Periactin 2mg/5ml Syrup
It is used to ease allergy signs.It is used to treat hives.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antihistamine, Anti-allergic, Appetite Stimulant
Pharmacologic Class
H1-receptor Antagonist, Serotonin Antagonist, Anticholinergic
Pregnancy Category
B
FDA Approved
Mar 1961
DEA Schedule
Not Controlled
Overview
What is this medicine?
Cyproheptadine is a medicine that can help relieve allergy symptoms like sneezing, runny nose, and itchy eyes. It can also be used to help increase appetite and weight in some people. It often causes drowsiness, so be careful when taking it.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. You can take this medication with or without food. If it causes stomach upset, taking it with food may help. When taking the liquid form, measure the dose carefully using the device that comes with the medication. If no device is provided, ask your pharmacist for a measuring tool to ensure accurate dosing.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets, to prevent accidental ingestion.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To use this medication correctly, follow your doctor's instructions and read all the information provided. You can take this medication with or without food. If it causes stomach upset, taking it with food may help. When taking the liquid form, measure the dose carefully using the device that comes with the medication. If no device is provided, ask your pharmacist for a measuring tool to ensure accurate dosing.
Storing and Disposing of Your Medication
Store this medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets, to prevent accidental ingestion.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Avoid driving or operating heavy machinery until you know how this medication affects you, as it can cause significant drowsiness.
- Avoid alcohol and other sedating medications, as they can increase drowsiness.
- To relieve dry mouth, suck on sugar-free candy or ice chips, or use artificial saliva.
- If taking for appetite stimulation, maintain a balanced diet and consult with a healthcare provider or dietitian.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
4 mg orally 3-4 times daily
Dose Range:
4 - 32 mg
Condition-Specific Dosing:
Allergies:
4 mg orally 3-4 times daily; maximum 0.5 mg/kg/day
Appetite Stimulation (off-label):
4 mg orally 3 times daily
Pediatric Dosing
Neonatal:
Contraindicated (due to risk of CNS depression)
Infant:
Not established (generally avoided in infants due to risk of CNS depression)
Child:
2-6 years: 2 mg orally 2-3 times daily, not to exceed 12 mg/day; 7-14 years: 4 mg orally 2-3 times daily, not to exceed 16 mg/day
Adolescent:
Same as adult dosing, 4 mg orally 3-4 times daily
Dose Adjustments
Renal Impairment:
Mild:
Use with caution; consider lower initial dose
Moderate:
Dose reduction recommended; start with lower end of dosing range
Severe:
Significant dose reduction recommended; use with extreme caution or avoid
Dialysis:
Not well studied; likely not dialyzable due to high protein binding and large volume of distribution. Use with caution and monitor for adverse effects.
Hepatic Impairment:
Mild:
Use with caution; consider lower initial dose
Moderate:
Dose reduction recommended; start with lower end of dosing range
Severe:
Significant dose reduction recommended; use with extreme caution or avoid due to extensive hepatic metabolism
Pharmacology
Mechanism of Action
Cyproheptadine is a first-generation antihistamine that competitively blocks H1 histamine receptors. It also possesses significant anticholinergic (muscarinic) and antiserotonergic (5-HT2) activity. Its appetite-stimulating effect is thought to be related to its antiserotonergic activity.
Pharmacokinetics
Absorption:
Bioavailability:
Not precisely quantified, but well absorbed orally
Tmax:
6-9 hours
FoodEffect:
Not significantly affected by food
Distribution:
Vd:
High (due to lipophilicity, widely distributed)
ProteinBinding:
Approximately 90-96%
CnssPenetration:
Yes
Elimination:
HalfLife:
Approximately 8 hours (range 8-16 hours)
Clearance:
Not readily available
ExcretionRoute:
Primarily urine (as metabolites), some via feces
Unchanged:
< 2%
Pharmacodynamics
OnsetOfAction:
15-60 minutes
PeakEffect:
6-9 hours
DurationOfAction:
8 hours
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Severe dizziness or fainting
Fast or abnormal heartbeat
Difficulty urinating
Changes in urination frequency
Confusion
Balance problems
Hallucinations (seeing or hearing things that are not there)
Irritability
Mood changes
Seizures
Fever, chills, or sore throat
Unexplained bruising or bleeding
Feeling extremely tired or weak
Abnormal sensations, such as burning, numbness, or tingling
Changes in vision
Ringing in the ears
Excessive sweating
Changes in menstrual periods
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention if they bother you or do not go away:
Dizziness
Drowsiness
Fatigue
Weakness
Headache
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
Decreased appetite
Increased appetite
Weight gain
Dry mouth
Dry nose
Stuffy nose
Nervousness
Restlessness
Shakiness
Sleep disturbances
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Severe dizziness or fainting
Fast or abnormal heartbeat
Difficulty urinating
Changes in urination frequency
Confusion
Balance problems
Hallucinations (seeing or hearing things that are not there)
Irritability
Mood changes
Seizures
Fever, chills, or sore throat
Unexplained bruising or bleeding
Feeling extremely tired or weak
Abnormal sensations, such as burning, numbness, or tingling
Changes in vision
Ringing in the ears
Excessive sweating
Changes in menstrual periods
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention if they bother you or do not go away:
Dizziness
Drowsiness
Fatigue
Weakness
Headache
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
Decreased appetite
Increased appetite
Weight gain
Dry mouth
Dry nose
Stuffy nose
Nervousness
Restlessness
Shakiness
Sleep disturbances
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe drowsiness or sedation that prevents normal activity
- Confusion or hallucinations
- Difficulty urinating or inability to urinate
- Severe dry mouth or blurred vision
- Fast or irregular heartbeat
- Seizures
- Unusual excitement or restlessness (especially in children)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions and situations to ensure safe treatment with this medication:
If you have a known allergy to cyproheptadine or any other component of this medication. Describe your allergic reaction and the symptoms you experienced.
