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Cyproheptadine may provide less costly treatment for pediatric gastrointestinal disorders
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According to a review published in Pediatric Annals, literature provides insight that cyproheptadine, a serotonin antagonist, is potentially effective and safe for the treatment of functional gastrointestinal disorders.
“[Functional gastrointestinal disorders (FGIDs)] affect a large number of children — up to 19% — in the Western world, cause negative impact on children’s quality of life, and increase the risk of depression,” Amornluck Krasaelap, MD, pediatric resident at Children’s Hospital of Michigan, and Shailender Madani, MD, assistant professor and pediatric gastroenterologist with the Carman and Ann Adams Department of Pediatrics at Wayne State University School of Medicine, wrote.
“It costs approximately $6,100 per patient for the initial gastroenterology consultation visit and an average of $18,000 per hospital stay. Cyproheptadine, a 5-HT receptor antagonist, is used off-label for several indications and is a potentially effective medication for FGIDs.”
The researchers reviewed literature concerning pathophysiology treatments for FGIDs, as well as recommended dosages and adverse effects of cyproheptadine. Although the benefits of the drug for functional dyspepsia are plausible considering a 5-HT3 receptor antagonist effectively treats symptoms, researchers note only two published retrospective studies regarding cyproheptadine, and it has not been formally studied in humans.
The drug is also known to provide pain relief for those with functional abdominal pain by hindering the calcium channel in intestinal muscles. However, minimal studies are available to corroborate this finding. The two available studies show positive results, one of which demonstrated 66% of patients had complete pain resolution.
The researchers also analyzed data concerning the drug’s use in treating abdominal migraine and irritable bowel syndrome (IBS). Although studies support cyproheptadine’s use in treating pediatric migraine headaches, data suggest that it could also be effective in treating abdominal migraine. One study showed a 72% response rate in children with abdominal migraine.
No studies have been conducted on humans regarding the direct efficacy of cyproheptadine use for IBS, but a recent study found that 10 children with IBS diagnoses were able to achieve complete resolution of symptoms with the drug. Additionally, a wide range of results (40%-83%) were seen in the effectiveness of cyproheptadine for treating cycling vomiting syndrome.
Reviewed studies demonstrate that dosages of cyproheptadine vary depending on the age of the child, and range from 2 mg up to three times daily for those between 2 and 6 years of age and 4 mg up to 3 times daily for those 15 years and older. The researchers noted that these dosages have not been supported by randomized clinical trials, although no major adverse effects have been noted in pediatric studies.
“[Cyproheptadine] can be prescribed in primary care and gastroenterology practices before resorting to expensive and invasive investigations in children if they meet the clinical criteria for FGIDs,” Krasaelap and Madani wrote. “Well-designed multicenter trials with long-term follow-up are needed to further investigate its efficacy in these children.” — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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