Usage
Cyproheptadine + Lysine + Peptone is prescribed as an appetite stimulant and for managing various conditions related to poor nutrition and weight loss. It is indicated for:
- Lack of appetite and unintentional weight loss
- Anorexia nervosa and other eating disorders
- Malnutrition or failure to thrive in children
- Weight loss due to chronic illnesses (e.g., cancer, HIV/AIDS)
- Countering appetite suppression from certain medications
Pharmacological Classification:
- Cyproheptadine: Antihistamine, antiserotonergic
- Lysine: Essential amino acid, nutritional supplement
- Peptone: Nutritional supplement
Mechanism of Action: This combination therapy works synergistically to stimulate appetite and promote weight gain. Cyproheptadine primarily antagonizes serotonin (5-HT2) receptors in the hypothalamus, the appetite-regulating center of the brain. It also has antihistaminic (H1 receptor blocking) properties. Lysine, an essential amino acid, aids in protein synthesis and growth, supporting overall nutritional status. Peptone provides readily digestible peptides and amino acids, contributing to improved nutrition.
Alternate Names
This combination medication is marketed under various brand names, including:
- Cyprowal Syrup
- Cyptone L Syrup/Drops
- Cydine Syrup
- Nyaibi Syrup
- Hepto Pep Syrup
- Peptone Gold Syrup
- Aptaup Syrup
- Oraxin (Oractine)
How It Works
Pharmacodynamics: Cyproheptadine’s primary action is serotonin (5-HT2) receptor antagonism in the hypothalamus, leading to increased appetite. It also exhibits antihistaminic effects by blocking H1 receptors. Lysine contributes to protein synthesis and growth, promoting overall nutritional status. Peptone’s components are absorbed and utilized in protein synthesis.
Pharmacokinetics: Cyproheptadine is metabolized primarily in the liver via CYP450 enzymes and excreted in urine and feces. Lysine is also metabolized in the liver and excreted in the urine. Information on the pharmacokinetics of peptone in this combination requires further study.
Dosage
Dosage needs to be personalized based on individual patient factors, including age, weight, medical condition, and concurrent medications. Always consult a physician for appropriate dosage determination.
Standard Dosage
Adults:
A typical adult dosage for syrup formulations is 10ml three times daily before meals. Tablet formulations of cyproheptadine alone range from 4mg to 20mg daily, divided into multiple doses.
Children:
Dosage needs to be individualized based on the child’s age, weight, and medical condition. Liquid formulations are generally preferred. For example:
- 2-6 years: 5ml syrup, two to three times daily before meals.
- 7-14 years: 10ml syrup, two to three times daily before meals.
Special Cases:
- Elderly Patients: Initiate with a lower dose and titrate cautiously based on tolerance and clinical response due to potential age-related decline in hepatic and renal function.
- Patients with Renal Impairment: Dosage reduction may be necessary based on the degree of impairment.
- Patients with Hepatic Dysfunction: Use cautiously and monitor closely due to the liver’s role in cyproheptadine metabolism. Dosage adjustment is warranted.
- Patients with Comorbid Conditions: Careful evaluation and dosage modification may be needed in patients with conditions like asthma, hypertension, hyperthyroidism, glaucoma, or urinary retention.
Clinical Use Cases
The primary clinical use of this combination is for stimulating appetite and promoting weight gain. Specific dosage recommendations for specialized clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations are not established.
Dosage Adjustments
Adjustments are made based on individual patient characteristics, including renal/hepatic function, other medical conditions, and concurrent medication use. Close monitoring of therapeutic response and potential side effects is advised.
Side Effects
Common Side Effects:
- Drowsiness
- Dizziness
- Dry mouth
- Nausea
- Headache
- Blurred vision
- Constipation
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling)
- Confusion
- Hallucinations
- Ataxia (impaired balance/coordination)
- Seizures
- Irregular heartbeat
Long-Term Effects:
Long-term effects are not well documented but may include dependence or tolerance to cyproheptadine’s appetite-stimulating properties.
Adverse Drug Reactions (ADR):
Clinically significant ADRs requiring immediate medical attention include severe allergic reactions, seizures, and cardiac arrhythmias.
