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Cyproheptadine is a first‑generation antihistamine with antiserotonergic properties; in pediatrics it is used for allergy symptoms and sometimes for appetite stimulation per clinician direction.
Expect sedation and anticholinergic effects; initiate bedtime dosing and titrate slowly
Approved for allergic conditions (rhinitis, conjunctivitis, urticaria) but commonly repurposed for appetite stimulation or migraine prevention under specialist care
Contraindicated with MAOIs, in newborns, and in breastfeeding mothers; screen for bladder outlet or glaucoma history
Monitor weight velocity, school performance, and behavior changes during prolonged use
Cyproheptadine is an antihistamine with additional antiserotonergic activity used for allergic conditions and select off-label pediatric indications.
Primary use centers on refractory allergic symptoms; off-label use includes appetite stimulation and migraine prophylaxis when supervised by specialists.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Perennial or seasonal allergic rhinitis and vasomotor rhinitis | Children ≥2 years | No | Reserve for refractory symptoms when non-sedating antihistamines are ineffective and sedation can be managed. |
| Chronic urticaria, dermatographism, and other histamine-mediated pruritus | Children ≥2 years | No | Useful for refractory itch after first-line second-generation antihistamines; reinforce trigger avoidance and step-down once controlled. |
| Appetite stimulation in functional GI disorders or feeding programs | No | Trial short courses (0.25 mg/kg/day divided twice daily) with close monitoring of weight velocity and behavioral side effects. | |
| Migraine or cyclic vomiting prophylaxis in younger children | No | Common preventive dose 0.2–0.4 mg/kg/day divided BID; track headache diary and taper once symptom-free for 6 months. |
FDA-approved primary uses with Level A evidence
Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Most children experience manageable sedation or appetite changes; serious neuropsychiatric or anticholinergic reactions are rare but warrant immediate evaluation.
Cyproheptadine’s first-generation antihistamine profile causes CNS depression and anticholinergic effects. Families should monitor for excessive sleepiness, behavioral changes, and urinary or vision complaints, especially during dose titration.
Sedation / somnolence
Very common • mild to moderate
Paradoxical excitation / hallucinations
Uncommon • severe
Increased appetite and weight gain
Common • variable
Dry mouth / constipation
Common • mild
Urinary retention or blurred vision
Uncommon • moderate to severe
CNS depression, seizures, respiratory arrest
Rare (overdose) • life-threatening
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Practical guidance for giving cyproheptadine safely to children.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Cyproheptadine blocks histamine and serotonin pathways, reducing allergic symptoms while stimulating appetite and preventing migraine triggers.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Clinical pearls to maximize benefit while lowering cyproheptadine risks.
Core insights every provider should know
Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Cyproheptadine and monitor your child's response to treatment.
Allergy relief can occur within hours. Appetite and migraine benefits often take 1–2 weeks of consistent dosing. Track changes and discuss them at follow-up visits.
Use bedtime-first dosing to assess sedation. Older adolescents should avoid driving or operating machinery until they know how sleepy they feel during the day.
Check weight, BMI percentile, sleep quality, mood, and bowel/bladder habits every 4–8 weeks. Contact your clinician sooner for hallucinations, severe agitation, or urinary retention.