μνλ‘ν΅νλ
μνλ‘ν΅νλμ κ°λ ₯ν νμΈλ‘ν λ νΉμ±μ μ§λ 1μΈλ ννμ€νλ―Όμ μ λλ€. μμνμμλ ννμ€νλ―Ό ν¨κ³Όλ³΄λ€λ μ£Όλ‘ νκ° μΈ(off-label) μμ©μ λͺ©μ μΌλ‘ μ¬μ©λ©λλ€. **μ£Όμ μμνμ μ©λ:** * **μμ μ΄μ§μ :** μμ¬μ μΌλ‘ κ³ μμ΄μ 1μ°¨ μμ μ΄μ§μ λ‘ μ¬μ©λμμΌλ, νλ μμμμλ μ£Όλ‘ λ―Έλ₯΄νμν(mirtazapine)μ΄λ μΉ΄νλ‘λͺ¨λ λ¦°(capromorelin)μΌλ‘ λ체λμμ΅λλ€. νμ§λ§ λ€λ₯Έ μ½λ¬Όμ μ¬μ©ν μ μκ±°λ κΈκΈ°μΈ κ²½μ° μ¬μ ν μ μ©ν λμμ λλ€. * **μΈλ‘ν λ μ¦νκ΅° ν΄λ μ :** κ°μ κ³ μμ΄μ μΈλ‘ν λ λ μ±(μ: μ¬λμ SSRI/SNRI νμ°μΈμ λλ 5-HTP μμμ μ€μ) μΉλ£μ μμ΄ **νμ€(gold standard)** 보쑰 μΉλ£μ μ λλ€. * **λ§λ₯ μν:** λ§μ κ΄μμ± ν€λ μμ΄νΉ(photic head shaking) κ΄λ¦¬ λ° λνμ체 μ€μ½ κΈ°λ₯ μ₯μ (PPID / λ§ μΏ μ±λ³)μ 2μ°¨ λλ 보쑰 μλ²μΌλ‘ μ¬μ©λ©λλ€(λ¨, PPIDμλ νλ₯΄κ³¨λ¦¬λκ° ν¨μ¬ μ°μν©λλ€). * **κ³ μμ΄ μ²μ λ° μμμ¦:** κ³ μμ΄μ νΈμ°κ΅¬μ± κΈ°λ μΌμ¦μ΄λ μλ λ₯΄κΈ°μ± νΌλΆ μ§νμ κ°νΉ μ¬μ©λμ§λ§, μμμ ν¨λ₯μ μ νμ μ λλ€. > **μμ ν:** μνλ‘ν΅νλμ κ°μμ λμ¬λκ³ μ μ₯μΌλ‘ λ°°μ€λλ―λ‘, λ§μ± μ μ₯ μ§ν(CKD)μ΄ μλ κ³ μμ΄μμλ μ©λ μ‘°μ μ΄ κΆμ₯λ©λλ€.
μμ© κΈ°μ : Cyproheptadine exhibits a multi-receptor antagonism profile: * **Serotonin (5-HT) Antagonism:** Competitively binds to **5-HT2A receptors** in the hypothalamus β blocks serotonin-induced satiety β stimulates appetite. In serotonin syndrome, blocking these receptors reverses life-threatening neuromuscular and autonomic hyperactivity. * **Histamine (H1) Antagonism:** Competes with histamine for **H1-receptors** on effector cells β prevents histamine-mediated capillary permeability, smooth muscle spasm, and pruritus. It does *not* prevent histamine release. * **Anticholinergic Activity:** Weakly antagonizes **muscarinic receptors** β leads to common side effects like dry mouth and urinary retention. * **Calcium Channel Blockade:** Exhibits mild calcium channel blocking properties, which may contribute to its efficacy in equine photic head shaking.
