Question: I was searching your site for more information about the use of cyproheptadine as an appetite stimulant. I recently had an evaluation with a kiddo who is taking this twice a day to increase appetite but mom doesn’t think it has helped much. Wondering what your team does for dosage? I have had some experience working with periactin and I remember that it was usually best to be on it for a period and then off again. Does cyproheptadine work the same way?
Answer:
Cypropheptadine (or periactin) is an antihistamine (similar to benadryl), which frequently has the side effects of increase in hunger. Typically this medication is used only after a child is very comfortable having no symptoms of reflux ( such as vomiting, gagging, choking), as well has constipation managed ( stooling 1-2 times per day pudding like stools). It is started to help jump start a child’s appetite. Often if a children’s GI symptoms are not medically managed there is not much benefit seen from the periactin.
The biggest side effects you see are sleepiness, and irritability. To help counteract this it is typically started once a day at bedtime. If the child does well with this after 3-7 days it is then increased up to twice per day. If the child is too sleepy, or irritable then it is reduced down to once per day. This medication typically works well for around 6-8 weeks and then the effectiveness wears off. For this reason it is often stopped x 3-4 days, and then restarted. At times to maintain effectiveness it is done 5 days on and 2 days off.
Victoria Powell RN, MSN, CPNP
Pediatric Gastroenterology Clinic
UNC Children’s Hospital
I have been wanting to post on the benefits of using an appetite stimulant (from the perspective of a feeding therapist) for some time now. I was reminded when I received this question from a reader.
Our feeding team uses many different medical management strategies to help kids feel more comfortable and eventually eat better. One of the the medicines we use is periactin to boost appetite. Tori explained how we use it but I will add that in addition to the hunger benefit, we feel it may also have a motility effect. We have some families report that their children have reduced vomiting while taking the medicine.
Like all medicines we use, it does not work for everyone, however, for some children we can see real benefit from it. Parents sometimes report that their children are asking for food for the first time or ask for more volume at meals. We combined the medical management (and nutritional) strategies with feeding therapy to get the best and most lasting effect. We also tend to see that over time as eating becomes easier, the children need this medicine less. They do not become dependent on it.
I specifically asked Tori not to provide dosing information here on the blog. If you have questions about periactin or are using it with your feeding patients please write in. If you are interested in trying it with your clients, talk with your medical team or referring physician about it.
I want to reiterate what Tori said above about making sure the child is comfortable from a GI perspective before adding the appetite stimulant. We have seen children that were given the periactin while still uncomfortable or were started on the medicine multiple times a day and became very sleepy. In both cases, parents were unhappy with the results.
However, if used correctly and the child responds it can have very positive outcomes. Typically, we start our feeding patients with gastroesophageal reflux and constipation management as well as nutritional management for caloric and nutrients needs and formula tolerance. A month later, at the second feeding team appointment is when, depending on symptoms, a child may be considered for a motility medicine or appetite stimulant. The time a child may take the periactin varies by case but most of kids use it for several months combined with feeding therapy. As eating becomes easier, and the dramatic effects of the medicine lessen, the periatin is cycled and then at some point stopped under the guidance of the GI nurse practitioners.
As a feeding therapist, I might also request a trial of periactin. Especially if I am working with a child who is having difficulty tolerating appropriate amounts of food, or who has poor hunger cues, or a long history of poor intake.
Case:
I am working with a patient now who has been struggling with intake. I have seen her a few times and have gotten her to eat 2-3 oz of puree in behavioral feeding therapy with frequent refusals and aversive behaviors. After periactin was started, the child came to therapy and I asked her Father if had noticed a difference. He said he had noticed a small difference and that she was asking to eat foods she used to eat and did seem to be eating bigger amounts. That day in therapy she accepted 10 ounces of puree easily! 2 flavors were familiar but she also accepted 2 oz of a totally new food without any refusals. I definitely saw a difference in this child. Now, we will build on this new acceptance to expand her diet and maintain age appropriate volumes of foods.
never heard of Cypropheptadine. am glad to know that it is an antihistamine (similar to benadryl), which frequently has the side effects of increase in hunger.should talk to my pediatrician on the same.thanks for sharing
My son has been on and off of this medication and it clearly has no effect on his appetite. He is severely underweight and has no natural appetite (quit self feeding at ten days and went on a feeding tube). What’s the next step?
