Cyproheptadine (Periactin) Interactions
- Amantadine
- Amoxapine
Antimuscarinics
Anxiolytics, Sedatives, and Hypnotics
Barbiturates
- Buprenorphine
- Butorphanol
- Clozapine
- Cyclobenzaprine
- Dextroamphetamine
- Disopyramide
- Dronabinol, THC
- Entacapone
- Ethanol
- Maprotiline
Monoamine oxidase inhibitors (MAOIs)
- Nabilone
- Nalbuphine
- Olanzapine
Opiate agonists
- Orphenadrine
- Pentazocine
Phenothiazines
- Pramipexole
- Pregabalin
- Ropinirole
Sedating H1-blockers
Selective serotonin reuptake inhibitors (SSRIs)
- Tolcapone
- Tramadol
Tricyclic antidepressants
- Venlafaxine
Cyproheptadine (Periactin) Interactions
The anticholinergic effects of cyproheptadine are moderate. The anticholinergic effects of cyproheptadine may be enhanced when combined with other drugs with antimuscarinic activity, including other sedating H1-blockers. Drugs with significant antimuscarinic effects include amantadine, amoxapine, antimuscarinics, clozapine, cyclobenzaprine, disopyramide, maprotiline, olanzapine, orphenadrine, most phenothiazines, and most tricyclic antidepressants. In addition to additive antimuscarinic effects, some medications mentioned may also have additive CNS depressant activity when combined with cyproheptadine.
Cyproheptadine use is specifically contraindicated during MAOI therapy (manufacturer recommendation). MAOIs may prolong and intensify the anticholinergic effects of antihistamines. Although the anticholinergic activity of MAOIs is minimal; anticholinergic effects sometimes occur. It is recommended that the concurrent use of MAOIs with drugs possessing anticholinergic activity be avoided, since the effects of other anticholinergic drugs are potentiated and may become severe. Most manufacturers recommend that sedating H1-antagonists not be used within 2 weeks of therapy with a MAOI.
CNS depression, manifested as drowsiness and/or dizziness, can occur during therapy with cyproheptadine. An enhanced CNS depressant effect may occur when cyproheptadine is combined with other CNS depressants including anxiolytics, sedatives, and hypnotics, barbiturates, buprenorphine butorphanol, dronabinol, THC, ethanol, entacapone, nabilone, nalbuphine, opiate agonists, pentazocine, pramipexole, pregabalin, ropinirole, tolcapone, or tramadol. In addition, concurrent use of cannabinoids with sedating H1-blockers may result in additive tachycardia, which may be pronounced.
Cyproheptadine is a serotonin and histamine antagonist. Cyproheptadine may interfere with serotonin-enhancing antidepressants, including the selective serotonin reuptake inhibitors (SSRIs) and drugs with similar activity, such as venlafaxine. Cyproheptadine has been used for the management of orgasm dysfunction caused by the SSRIs and for the adjunctive treatment of SSRI or venlafaxine overdose (i.e., serotonin syndrome) in emergency situations; however, a reversal of antidepressant effects may occur when cyproheptadine is given in a routine manner along with the SSRIs due to the serotonin antagonistic effects of cyproheptadine.
Dextroamphetamine and other amphetamines may pharmacodynamically counteract the sedative properties of some antihistamines, such as the sedating H1-blockers. If a patient is receiving an amphetamine for treatment of narcolepsy, the combination with a sedating antihistamine may reverse the action of the amphetamine.
[ Last revised: 6/21/2006 3:19:00 PM ]
References
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. Periactin® (cyproheptadine) package insert. West Point, PA: Merck and Company, Inc.; 1999 Jan.
. Hoffman BB, Lefkowitz RJ. Atropine, scopolamine, and related antimuscarinic drugs. Gilman AG, Rall TW, Nies AS, Taylor P, (eds.) In: Goodman and Gilman’s Pharmacological Basis of Therapeutics. 8th ed., New York, Pergamon Press. 1990. 150 - 61.
. Seixas FA. Alcohol and its drug interactions. Ann Intern Med 1975;83:86 - 92.
. Hoffman BB, Lefkowitz RJ. Monoamine oxidase (MAO) inhibitors. Gilman AG, Rall TW, Nies AS, Taylor P, (eds.) In: Goodman and Gilman’s Pharmacological Basis of Therapeutics. 8th ed., New York, Pergamon Press. 1990. 416 - 17.
. Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs. 2005;65:111 - 8.
. Cesamet™ (nabilone) package insert. Costa Mesa, CA: Valeant Pharmaceuticals International; 2006 May.
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