λλ¬Ό μ’ λ³ μ©λ
- As an appetite stimulant Β· 2-4 mg per cat Β· PO Β· once or twice daily
- As an appetite stimulant Β· 1-4 mg/cat, or 0.35-1 mg/kg Β· PO Β· once or twice a day
- As an appetite stimulant Β· 2 mg per cat Β· PO Β· q12h
- As an appetite stimulant Β· 0.35-1 mg/kg Β· PO Β· q12h Β· May be dosed less frequently if inappetence is mild.
- As an appetite stimulant in cats with renal insufficiency Β· 1 mg per cat Β· PO Β· q12h
- As an antihistamine/antipruritic Β· 2 mg per cat Β· PO Β· q12h
- As an antihistamine/antipruritic Β· 2 mg per cat or 1.1 mg/kg Β· PO Β· q12h
- For feline asthma Β· 2 mg Β· PO Β· q12h Β· Particularly when cats are maxed out on dosages of corticosteroids and terbutaline. Therapeutic response may not be seen for 4-7 days, but CNS depression can occur in 24 hours.
- For adjunctive treatment of serotonin syndrome Β· 2-4 mg (total dose) Β· PO Β· q4-6h Β· until signs have resolved Β· In cases where PO dosing not possible (severe vomiting), may crush tablets and mix with saline and give rectally.
- Management of allergic disease / Appetite stimulation / Aortic thromboembolism Β· 0.1-0.5 mg/kg Β· PO Β· q8-12h
ν¬μ¬ κ²½λ‘
κΈκΈ°
- Hypersensitivity to cyproheptadine
- Prostatic hypertrophy
- Bladder neck obstruction
- Severe cardiac failure
- Angle-closure glaucoma
- Pyeloduodenal obstruction
- Urinary retention (relative)
- Angle-closure glaucoma (relative)
- Pyloroduodenal obstruction (relative)
μ΄μλ°μ
- Sedation / CNS depression
- Paradoxical hyperexcitability or agitation (especially in cats)
- Anticholinergic effects (dry mucous membranes, urinary retention, tachycardia)
- Hemolytic anemia in cats (rare)
- Polyphagia (in dogs at higher doses)
- Mild depression, anorexia, or lethargy (in horses)
- Mild sedation
- Polyphagia
- Weight gain
- Reduced seizure threshold
μ½λ¬Ό μνΈμμ©
- CNS Depressants (barbiturates, tranquilizers, etc.) Β· Additive CNS depression
- SSRIs (sertraline, fluoxetine, paroxetine, etc.) Β· Cyproheptadine may decrease the efficacy of the SSRI due to its serotonin antagonist properties
λͺ¨λν°λ§
- Clinical efficacy (e.g., body weight if used for anorexia, resolution of neurologic signs if used for serotonin syndrome)
- Adverse effects (sedation, anticholinergic signs)
- Serum BUN/Creatinine in cats with long-term use
- Appetite and weight gain
- Resolution of allergic signs
- Neurological status (seizure activity)
κ³Όμ©λ
There are no specific antidotes available for cyproheptadine overdose. **Clinical Signs of Toxicity:** * Extensions of pharmacological effects: profound CNS depression (though paradoxical CNS stimulation/seizures may occur). * Severe anticholinergic effects: extreme drying of mucous membranes, tachycardia, urinary retention, hyperthermia. * Hypotension. **Management:** * **Decontamination:** Standard gut emptying protocols (emesis/activated charcoal) if caught early and patient is stable. * **Supportive Care:** IV fluids for hypotension, temperature regulation. * **Specific Interventions:** Physostigmine may be considered for life-threatening central anticholinergic effects. Diazepam should be employed to treat seizures if they occur. > *Note: Horses receiving 2x the recommended dose apparently showed no untoward effects.*
VetSheet μ½λ¬Ό λ νΌλ°μ€λ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μμ¬κ²°μ 보쑰 λꡬμ΄λ©°, μ λ¬Έμ νλ¨μ΄λ μ μ‘°μ¬μ μ΅μ λΌλ²¨μ λμ νμ§ μμ΅λλ€.