Dawn, I know this comment is many years ago, but I was curious what you have done and what improvements you have had with your child. I would love to hear from you. My child is the same.
Thanks for the write-up, it’s allayed a few fears I had. I’d however like to know if it’s safe to use cyproheptadine for babies under 1.
Thanks for the write-up, it’s allayed a few fears I had. I’d however like to know if it’s safe to use cyproheptidine for babies under 1.
My daughter had a primary complex and was treated for 10 months. She’s turning 2 years old this August and weighs 9kgs. I tried lots of vitamins as prescribed by her pediatrician still didn’t work. On Monday we have a follow up check up and will ask this periactin to her pedia. But I think this med is not available here in our country (Philippines).
Is it safe in children 1year and 6month age?
My 6 year old just started Periactin twice daily. She’s underweight., a struggle for 5 years now though we did make good momentum upward between ages 3.5 and 5 but dropped back to 13 percentile. We had a lengthy discussion with the G.I. but I’m not for remembering or maybe understanding but we’re essentially using this along with Nexium twice today to see if it’s possible for her to gain the weight comfortably before jumping to scope her to look for something like EOE. Allergy, stool and thyroid labs were all normal as a toddler.
We’re only on day 3 of 2.5mg BID and I’m definitely not noticing an appetite change yet. I see “irritability” is mentioned above, would mood swings sound right st this age? She’s a very emotional child but overwhelmingly well-behaved and usually only has trouble coping with little things without an emotional outburst if she is overly tired which I don’t believe she has this week. The medication does not seem to make her sleepy in the waste however unless it is going today and then about 30 to 45 minutes after each does she have had a major breakdown of frustration over something very small. One time it was because it was 30° out and I made her wear a winter coat that she said made her look ugly then last night as another example is playing with make up before that and thought she made her eyebrows look ugly so she had a big meltdown. Two minutes later though she can be absolutely fine but then she got cold in the bathtub and was a mess crying to get out of the bath. So an emotional rollercoaster!! Does this sound typical of the drug or likely coincidence? Her G.I. doctor wanted to start with a smaller dose so doesn’t make her sleepy. Is this does too small to even be affective as it does not seem to be increasing appetite in fact she weighed last night had a half a pound less than the average she has been for the last three or four days. She hasn’t joyed seeing her progress in the last two months so she chooses to get on the scale most nightS.
And I realize as a pediatric nurse that this is all very complicated but I appreciate any insight. I definitely see with the pound and a half that she has gain since the end of September she looks healthier and I believe she needs to gain another pound or two but I also see her next to her peers and sometimes it is hard to believe all of the Pediatrician in G.I. doctors worries. I worry that she seems to need reflux medicine and I worry when she seems to eat less than the one-year-old me babysit but she is the youngest in her class by up to a year and is the same height as all the other children and even the same exact weight as a few of her good friends. She has a normal stool once every day and she sleeps well and is entering a gifted program. She has never had any swallowing issues ever outside of maybe a week this summer when she said it felt funny when she was swallowing but that resolved on its own. She also has no serious aversions by the definition that I know.
Update: this drug has its challenges ( like emotions at times!) but now we can do even just 3cc once daily or even every other day and she’s gained 6 pounds since September. Looks healthier and can wear clothing better! She’s on the growth chart again and our main concern was her vertical growth stopping from age 5-6. Now going on 7 she is as tall as her peers and almost a full year younger. She has grown like a weed since December. The behavior and emotional roller coaster weren’t an issue with small doses twice daily after a few weeks. It’s more now that I’ve drastically reduced the amount and frequency since her weight is currently small but healthy. Double edged sword.
But she’s FAR more willing to try foods and consumes drastically more when on the Med.
Hi
I am Zulay and i have been reading your page.
You see….I have a granddaughter that is 2 years old.
She has continually colds and even without having colds her apetite is gone.
I remember my sister was the same way. My mother gave her Periactin and it helped her.
This was ofcourse decades ago and when we were living in Venezuela.
We are now in Holland and the doctors here don”t believe in medicine and they”re not helping my granddaughter at all.
My daughter is broken and can’t stop crying.
