Indications: Perennial and seasonal allergic rhinitis and other allergic symptoms including urticaria

Cautions: used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction.also in elderly patients. Caution may be required in epilepsy. Children and the elderly are more susceptible to side effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe.

Contra-indications: Hypersensitivity to cyproheptadine or any component of the formulation. narrow-angle glaucoma. bladder neck obstruction. pyloroduodenal obstruction. symptomatic prostatic hyperplasia. stenosing peptic ulcer. concurrent use of MAO inhibitors. Use in debilitated elderly patients. use in premature and term newborns due to potential association with SIDS and in breast feeding.

Renal Impairment: No dosage adjustment provided in manufacturer’s labeling. However, elimination is diminished in renal insufficiency.

Hepatic Impairment: No dosage adjustment provided in manufacturer’s labeling.

Pregnancy: Most manufacturers of antihistamines advise avoiding their use during pregnancy, however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor.

Breast-feeding: Most antihistamines are present in breast milk in varying amounts; although not known to be harmful, most manufacturers advise avoiding their use in mothers who are breast-feeding.

Side Effects: Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines. more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.

Rare: of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.

Dose: Adult: 4 mg 3 times daily. usual range: 4–20 mg daily, max. 32 mg daily. CHILD 2–6 years 2 mg 2–3 times daily, max. 12 mg daily 7–14 years 4 mg 2–3 times daily, max. 16 mg daily