OBJECTIVE: Neuroleptic Induced Akathisia(NIA) often occurs in neuroleptic treated patients. Cyproheptadine, an antiserotonergic agent, was used to treat neuroleptic induced akathisia. METHOD: In an open trial 21 neuroleptic-treated patients with akathisia were administrated Cyproheptadine(16mg/day) over 4 days. Assessment of akathisia was evaluated using Barnes' rating scale(BAS) for neuroleptic induced akathisia. The degree of depression and psychosis were assessed by brief psychiatric rating scale(BFRS) and Hamilton rating scale for depression(HAM-D). RESULT: Most patients(20 of 21) with neuroleptic induced akathisia(NIA) showed improvement under the treatment of cyproheptadine. There was no aggravation of psychosis or depression during the treatment. Symptoms of akathisia aggravated when cyproheptadine was discontinued. CONCLUSION: Cyproheptadine may be useful in the treatment of neuroleptic induced akathisia(NIA).
Cyproheptadine* ; Depression ; Humans ; Psychomotor Agitation* ; Psychotic Disorders

This study is an attempt to investigate the effect of total Ginseng saponin (GTS) on the blood pressure of the rat and to elucidate its mechanism of action. GTS, when injeced into a femoral vein of the rat, caused dose-related fall in blood pressure with secondarily elevation of the blood pressure. The depressor effect of GTS was blocked by treatment of atropine and prazosin, but not affected by pretreatment with chlorisondamine or cyproheptadine. GTS inhibited significantly the pressor response evoked by norepinephrine. The pressor effect of GTS was not affected by treatment with atropine or cyproheptadine, but was attenuated markedly by pretreatment with chlorisondamine. From the above mentioned results, it is thought that GTS produces the pressor and the depressor actions in the rat, and that its depressor response is exerted partly through the stimulation of cholinergic muscaric receptors with the blockade of adrenergic alpha-receptors, and that its pressor response is revealed by stimulation of nicotinic receptors in autonomic ganglia.
Animals ; Atropine ; Blood Pressure* ; Chlorisondamine ; Cyproheptadine ; Femoral Vein ; Ganglia, Autonomic ; Norepinephrine ; Panax* ; Prazosin ; Rats* ; Receptors, Adrenergic, alpha ; Receptors, Nicotinic ; Saponins*

A case of urticaria pigmentosa, the first case of nodulo-bullous variety in Korea, is herein, described. A 4-mo#nth old female baby was brought: to our hospital by her mother with the presenting signs of darkish brown infiltrated macules and nodules scattered on the trunk, neck, and extremities. The first lesion was noticed by her mother as a pea sized flat macule of pinkish brown, which was seated on the right shin at birth For the period of 4 months, it has developed into multiple similar macules on the above mentioned areas, and most of them became gradually to the nodules with lichenoid surface, She also experienced frequent bullae on them and occasional facial flushing without any specific cause. A strong stroke, performed on the nodule, produced a severe whea1ing reaction followed by marked erythema around it. and facial flushing ensued, The histologic findings of the nodule revealed massive infiltration of cuboidal cells throughout the entire dermis which proved to be mast cells on toluidine blue staining. Oral administration of the reserpine and periactin proved to be effective in this case.
Administration, Oral ; Cyproheptadine ; Dermis ; Erythema ; Extremities ; Female ; Flushing ; Humans ; Korea ; Mast Cells ; Mothers ; Neck ; Parturition ; Peas ; Reserpine ; Stroke ; Tolonium Chloride ; Urticaria Pigmentosa* ; Urticaria*

OBJECTIVETo search for an effective therapy for cold erythema multiforme in ham.

METHODSOne hundred and eighty cases with cold erythema multiforme in ham were randomly divided into a Santong group (n=90) and a western medicine group (n=90). The Santong group was treated by He's Santong needling methods and Huantiao (GB 30), Fengshi (GB 31), Zusanli (ST 36), etc. were selected. The western medicine group was treated by oral administration of Cinnarizine, Cyproheptadine and Vitamin E. Two weeks later, their therapeutic effects were observed.

RESULTSThe cured rate was 68.9% and the recurrence rate was 11.3% in the Santong group, and 33.3% and 53.3% in the western medicine group, with significant differences in the cured rate and the recurrence rate between the two groups (both P<0.01).

CONCLUSIONHe's Santong needling methods can increase the cured rate and reduce the recurrence rate of cold erythema multiforme in ham.

Acupuncture Therapy ; Adolescent ; Adult ; Cinnarizine ; therapeutic use ; Cyproheptadine ; therapeutic use ; Erythema Multiforme ; drug therapy ; therapy ; Female ; Histamine H1 Antagonists ; therapeutic use ; Humans ; Male ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the antagonistic effect and mechanism of the effect of cyproheptadine (Cyp) on endotoxic shock in rats.

