Screen for allergy, MAOI use, and conditions that raise anticholinergic risk before prescribing cyproheptadine.
Absolute: newborn/premature infants, breastfeeding, MAOI therapy, hypersensitivity, angle-closure glaucoma, urinary or GI outlet obstruction. Relative: asthma, cardiovascular disease, hypertension, hyperthyroidism, increased intraocular pressure.
Known hypersensitivity to cyproheptadine or other first-generation antihistamines
Concurrent monoamine oxidase inhibitor therapy
Newborn or premature infants
Breastfeeding mothers (risk of infant sedation)
Angle-closure glaucoma
Stenosing peptic ulcer or pyloroduodenal obstruction
Bladder neck obstruction or symptomatic prostatic hypertrophy
Bronchial asthma or chronic obstructive lung disease
Cardiovascular disease or uncontrolled hypertension
Hyperthyroidism
Increased intraocular pressure
History of severe anticholinergic reactions
Concurrent sedatives, alcohol, or other CNS depressants
Elderly or debilitated patients—heightened fall risk
Avoid during breastfeeding due to increased infant risk of sedation and excitability; use in pregnancy only if benefits outweigh risks.