Usage
Cyproheptadine + Sorbitol + Tricholine Citrate is primarily prescribed as an appetite stimulant. It is used to treat anorexia, loss of appetite, and to promote weight gain in underweight children and adults, particularly in cases of inadequate dietary intake, anemia, or following a debilitating illness. Additionally, it is used as an adjunct to anti-tubercular and antiretroviral treatment for weight gain. It is also indicated in hepatobiliary disorders associated with anorexia.
This combination medication falls under several pharmacological classifications:
- Cyproheptadine: Antihistamine, antiserotonergic, orexigenic (appetite stimulant).
- Sorbitol: Osmotic laxative.
- Tricholine Citrate: Bile acid-binding agent, lipotropic agent.
Mechanism of Action: Cyproheptadine stimulates appetite by antagonizing serotonin receptors in the hypothalamus, the appetite control center of the brain. Sorbitol acts as an osmotic laxative, relieving constipation. Tricholine citrate, as a bile acid-binding agent, enhances cholesterol breakdown into bile acids in the liver.
Alternate Names
This combination drug does not have a universally recognized alternate name. It is often referred to by its constituent drug names. Brand names vary regionally and internationally; some popular ones include Cyptoss, Pep-on, and CYP-L.
How It Works
Pharmacodynamics: Cyproheptadine, an antihistamine, primarily blocks histamine and serotonin receptors. Its appetite-stimulating effect is linked to its antiserotonergic action in the hypothalamus. Sorbitol increases osmotic pressure in the gut lumen, leading to water retention and softened stools. Tricholine citrate binds bile acids, facilitating their excretion; the liver compensates by synthesizing new bile acids from cholesterol, lowering cholesterol levels.
Pharmacokinetics: Cyproheptadine is well-absorbed orally and metabolized by the liver, primarily through CYP450 enzymes. Sorbitol is absorbed slowly from the gastrointestinal tract. Tricholine citrate is absorbed and metabolized in the liver. The elimination pathways for all three components are primarily through hepatic and renal routes.
Mode of Action: Cyproheptadine’s action on serotonin receptors in the hypothalamus is thought to disinhibit appetite control. Sorbitol’s osmotic properties draw water into the intestines, promoting bowel movements. Tricholine citrate facilitates bile acid synthesis by binding to and removing existing bile acids.
Dosage
Dosage and administration guidelines are general recommendations and must be individualized based on patient-specific factors.
Standard Dosage
Adults:
The standard adult dose is generally 5 ml of syrup three times daily for 15 days, but this can be adjusted by the physician. The strength is usually 2 mg Cyproheptadine, 275 mg Tricholine Citrate, and 2g Sorbitol Solution (70%) per 5 ml.
Children:
Dosage in children varies depending on age and weight. For infants (below 1 year) a formulation with 1.5mg Cyproheptadine and 55mg Tricholine Citrate per ml is available. For children over 1 year, the standard pediatric syrup is used and the dosage adjusted as per the child’s weight.
Special Cases:
- Elderly Patients: Dosage should be initiated at the lower end of the adult range and carefully titrated due to potential age-related changes in metabolism and organ function.
- Patients with Renal Impairment: Caution is advised and dose adjustments may be necessary based on creatinine clearance.
- Patients with Hepatic Dysfunction: Dosage adjustments may be required. Close monitoring of liver function tests is essential.
- Patients with Comorbid Conditions: Dose adjustments should be made as needed, particularly for patients with diabetes, cardiovascular disease, asthma, thyroid disorders, glaucoma, urinary retention, and peptic ulcers.
Clinical Use Cases
The use of this combination is not indicated for intubation, surgical procedures, mechanical ventilation, intensive care unit (ICU) use, or emergency situations. Its primary indication is appetite stimulation.
Dosage Adjustments
Dosage adjustments are necessary based on patient response, renal and hepatic function, and comorbid conditions.
Side Effects
Common Side Effects:
Dry mouth, constipation, drowsiness, sleepiness, blurred vision, confusion, and ataxia (impaired balance or coordination).
