Cyproheptadine (Periactin)
Similar to mirtazapine: Histamine (H1) and serotonin (5-HT2, 5-HT1A) antagonist, anticholinergic
- Anorexia2
- Alcohol (with prazosin)2
- Hypnotic (safe in elderly)4
- Nightmares4
- Sexual dysfunction on SSRI3
Features
Dosing
4mg 1 qhs x7days, 2 qhs x7days, 1 qam 2 qhs x7days then 2 bid for depression.
For alcohol: target 8-12 mg/day but only works with prazosin
Management
Well tolerated except for sedation and weight gain.
EMR Text
Anorexia
Cyproheptadine used based on a small controlled and uncontrolled trials in anorexia nervosa (Halmi KA, Arch Gen Psychiatry. 1986;43(2):177-81)
Cyproheptadine’s risks, including sedation and weight gain, reviewed with patient.
Alcohol
Cyproheptadine used based on randomized controlled trial where it reduced alcohol use in combination with prazosin (Aubin HJ et al, Addiction 2024;119(7):1211-1223).
Cyproheptadine’s risks, including sedation and weight gain, reviewed with patient.
Nightmares
Cyproheptadine used based on a small trial where it reduced nightmares (Clark RD et al, J Clin Psychopharmacol 1999;19(5):486-7).
Cyproheptadine’s risks, including sedation and weight gain, reviewed with patient.
Sexual Side Effects
Cyproheptadine used based on a small trial where it reduced sexual side effects of serotonergic medications (Aizenberg D et al, Clin Neuropharmacol 1995;18(4):320-4).
Cyproheptadine’s risks, including sedation and weight gain, reviewed with patient.