News
Evidence to support the use of Periactin (cyproheptadine hydrochloride) to stimulate appetite
We found a number of sources that discuss the use of cyproheptadine in stimulating the appetite. Clinical Evidence, in their chapter on anorexia nervosa [1] states that cyproheptadine has ‘unknown effectiveness’, stating: “Two RCTs in inpatient settings provided insufficient evidence to assess cyproheptadine in people with anorexia nervosa”
A 2004 Australian and New Zealand guideline on anorexia nervosa also discuss cyproheptadine, stating: “When cyproheptadine, a serotonin and histamine antagonist, was compared with amitriptyline and placebo, both treatment groups reached target weights an average 10 days earlier than placebo. (Patients were offered food and controlled the amount consumed and were required to meet minimal levels of weight gain to remain in the study). Cyproheptadine, with vitamins, increased weight gain compared to placebo, but produced hypersomnia in 60% of participants (as well as stomatitis). Three other studies offer limited support for a role for cyproheptadine.”
Making the following recommendation: “Evidence for antidepressant and antipsychotic efficacy is insufficient. However, the consensus is that antidepressants have a role in patients with marked depressive symptoms and olanzapine helps to attenuate hyperactivity. Cyproheptadine, zinc supplements, lithium and naltrexone warrant further study.”
PRODIGY, in their guideline on eating disorders, lists cyproheptadine amongts: “Drugs that have been studied have not shown any significant benefit in terms of weight gain, relapse of clinical deterioration, acceptability, or tolerability.
A 2002 review in Evidence-Based Nursing looked at a variety of interventions to improve appetite in cancer patients, reporting: “1 placebo controlled trial (n=295) found that cytoheptadine resulted in small increases in appetite, food intake, and sedative effects.”
A search on medline found a number of primary research articles (which we have not appraised for bias). A 2004 paper examined the use of cyproheptadine in stimulating appetite in people with cystic fibrosis [5]. In this small study Subjects in the cyproheptadine (CH) group showed significant increases in weight (mean 3.45 kg vs. 1.1 kg in the placebo group). The authors concluded: “CH appears to be an effective appetite stimulant with minimal side effects in children and adults with CF”
A 1992 paper looked at patients with HIV, the abstract reporting: “Two appetite stimulants, megestrol acetate and cyproheptadine were administered in a randomized trial to 14 patients who had no evidence of opportunistic infection or malabsorption but were wasted (had lost more than 5 kg body weight) as a result of human immunodeficiency virus (HIV) infection. Energy intakes were calculated from a 7 day weighed dietary record. Mean energy intakes per kilogramme body weight were similar in both treatment groups (greater than 34 kcal/kg) and were higher than that in well British males. Energy intakes increased by just over 500 kcal during both treatments, but fell to pretreatment levels after therapy. Patients in both treatment groups gained a moderate amount of weight. Megestrol acetate was associated with impotence in 4 patients. Insufficient calorie intake alone is not a common cause of wasting associated with HIV and the role of appetite stimulants is likely to be limited.”