Contraindications
- Hypersensitivity to any component of the medication
- Glaucoma
- Urinary retention
- Severe asthma
- Pyloroduodenal obstruction
- Bladder neck obstruction
- Prostatic hypertrophy
Drug Interactions
This combination can potentially interact with a wide range of medications, including:
- Other antihistamines (e.g., diphenhydramine, cetirizine)
- Antidepressants (e.g., duloxetine, fluoxetine, sertraline, MAOIs)
- Anti-anxiety medications (e.g., diazepam, lorazepam)
- Sleeping pills (e.g., zolpidem, temazepam)
- Muscle relaxants (e.g., baclofen, tizanidine)
- Opioid pain relievers (e.g., morphine, fentanyl)
- Antifungals (e.g., ketoconazole, itraconazole)
- Antibiotics (e.g., erythromycin, ciprofloxacin)
- Alcohol
It is crucial to inform your physician about all medications, including OTC drugs and supplements, before starting this combination therapy.
Pregnancy and Breastfeeding
The safety of this combination during pregnancy and breastfeeding is not fully established. Consult a physician before use, especially during pregnancy. Potential fetal risks are not well characterized, and excretion in breast milk needs further investigation.
Drug Profile Summary
- Mechanism of Action: Appetite stimulation through serotonin antagonism (cyproheptadine), nutritional support (lysine and peptone)
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, blurred vision, constipation. Rarely: allergic reactions, seizures, cardiac arrhythmias.
- Contraindications: Glaucoma, urinary retention, asthma, peptic ulcer, hypertension, hyperthyroidism.
- Drug Interactions: Numerous drug interactions, particularly with CNS depressants, antihistamines, and certain antimicrobials.
- Pregnancy & Breastfeeding: Consult a physician before use; safety not fully established.
- Dosage: Varies with formulation and patient factors; always physician-determined.
- Monitoring Parameters: Appetite, weight, potential side effects (drowsiness, dizziness, etc.), liver and renal function in specific cases.
Popular Combinations
Specific combinations involving Cyproheptadine + Lysine + Peptone are not commonly mentioned, although the individual components may be part of broader nutritional support regimens. Clinical experience should guide any combination therapy.
Precautions
- General Precautions: Screen for allergies, metabolic disorders, and organ dysfunction before prescribing.
- Pregnant Women: Exercise extreme caution due to limited safety data.
- Breastfeeding Mothers: Safety not established; potential neonatal exposure risk.
- Children & Elderly: Age-appropriate dosage adjustments are essential. Closely monitor for adverse effects.
- Lifestyle Considerations: Avoid alcohol and activities requiring alertness (driving, operating machinery) due to potential drowsiness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cyproheptadine + Lysine + Peptone?
A: Dosage is individualized based on factors like age, weight, condition, and other medications. Consult a physician for precise guidance. Syrup formulations may be 10ml TID for adults and 5-10ml TID for children (depending on age), before meals.
Q2: What is the mechanism of action of this combination?
A: Cyproheptadine antagonizes hypothalamic serotonin receptors, stimulating appetite. Lysine and peptone provide nutritional support.
Q3: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, nausea, headache, blurred vision, and constipation.
Q4: Are there any serious side effects?
A: Rarely, allergic reactions, confusion, hallucinations, ataxia, seizures, or irregular heartbeat can occur. Seek immediate medical attention if these manifest.
Q5: Who should not take this medication?
A: Individuals with glaucoma, urinary retention, severe asthma, or hypersensitivity to any component.
Q6: Can I drink alcohol while taking this medication?
A: Alcohol should be avoided due to the risk of increased drowsiness and other potential interactions.
Q7: What if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the next scheduled dose. Do not double up on doses.
Q8: Is this medication safe for children?
A: Yes, but dosage adjustments are crucial based on the child’s age and weight. Liquid formulations are preferred for ease of administration.
Q9: Can this be used during pregnancy?
A: Safety during pregnancy is not fully established. Consult a physician before using this medication if you are pregnant or planning to become pregnant.
Q10: Is this medication safe for breastfeeding mothers?
A: Information is limited on safety during breastfeeding; consult a physician. There is a potential for neonatal exposure through breastmilk.
