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?
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.
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.