy in allergic conditions with 60-70% of patients experiencing significant symptom relief. For appetite stimulation, studies show average weight gain of 1-2 kg per month in appropriate patient populations. Many clinicians report satisfactory results particularly in pediatric patients with failure to thrive. Some patients report sedation as a limiting factor, though this often diminishes with continued use. Overall satisfaction rates among prescribing physicians remain high for indicated uses, with particular appreciation for its dual mechanism of action and cost-effectiveness compared to newer alternatives.