The baby”s weight is 10kg that is more or less than 20 lbs and that is just too little for a girl of 2 years and 5 months old.
She has no sickness or vomid or diarrea….nothing like that.
Only colds. Teething and she just hates food.
Please help me.
I wanted to buy the periactin and give it too her myself.
But a little service first is better.
I really hope to hear from you soon.
My daughter is desparate.
Thank you
Zulay Romero
Wow. I’m so sorry. I’m not a doctor here but the psychology of feeding little ones is so strong I wonder if since you say she “hates food” she has actually created some aversions . We had great success with the Ellyn Satter DOR methods when my daughter was ages two until four. Our pediatrician and G.I. doctors as well as all of the nutritionist I work with all believe in her methods. When my same daughter got older though she just has a natural tendency towards liking healthier foods and junk food like potato chips but nothing in between. With her tiny appetite she stopped growing vertically and that’s when they got worried. Periactin was a rough start with a lot of emotional highs and lows and if we take the drug holidays where we stop at for a week every few weeks as recommended we have the emotions all over again so I just don’t stop . It has worked wonders for us though and she has put on almost 5 pounds in about five months. She legitimately eat a lot of garbage but the doctors say that calories are more important for her right now then even nutrition. But for example now instead of a tiny bowl of cereal she will eat two or three toaster strudels which give her 4 to 600 cal before school . Yes there is a lot of sugar in there as well but at this point everybody is just happy that she’s growing and when her stomach is stretched and used to eating the same amount of food as normal children then we will probably be able to go off of medication and even now we are getting more of those healthy foods and it’s just that they have no calories. The liquid coconut cooking oil that is flavorless and stays liquid at room temperature has been a godsend for us because I can mix 130 extra calories with just 1 tablespoon into a tiny bit of yogurt and she has no idea. Milkshakes do not work because she does not like them unless they are the ice cream type and Pediasure has too much protein so she gets too full and won’t eat anything else. .
Anywhere I feel for you because it is such a struggle and I wish her doctors would help you saying that you were willing to try anything but honestly I wonder if your next step should be to take her to a nutritionist that specializes in pediatrics and from there she could recommend whether she thinks a feeding therapy or appetite stimulant could be beneficial. The other thing to consider since you mentioned that she has chronic colds is could she have something like a sinus infection that is rendering her no taste ? Or could there be anything else going on that is making her have zero desire to eat ? Like will she eat garbage if she is allowed or does she not even want that ? Our beloved G.I. doctor literally prescribed our family a dinner or lunch at the local pizza buffet that my daughter states is her favorite restaurant once a week or more. It’s fantastic now on the Periactin to see her go to her favorite restaurant and eat an entire plate full of food . We were on vacation last week and a few days we even skip the dose of Periactin and she still ate well. She has more energy and she was happier when she has enough calories to carry through her day!
I wish you the best of luck and keep advocating for your granddaughter. I am a pediatric nurse and a mom and I know that children grow at all different rates and some are just small So long as they stay on their growth curve!! It’s when the growth stops that’s we worry.
what a wonderful reply, packed full of nuggets of great information and positive advice.
Thanks for sharing.
I work with kids on behavioral medications, and this is quite helpful, filled with practical advice and suggestions I will share with them.
My bother who had a stroke in February 2017. Stopped eating about two months ago, he says he doesn’t want to eat, has no taste for food.. He smokes constantly, has lost so much weigh. Do you think Cyproheptadine will help him?.?
My baby is a year old who has feeding disorder,
What should I do?
i am in hyderabad my child is 7 years old bus he is thin he was not eating food . weight is onl 14 kg please send me cyproheptadine syrup/powder name i search but hyderabad in not available . medical store
An awesome site for mothers
I had a twin boy and they really picky eater … they are 19 month now and only 20 lb. should I give them using this medicine ???
Using peritol for my 9months old who refused for feeds all of a sudden,still scared of its dependancy.please advise
Honestly I don’t want mine dependent on meds either so we used it to get her up to a somewhat healthier weight and interested in eating again and stopped daily use. I really hope your MD amd GI are involved as yours is very little and should have a good appetite naturally. Or st least the desire to eat even if little. Don’t be afraid to ask for help. These early years set up their earing attitudes for a long time. Ellen Satter DOR helped us a lot at age 4 then it didn’t when an allergic toddler and traveling spouse at the time changed our cooking and eating routines. Great books. Highly recommended by nutritionists and specialists.
