Cypomeal

Description

Cypomeal Syrup

Generic Name: Cyproheptadine HCl

Manufacturer: Alliance Pharmaceuticals Pvt. Ltd.

Availability: Available in Nepal

Indications

Cypomeal Syrup is used to treat a variety of conditions, including:

• Allergic Conditions: Helps relieve rash and itching (pruritus) associated with various allergic reactions.
• Appetite Stimulation: Can be used to stimulate appetite, particularly in cases of anorexia nervosa.
• Endocrine Disorders: Beneficial in managing conditions like Cushing’s syndrome, Nelson’s syndrome, acromegaly, and hyperprolactinemia.
• Migraine Headaches: Used for both the treatment and prevention of migraines and other types of vascular headaches.
• Antidepressant-Induced Anorgasmia: May help address the inability to achieve orgasm when caused by antidepressant medications.

Dosage and Administration

Adult Dosing

1. Allergic Conditions (Oral)

• Initial Dose: 4 mg three times a day (TID).
• Adjustment: Your doctor will adjust the dose as needed.
• Typical Dose: 12-16 mg daily, divided into 3-4 doses.
• Maximum Dose: Do not exceed 32 mg per day.

2. Migraine and Other Vascular Headaches (Oral)

• Acute Treatment: Take 4 mg, which can be repeated after 30 minutes if necessary.
• Maximum: Do not take more than 8 mg within a 4- to 6-hour period.
• Maintenance: 4 mg every 4-6 hours.

Child Dosing (Oral)

1. Allergic Conditions

• Children 2-6 years: 2 mg once or twice a day (BID) or three times a day (TID).
• Maximum (2-6 years): 12 mg per day.
• Children 7-14 years: 4 mg once or twice a day (BID) or three times a day (TID).
• Maximum (7-14 years): 16 mg per day.

2. Migraine Prophylaxis

• Children under 3 years: The safety and effectiveness of Cypomeal Syrup have not been established in this age group.
• Children over 3 years and Adolescents: 0.2-0.4 mg/kg/day orally, divided into two doses (BID).
• Maximum: Do not exceed 0.5 mg/kg/day.

Administration Tips

• Cypomeal Syrup can be taken with or without food.
• Taking it with meals may help to reduce any stomach upset you might experience.

Contraindications

Do not use Cypomeal Syrup if you have any of the following conditions:

• Narrow-angle glaucoma.
• An acute asthmatic attack.
• Bladder neck obstruction.
• Stenosing peptic ulcer (a narrowing ulcer in the stomach or duodenum).
• Gastrointestinal tract (GIT) obstruction.
• You are currently undergoing MAOI (monoamine oxidase inhibitor) therapy.
• Known hypersensitivity to cyproheptadine or any of its ingredients.
• You are a neonate (newborn).
• You are breastfeeding (lactation).

Precautions

Use Cypomeal Syrup with caution if you have any of the following:

• You are elderly.
• Epilepsy or a history of seizures.
• You perform tasks requiring mental alertness (e.g., driving, operating machinery) due to potential drowsiness.
• Symptomatic prostate hypertrophy (enlarged prostate with symptoms).
• Alcoholism.
• You are pregnant.

Specific Considerations:

• Lactation: It’s unknown if Cypomeal Syrup passes into breast milk, but it’s contraindicated for breastfeeding mothers.
• Pregnancy: Use with caution.

Interactions

• CNS Depressants: Cypomeal Syrup may have additive sedative effects when taken with other central nervous system (CNS) depressants, such as hypnotics, sedatives, tranquilizers, and anti-anxiety medications.
• Potentially Fatal Interaction:
  • MAOIs (Monoamine Oxidase Inhibitors): MAOIs can significantly prolong and intensify the anticholinergic effects of antihistamines like cyproheptadine, which can be dangerous. Therefore, using Cypomeal Syrup with MAOIs is contraindicated.

Adverse Effects

Side effects of Cyproheptadine HCl can vary. They commonly affect the central nervous system but can impact other body systems.

Common Side Effects (Psychiatric/Neurologic):

• CNS Depression: This is the most frequent side effect and can range from mild drowsiness to deep sleep.
• Dizziness.
• Lassitude (feeling of weariness or lack of energy).
• Disturbed coordination.
• Less commonly: Restlessness, insomnia, tremors, euphoria, nervousness, irritability, delirium, seizures, toxic psychosis, paresthesia (tingling or numbness).

Other Potential Side Effects:

• Muscular: Weakness.
• Cardiovascular: Palpitation, tachycardia (rapid heart rate), ECG changes (e.g., widened QRS complex), arrhythmias (e.g., extra heartbeats, heart block), hypotension (low blood pressure), hypertension (high blood pressure).
• Gastrointestinal (GI): Epigastric distress (discomfort in the upper abdomen), anorexia (loss of appetite), nausea, vomiting, diarrhea, constipation.
• Hepatic (Liver): Cholestasis (reduced bile flow), hepatitis (liver inflammation), hepatic failure, abnormal liver function tests, jaundice (yellowing of skin/eyes, rare).
• Skin: Eczema, pruritus (itching), inflammation, papular rash (small, raised bumps), erythema (redness) on exposed skin.
• Sensory: Visual disturbances, blurred vision, diplopia (double vision), tinnitus (ringing in the ears), acute labyrinthitis (inner ear inflammation).
• Renal (Kidney): Dysuria (painful urination), urinary retention.
• Respiratory: Thickening of bronchial secretions, wheezing, nasal stuffiness.
• Other: Vertigo (spinning sensation), sweating, chills, early menstruation, headache, impotence, dryness of mouth, nose, and throat, facial dyskinesia (involuntary facial movements), tightness of chest, faintness.

Mechanism of Action

Cyproheptadine is a sedating antihistamine that works by competing with histamine for H1-receptor sites on cells in the gastrointestinal tract, blood vessels, and respiratory tract. It also has additional properties, including antimuscarinic (blocking acetylcholine effects), serotonin antagonist (blocking serotonin effects), and calcium channel blocking actions, which contribute to its various therapeutic and side effects.