Usage
Cyproheptadine + Peptone is primarily prescribed as an appetite stimulant. It is used to treat conditions such as:
- Loss of appetite and poor eating habits.
- Loss of appetite after surgery or major illness.
- Anorexia nervosa.
- Certain allergies, including allergic rhinitis, angioedema, hives, and insect sting allergies.
- Migraine in children (off-label).
Pharmacological Classification:
- Cyproheptadine: Antihistamine, antiserotonergic
- Peptone: Nutritional supplement
- Lysine (often included): Essential amino acid
Mechanism of Action: Cyproheptadine acts as an antagonist at histamine H1 receptors and serotonin 5-HT2 receptors in the hypothalamus, a region of the brain that regulates appetite. This antagonism leads to increased appetite. Peptone provides easily digestible protein fragments, supporting nutritional needs. Lysine is an essential amino acid crucial for protein synthesis and growth.
Alternate Names
No widely recognized alternate names exist for this combination product. It is often referred to as Cyproheptadine-Peptone-Lysine.
How It Works
Pharmacodynamics: Cyproheptadine exerts its appetite-stimulating effects by blocking H1 and 5-HT2 receptors in the hypothalamus. It also has anticholinergic, antiserotonergic, and sedative properties. Peptone provides readily available amino acids for protein synthesis. Lysine contributes to growth and development.
Pharmacokinetics:
- Absorption: Cyproheptadine is well-absorbed orally.
- Metabolism: Primarily hepatic, possibly involving CYP450 enzymes.
- Elimination: Primarily renal excretion. Reduced elimination in patients with renal insufficiency.
Mode of Action: Cyproheptadine competitively antagonizes histamine H1 and serotonin 5-HT2 receptors. Peptone is digested and absorbed as amino acids. Lysine participates in protein synthesis.
Dosage
Standard Dosage
Adults: 10 ml (syrup) three times daily before meals. Some sources indicate a range of 12-16mg daily for adults, up to 32 mg in certain cases. This dose usually refers to the amount of cyproheptadine only, not the combination syrup.
Children:
- 2-6 years: 5ml (syrup) two to three times daily before meals.
- 7-14 years: 10 ml (syrup) two to three times daily before meals.
- Migraine: 0.2-0.4 mg/kg/day of cyproheptadine, divided twice daily; not to exceed 0.5 mg/kg/day
Special Cases:
- Elderly Patients: Initiate with lower doses and titrate based on response and tolerability due to potential age-related decline in hepatic and renal function.
- Patients with Renal Impairment: Reduce dosage and monitor closely due to decreased cyproheptadine clearance.
- Patients with Hepatic Dysfunction: Start with a lower dose and adjust according to patient response.
- Patients with Comorbid Conditions: Careful evaluation and dose adjustments are necessary.
Clinical Use Cases
Dosage adjustments for intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are not specifically established for this combination and should be made cautiously on a patient specific basis.
Dosage Adjustments
Adjustments are made based on patient age, weight, renal and hepatic function, and other factors.
Side Effects
Common Side Effects:
- Drowsiness
- Dizziness
- Dry mouth
- Nausea and vomiting
- Constipation
- Confusion
Rare but Serious Side Effects:
- Allergic reactions (e.g., skin rash, itching, swelling)
- Difficulty urinating
- Severe dizziness or confusion
Long-Term Effects:
Data on long-term effects are limited.
Adverse Drug Reactions (ADR):
Any severe or persistent side effect should be considered an ADR and warrants immediate medical attention.
Contraindications
- Hypersensitivity to cyproheptadine, peptone, or any component of the formulation.
- Glaucoma
- Urinary retention
- Pyloric or duodenal obstruction
- Stenosing peptic ulcer
- Asthma
- Bladder neck obstruction
- Concurrent use of MAOIs
Drug Interactions
- MAO inhibitors: Concurrent use may cause hypertensive crisis.
- Alcohol: May enhance sedative effects.
- Anticholinergics: Additive anticholinergic effects.
- CNS depressants: Increased sedation.
Pregnancy and Breastfeeding
- Pregnancy: Considered relatively safe during pregnancy, but caution is advised. Consult with an OB/GYN to evaluate potential benefits versus risks.
- Breastfeeding: Small amounts of cyproheptadine may be excreted in breast milk. Exercise caution while breastfeeding.
Drug Profile Summary
- Mechanism of Action: Cyproheptadine antagonizes H1 and 5-HT2 receptors, stimulating appetite. Peptone and lysine provide nutritional support.
- Side Effects: Drowsiness, dizziness, dry mouth, nausea, constipation, confusion.
- Contraindications: Hypersensitivity, glaucoma, urinary retention, MAOI use.
- Drug Interactions: MAOIs, alcohol, anticholinergics, CNS depressants.
- Pregnancy & Breastfeeding: Consult with doctor; can be used with caution.
- Dosage: See detailed section above.
- Monitoring Parameters: Appetite, weight, and potential side effects.
Popular Combinations
Often combined with other vitamins and minerals to enhance nutritional support.
Precautions
- Assess for contraindications and potential drug interactions.
- Monitor for side effects.
- Caution in elderly patients and those with renal or hepatic impairment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cyproheptadine + Peptone?
A: See dosage section above for specific recommendations based on age and condition.
Q2: What are the common side effects?
A: Drowsiness, dizziness, dry mouth, nausea, constipation, and confusion.
Q3: Is it safe during pregnancy?
A: Consult with an OB/GYN. Generally considered safe, but weigh the risks versus benefits.
Q4: Can it be used in children?
A: Yes, with appropriate dose adjustments based on age.
Q5: How does it work to increase appetite?
A: Cyproheptadine blocks H1 and 5-HT2 receptors in the hypothalamus.
Q6: What are the contraindications?
A: Glaucoma, urinary retention, hypersensitivity, and concurrent MAOI use are primary contraindications.
Q7: Does it interact with other medications?
A: Yes, interactions with MAOIs, alcohol, anticholinergics, and CNS depressants are important considerations.
Q8: Are there any long-term side effects?
A: Limited data exist regarding long-term effects.
Q9: What should I monitor in patients taking this combination?
A: Monitor for side effects, appetite changes, and overall nutritional status.