Now we use periactin sporadically. Three milliliters (3cc) once daily or every other day or even less frequently when it seems we arent eating even like a bird. It makes a drastic difference for us. She is slightly more willing to try things as well. A child who quits eating altogether or has no interest in eating beyond an illness in my book needs an MD or GI appointment asap, but you have already been for the problem. Our GI used a PPI and periactin as a little test before going a scope. His thought was if she starts eating more, it’s likely a hunger ( lack of) problem over a disorder like EOE. Then I did a lot of high calorie foods -some were awful like Cheetos , weekly pizza buffet, coconut cooking oil in everything and toaster strudels. She stopped growing so MD, GI, and nutrition said to get her eating first and calories in and work on nutrition later. We needed it, might not be for everyone.
Good luck with your sweet one!!! It’s so hard !
I have been taking periactin for about two weeks now, I am 17 and have struggled with appetite issues for years. This is the only thing that gives me motive to eat but on days I don’t take it I again don’t want to eat. Does this mean I will only get the appetite benefits while on it? I have finally gained some weight and don’t want to continue gaining weight if I’m going to lose it all again as soon as I’m dome taking it
My child does not have appetite for food and drinks.
I was given toractin tablets to administer, she improved slightly but if i do not give her the medicine she does not want to eat, what should i do?
My child does not have appetite we struggle when it is meal time, as a result her wait has droped and also her stool is always hard as she is constipated all the time. Can you advice me with anything that i can use because it is worrying me.
Need help my son doesn’t eat all day. N I don’t know what to do. His school says he doesn’t eat his lunch. Only drinks juice. His doctor said if I could find a prescription she will write it for him.
Hi thank you for the information
My son is four month old and been refusing the Fedd when awake he just cries n cries but won’t take a sip or latch on , once we put him to sleep he will take the bottle just fine
So my feeding therapist told it’s purely behavioral so try to wait till he gets super hungry n give him bottle still no luck with day two do u think we are doing the right thing or should we continue dream feed
Whenever gets hungry he cries n cries n we had to put him to sleep then he takes the bottle that’s with every feed
Please she’d some light for me on this! Thanks
I had the same issue and I started dream feeding and feeding with distraction when awake. Now he is 15 months old and If I dont feed him with distraction, he is happy without food for hours even for an entire day. We may do endoscopy soon. He has reflux and is on nexium once daily. If I have to guess, I think he had reflux, severe one, since birth which went unnoticed by his ped even though I gave her some of the classic symptoms of silent reflux. By the time he was diagnosed and treated for reflux, think he already had aversion towards milk and no matter how much I tried I was not able to get him to drink milk willingly..My point is, don’t dreamfeed your baby. Don;’t distract him. He should drink milk willingly and if he does not he may have some GI issue and you need to work on that. Dream feeding may work now but it won’t in a few months. Trust me. What I am going through now, i won’t even wish it on my enemy.
Going through same. I am dreamfeedjng my 16 mon old since she was 3 mon old. She has severe reflux since birth. I am sure it is with reflux or GI issues for ur kid too
Am 25 of age 46kg(weight)can cyproheptadine help me in gaining weight
My child’s been having constipation problems for over a year now. She is 3. All her blood work and x-rays have came back fine. She eats & snacks all the time. The only time she doesn’t really eat is when she’s been constipated and her tummy is hard as a rock. But she will keep drinking her liquids. We just recently saw a GI doctor who put her on this medication. She did lose 2 pounds since her last check up. Is 5ML to much to be taking at bedtime?? Seems like a lot to take for a 34 pound child. Plus will this medicine even help her with constipation ? She was taking miralax for several months once a day but I’m starting to wean her off of that now. What do you think about all this? Thank you so much – Sara
This was given to my elderly husband as appetite stimulant.4mg at bedtime.taken 1 wk no difference.has been dizzy but was 12 hrs after intake,dont think connected.seems like a low dose
Hello, my daughter is 2 years old she never accepted formula or milk she is struggling to eat and the doctors here in Toronto have been no help to us. I’m desperate what can I do ?