Rare but Serious Side Effects:
Allergic reactions, urinary retention, hypotension, cardiac arrhythmias.
Long-Term Effects:
Chronic complications are rare but might include metabolic disturbances, weight gain, and potential for dependence with prolonged use.
Adverse Drug Reactions (ADR):
Severe allergic reactions, angle-closure glaucoma exacerbation, paralytic ileus.
Contraindications
Absolute contraindications include hypersensitivity to any of the components, angle-closure glaucoma, stenosing peptic ulcer, bladder neck obstruction, pyloroduodenal obstruction, and concomitant use of MAO inhibitors. Relative contraindications include pregnancy, breastfeeding, prostatic hypertrophy, and impassable urine pathways.
Drug Interactions
This combination can interact with a wide range of medications:
- Antihistamines: Additive anticholinergic effects.
- Antidepressants (especially MAOIs): May prolong and enhance the effects of cyproheptadine.
- Anticonvulsants: Increased risk of sedation.
- Antipsychotics: Additive anticholinergic and sedative effects.
- CNS Depressants: Increased sedation and respiratory depression.
- Alcohol: Increased drowsiness and risk of stomach problems.
Pregnancy and Breastfeeding
This drug combination is generally contraindicated during pregnancy and breastfeeding. Cyproheptadine may cause adverse effects on the fetus. Cyproheptadine is excreted in breast milk and can cause drowsiness in the infant. Safer alternatives should be considered if necessary.
Drug Profile Summary
- Mechanism of Action: Cyproheptadine: Antihistamine, antiserotonergic, appetite stimulant. Sorbitol: Osmotic laxative. Tricholine Citrate: Bile acid-binding agent.
- Side Effects: Dry mouth, constipation, drowsiness, blurred vision.
- Contraindications: Hypersensitivity, angle-closure glaucoma, bladder neck obstruction.
- Drug Interactions: MAOIs, CNS depressants, anticholinergics.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: 5ml TID. Pediatric: Adjust by age and weight.
- Monitoring Parameters: Appetite, weight, bowel movements, liver function tests, and any signs of adverse reactions.
Popular Combinations
While often prescribed as a fixed-dose combination, it may be given concurrently with vitamins and mineral supplements in malnourished patients.
Precautions
- General Precautions: Assess for pre-existing medical conditions, drug allergies, and concurrent medication use.
- Specific Populations: Use with caution in the elderly, patients with renal or hepatic impairment, and those with cardiovascular or respiratory disease.
- Lifestyle Considerations: Avoid alcohol and activities requiring alertness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cyproheptadine + Sorbitol + Tricholine Citrate?
A: The standard adult dosage is 5 ml three times daily for 15 days. Pediatric dosages are adjusted based on the age and weight of the child.
Q2: Can this combination be used in pregnant or breastfeeding women?
A: No, it is generally contraindicated in both pregnancy and breastfeeding.
Q3: What are the common side effects?
A: Common side effects include dry mouth, constipation, drowsiness, sleepiness, blurred vision, confusion, and ataxia.
A: Serious side effects include allergic reactions, urinary retention, hypotension, and cardiac arrhythmias. Seek immediate medical attention if these occur.
Q5: Does this medicine interact with other drugs?
A: Yes, it can interact with antihistamines, antidepressants (especially MAOIs), anticonvulsants, antipsychotics, and CNS depressants, potentially leading to enhanced side effects.
Q6: What precautions should be taken while driving?
A: This combination can cause drowsiness. Avoid driving or operating heavy machinery until the effects are known.
Q7: Can patients with liver disease use this medication?
A: Use with caution in patients with liver disease. Dose adjustment may be necessary. Closely monitor liver function tests.
Q8: What should be done if a dose is missed?
A: Take the missed dose as soon as remembered unless it is close to the next scheduled dose. Do not double the dose.
Q9: Can this medication be used in children under one year of age?
A: A specific formulation with lower strength is available for infants below one year. Consult a pediatrician for appropriate prescription and dosage.
Q10: Can a patient consume alcohol while taking this medicine?
A: No, alcohol should be avoided as it can increase drowsiness and the risk of stomach problems.
