Cyproheptadine

Indications: 

• Serotonin syndrome (mild to mod)
  • Antagonises – H1 and 5HT1+2 Receptors 
  • Not an antidote -> helps to alleviate symptoms 
• Serotonin syndrome: CNS toxicity/ Autonomic features/ Neuromuscular  excitability.

• Consider the use of oral benzodiazepines in cooperative patients with mild to  moderate agitation. 

Formulation: 

• Cyproheptadine 4mg tablets 

Dosage and Administration 

• Adults:
  • For patients with significant agitation and sustained clonus use 12mg as a  single dose
  • Continue with 8mg PO / NG TDS for 24hrs until resolution of symptoms  o Paediatrics 
•  <7 years of age 2mg as a single dose. 
  
• >7 years of age  4mg as a single dose. 

• Continued symptoms <7 years of age 2mg tds
• >7 years of age 4mg tds  until symptom resolution 

Side Effects 

• Anticholinergic properties but generally well tolerated 

Pit Falls 

• Contraindicated in:
  • Acute asthma, closed angle glaucoma, bladder neck obstruction
  • Use alongside benzodiazepines & supportive care