Julianna, Have you figured anything out yet with your daughter? Has she had feeding issues since birth?
Hi
Thank you for useful information
I have a daughter. She’s 27 months old. She’s underweight(10 kilogram).from the first, she had low appetite. But,from 6 mounts ago when she was 18 mounts old,her appetite became very very low and her father and me was fullstress. I consalt with her doctor to started drug and he described racip for one month. Her appetite became good and she ate more amount food. But then doctor discontinued it and again her appetite dropped. We(her father and me) started racip again without get permit from dr.
I think he can’t understand our situation.
Now I give racip her 3-4times in week and has positive effect. She has normal appetite now.
Doctor said we should discontinue it suddenly for one mount and again start (one month give racip and one month off)but after off my duagher become nervous and don’t eat any food.
Please help me and give me the best way for use ciproheptadin for my kid
Thanks so mush
I need this for my baby aged 1year 7
Hi
Thanks for useful information. I have a daughter. She’s 28 mounths old.Now her weight is 10 kilogram and her height is 86 cm. (based last data from 2 month’s ago).
Her doctor prescribed cyproheptadine for her almost 6 months ago and after 1 month, discontinued it.But her appetite dropped again as we(Her father and me)became very tired and started cyproheptadine for her without doctor’s permission.
Now we have stress about this drug because when we stopped it,her appetite decreased and don’t eat anything.
Please help us.
Thanks
Please what mg of cyproheptadine should be used on a baby of 9 months old, thanks.
Good,my toddler has lost appetite,no temperature,
Can I give the appetizer
Hello,
My son has been on and off this medicine since he was about 7 months old. He is currently 13 months. Al thought the medicine is working I worry about side effects. I brought this up to his GI who assure me this is safe like Benedryl. Seeking a second opinion here. I care to know what your thoughts are. Hope to hear from you soon. Thanks in advance!
Hi, my daughter is 2yrs, 7mnths old and doesn’t eat much n when she tries to she’s picky. Doctors keep saying to leave her be bcos since birth she’s never declined in weight. She’s schooling now n won’t eat in school n when her teacher makes her eat she vomits it out. Should I give her a booster n if yes pls recommend
Can I give my 7 months old baby cyprivit
My child GI gave him this medicine, because he wasn’t drinking at all. 1 oz here and there. We started this medicine 1 month ago. Now he is 9.5 months. I saw a huge difference immediately but he is back again to 2 oz in 2.5 hrs. And nothing overnight. He does not want to eat solid either. 1-2 spoon after so much distraction. What should I do. He had lip and tongue tie released a week after his medicine was started. He was doing well but he suddenly stopped drinking again. Please help!
In the fifties, my doctor gave me this tool to pick up my appetite. It did work, does this change anything in the brain? Ever since then I have struggled with my weight my whole life. I think it would be beneficial to do a study. I’d be interested in knowing if any other person has had the same experience.
I wonder if you were ever tested for why you needed to increase your appetite? This medication definitely increased my sons appetite dramatically. After looking into side effects and different things that is not one of the side effects. However, we are testing to determine the cause of his decreased appetite because he never had it before like this. Something is going on and we have to figure it out. We have done medical testing and they said everything was normal and there’s nothing else they can do. His G.I. doc put him on this and it helped a lot but it is starting to not help anymore. We are getting testing done this week from a functional medicine standpoint . They are looking into pandas. It actually changes something in the brain to cause the decreased appetite. I am actually hoping it is something simple because no one seems to know what to do with him
My son was put on this medication recently. He is 17 years old. It was doing wonderfully and he was able to eat and not gag but he refused to take breaks on it. His doctor never suggested taking breaks. I just heard that from other speech therapist since I am a therapist as well. I work with adults though. He is starting to have more difficulties and is finding that it is working as much I am assuming because he refused to take any breaks in about six months. Will the appetite increase again and the symptoms that were subsiding on the med go away again if he takes a break from it for about a week or do you know? He is getting ready to go in to be tested for pans or pandas this week. However I would really like something to help him while he is struggling until we figure out what the problem is. Thanks
My son is 12 and has suffered from no appetite and extremely underweight. We’ve been on this medicine and it does work, only when my son’s GI is under control. He takes famotidine and with his stomach being happy we are definitely noticing the periactin working.