If you have any of the following health conditions:
+ Bowel blockage
+ Enlarged prostate
+ Glaucoma
+ Difficulty urinating
+ Stomach or bowel ulcers
If you are taking certain medications, such as:
+ Isocarboxazid, phenelzine, or tranylcypromine (used to treat depression)
+ Selegiline or rasagiline (used to treat Parkinson's disease)
+ Linezolid or methylene blue
If you are 65 years or older
If you are breastfeeding. Note that you should not breastfeed while taking this medication.
Special Considerations for Children:
If your child is a premature baby or a newborn, do not administer this medication. It is not suitable for premature babies or newborns.
Additional Important Information:
This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions.
Before starting, stopping, or changing the dose of any medication, consult with your doctor to ensure it is safe to take with this medication.
It is essential to inform your doctor about the following conditions and situations to ensure safe treatment with this medication:
If you have a known allergy to cyproheptadine or any other component of this medication. Describe your allergic reaction and the symptoms you experienced.
If you have any of the following health conditions:
+ Bowel blockage
+ Enlarged prostate
+ Glaucoma
+ Difficulty urinating
+ Stomach or bowel ulcers
If you are taking certain medications, such as:
+ Isocarboxazid, phenelzine, or tranylcypromine (used to treat depression)
+ Selegiline or rasagiline (used to treat Parkinson's disease)
+ Linezolid or methylene blue
If you are 65 years or older
If you are breastfeeding. Note that you should not breastfeed while taking this medication.
Special Considerations for Children:
If your child is a premature baby or a newborn, do not administer this medication. It is not suitable for premature babies or newborns.
Additional Important Information:
This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions.
Before starting, stopping, or changing the dose of any medication, consult with your doctor to ensure it is safe to take with this medication.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Until you understand how this drug affects you, avoid operating a vehicle or engaging in any activities that require your full attention.
This medication may interfere with the results of allergy skin tests. Therefore, it is crucial to notify your doctor and laboratory personnel that you are taking this drug.
Before consuming alcohol, using marijuana or other cannabis products, or taking prescription or over-the-counter medications that can cause drowsiness, consult with your doctor.
Be cautious when exposed to sunlight, as this medication may increase your risk of sunburn. If you experience increased sensitivity to the sun while taking this medication, notify your doctor.
It is vital to exercise extreme caution when administering this medication to children, as overdoses can occur and may lead to severe health complications or even death. If you have any questions or concerns, discuss them with your doctor.
Additionally, children should use this medication with caution, and you should consult with your doctor to discuss any potential risks.
If you are pregnant or planning to become pregnant, inform your doctor, as it is necessary to weigh the benefits and risks of using this medication during pregnancy.
Until you understand how this drug affects you, avoid operating a vehicle or engaging in any activities that require your full attention.
This medication may interfere with the results of allergy skin tests. Therefore, it is crucial to notify your doctor and laboratory personnel that you are taking this drug.
Before consuming alcohol, using marijuana or other cannabis products, or taking prescription or over-the-counter medications that can cause drowsiness, consult with your doctor.
Be cautious when exposed to sunlight, as this medication may increase your risk of sunburn. If you experience increased sensitivity to the sun while taking this medication, notify your doctor.
It is vital to exercise extreme caution when administering this medication to children, as overdoses can occur and may lead to severe health complications or even death. If you have any questions or concerns, discuss them with your doctor.
Additionally, children should use this medication with caution, and you should consult with your doctor to discuss any potential risks.
If you are pregnant or planning to become pregnant, inform your doctor, as it is necessary to weigh the benefits and risks of using this medication during pregnancy.
