Cyproheptadine for dyspepsia

A retrospective open-label study has shown that cyproheptadine can be effective for children with dyspeptic symptoms (J Pediatr 2013; 163: 261-7) –thanks to Mike Hart for suggesting this reference.

Methods: In this study, 80 children (65% female) received cyproheptadine for refractory upper gastrointestinal symptoms, including nausea, early satiety, vomiting, retching after fundoplication, and abdominal pain.  The median age was 9.8 years; 48 children were <12 years.  The median dose was 0.19 mg/kg/day and median duration of treatment was 20 weeks.  All patients had undergone upper endoscopy with biopsy.  Gastric emptying studies were undertaken in 52 patients and antroduodenal manometry in 23 patients.


  • 33 (41%) had a significant response and symptoms resolved in 11 (14%); thus, 55% in total had improvement
  • In those without response, gastrojejunostomy/jejunostomy was placed in 7 patients, and botulinum toxin intrapyloric injection was undertaken in 3 patients
  • Better responses were more common in children <12 years and in females (P=0.04 and 0.03 respectively)
  • Early vomiting after eating and retching after fundoplication responded more favorably than other symptoms
  • Side effects: somnolence (16%), irritable/behavior change (6%), weight gain (5%)

How does cyproheptadine work? While this is not known, the authors speculate that the antiserotonin effects may improve gastric accommodation.

Take-home message: Cyproheptadine may help dyspeptic symptoms, especially in children <12 years and in those with vomiting and retching after fundoplication.  A prospective study would be helpful too.

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