Overdose Information
Overdose Symptoms:
- Severe drowsiness or deep sleep
- Coma
- Seizures
- Dry mouth, flushed skin, dilated pupils, fever (anticholinergic syndrome)
- Ataxia (loss of coordination)
- Hallucinations
- Cardiovascular collapse
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment is supportive and symptomatic. Activated charcoal may be administered if ingestion was recent. Physostigmine may be used for severe anticholinergic symptoms.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) (concurrent use or within 14 days of MAOI discontinuation)
Major Interactions
- CNS Depressants (e.g., alcohol, sedatives, hypnotics, anxiolytics, opioids, other antihistamines) - increased sedation and CNS depression
- Anticholinergic Drugs (e.g., tricyclic antidepressants, atropine, some antipsychotics) - increased anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
Moderate Interactions
- Potassium Chloride (oral) - increased risk of GI lesions due to anticholinergic effects slowing GI motility
- Topical Anesthetics (e.g., pramoxine) - additive CNS depression if systemic absorption occurs
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Allergy symptoms (if for allergies)
Rationale: To establish baseline severity and track treatment efficacy.
Timing: Prior to initiation of therapy
Weight (if for appetite stimulation)
Rationale: To monitor for desired weight gain.
Timing: Prior to initiation of therapy
Renal and Hepatic Function
Rationale: To assess baseline organ function, especially in patients with pre-existing impairment, as dose adjustments may be necessary.
Timing: Prior to initiation of therapy in patients with suspected impairment
Routine Monitoring
Sedation/Drowsiness
Frequency: Daily, especially during initial therapy or dose changes
Target: Minimal to tolerable
Action Threshold: Excessive drowsiness interfering with daily activities; consider dose reduction or alternative
Anticholinergic Side Effects (dry mouth, blurred vision, urinary retention, constipation)
Frequency: Regularly, especially in elderly patients
Target: Minimal to tolerable
Action Threshold: Severe or persistent symptoms; consider dose reduction or alternative
Weight (if for appetite stimulation)
Frequency: Weekly to monthly
Target: Desired weight gain
Action Threshold: Lack of desired weight gain or excessive weight gain
Allergy symptom control
Frequency: As needed, based on patient report
Target: Improved or resolved symptoms
Action Threshold: Persistent or worsening symptoms; consider dose adjustment or alternative
Symptom Monitoring
- Drowsiness
- Dizziness
- Dry mouth
- Blurred vision
- Urinary retention
- Constipation
- Nausea
- Vomiting
- Nervousness
- Irritability
- Paradoxical excitation (especially in children)
Special Patient Groups
Pregnancy
Category B. Studies in animals have not shown risk, but human studies are limited. Use only if clearly needed and potential benefits outweigh risks.
Trimester-Specific Risks:
First Trimester:
Generally considered low risk, but limited human data.
Second Trimester:
Generally considered low risk.
Third Trimester:
Generally considered low risk, but caution near term due to potential for neonatal anticholinergic effects.
Lactation
L3 (Moderately safe). Cyproheptadine is excreted into breast milk. It can cause sedation in the infant and may decrease milk supply due to its anticholinergic effects. Use with caution; monitor infant for drowsiness or irritability.
Infant Risk:
Moderate risk of sedation, irritability, or decreased milk supply.
Pediatric Use
Contraindicated in neonates and premature infants due to increased susceptibility to anticholinergic effects and CNS depression. Use with caution in young children (under 2 years) due to potential for paradoxical excitation (restlessness, irritability, insomnia) or increased sensitivity to sedative effects. Dosage must be carefully calculated by weight for children over 2 years.
Geriatric Use
Elderly patients are more susceptible to the sedative and anticholinergic side effects (e.g., confusion, urinary retention, constipation, dry mouth, blurred vision). Start with lower doses and titrate slowly. Avoid in elderly patients with conditions exacerbated by anticholinergic effects (e.g., glaucoma, prostatic hypertrophy).
Clinical Information
Clinical Pearls
- Cyproheptadine is a first-generation antihistamine with significant sedative and anticholinergic properties, which can be beneficial for nighttime allergy symptoms but problematic for daytime use.
- It is widely used off-label as an appetite stimulant, particularly in children or patients with conditions causing poor appetite/weight loss.
- Patients should be warned about potential for significant drowsiness and advised to avoid activities requiring mental alertness.
- Paradoxical excitation (restlessness, nervousness, insomnia) can occur, especially in young children, rather than sedation.
Alternative Therapies
- For allergies: Second-generation antihistamines (e.g., loratadine, cetirizine, fexofenadine) for less sedation; other first-generation antihistamines (e.g., diphenhydramine) for similar sedative effects.
- For appetite stimulation: Mirtazapine (off-label, antidepressant with appetite-stimulating side effect), dronabinol, megestrol acetate (for cachexia in specific conditions).
Cost & Coverage
Average Cost:
$15 - $40 per 473ml bottle (generic syrup)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.