METHODSEndotoxic shock was produced in rats by i.v. injection of lipopolysaccharides (LPS) (5 mg/kg). Tumor necrosis factor (TNF(alpha)) mRNA expression was assessed by Northern blot. Plasma TNF(alpha) content was measured by radioimmunoassay. Plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were measured. The intracellular free calcium concentration ([Ca(2+)](i)) in single endothelial cells was determined by laser scanning confocal microscopy (LSCM).

RESULTSCyp 5 mg/kg injected immediately after i.v. LPS raised the mean arterial blood pressure (MABP) of shocked rats and improved their 24 h survival rate. Meanwhile, Cyp markedly decreased TNF(alpha) mRNA levels in rat liver (18 +/- 10 vs. LPS + saline 38 +/- 10, P < 0.01) as well as plasma TNF(alpha) content [(7.8 +/- 2.4) microg/L vs. LPS + saline (21.5 +/- 3.2) microg/L, P < 0.01)]. It enhanced plasma SOD activity [(1037.2 +/- 112.8) NU/L vs LPS + saline (615.4 +/- 92.6) NU/L, P < 0.01], reduced the MDA content [(5.2 +/- 1.1) micromol/L vs. LPS + saline (9.8 +/- 1.5) micromol/L, P < 0.01], and inhibited TNF(alpha)-induced [Ca(2+)](i) elevation.

CONCLUSIONCyp exerts an anti-endotoxic shock effect by inhibiting TNF(alpha) gene expression, enhancing SOD activity, reducing lipid peroxidation, and preventing [Ca(2+)](i) overload.

Animals ; Cyproheptadine ; pharmacology ; Histamine H1 Antagonists ; pharmacology ; Malondialdehyde ; blood ; Rats ; Rats, Wistar ; Shock, Septic ; drug therapy ; metabolism ; Superoxide Dismutase ; blood ; Tumor Necrosis Factor-alpha ; biosynthesis ; genetics

Effects of serotonin (5-HT) on spontaneous discharges of single hypothalamic arcuate neurons were observed in rat brain slices by extracellular recordings. The results showed that (1) of 149 neurons selected randomly and tested for 5-HT application, 33 (22.2%) were excited, 82 (55.0%) were inhibited, and 34 (22.8%) showed biphasic responses or failed to respond; (2) substitution of low Ca(2+)-high Mg(2+) artificial cerebrospinal fluid (aCSF) for normal aCSF abolished the 5-HT-induced inhibitory effect but failed to affect the 5-HT-induced excitatory effect; (3) cyproheptadine, a non-selective 5-HT receptor antagonist, could block either the 5-HT-induced excitatory or inhibitory effects in all neurons tested; and (4) bicuculline, a GABA(A)-receptor antagonist, blocked the 5-HT-induced inhibitory effect. These results imply (1) 5-HT excites arcuate neurons through a mechanism that is insensitive to the decreased extracellular Ca(2+), suggesting a direct postsynaptic action of 5-HT on the 5-HT-receptors located in the membrane of the neurons recorded; and (2) 5-HT might elicit the inhibitory effect through a Ca(2+)-sensitive release of GABA from intercalated GABAergic local neurons that are excited first by 5-HT.
Animals ; Arcuate Nucleus of Hypothalamus ; drug effects ; physiology ; Cyproheptadine ; pharmacology ; In Vitro Techniques ; Neurons ; drug effects ; physiology ; Rats ; Rats, Wistar ; Serotonin ; pharmacology ; gamma-Aminobutyric Acid ; physiology

Anorexia is one of the most common issues in older patients. Although there is a tendency for loss of appetite in older persons due to decreased physical activity and reduced resting metabolic rate, this physiological anorexia of aging can easily develop into progressive anorexia and weight loss. This pathologic anorexia and resultant weight loss is associated with increased morbidity and mortality, especially in the frail elderly. To prevent older persons from entering a vicious cycle of frailty, that is, anorexia-malnutrition-sarcopenia-functional impairment, routine screening for anorexia and malnutrition should be implemented in geriatric clinical practice. All anorexic elderly patients should be strongly encouraged to maintain their nutrition, and appetite stimulants can be considered if non-pharmacological interventions are not effective. Although there are no US or Korea Food and Drug Administration approved medications for geriatric-specific anorexia and weight loss, several appetite stimulants can be prescribed and are used widely. Megestrol acetate is the most widely studied and commonly used of these drugs. Cyproheptadine, dronabinol, mirtazapine, corticosteroids, anabolic steroids (e.g., testosterone or oxandrolone), and growth hormone are also effective in increasing appetite or weight. However, the use of these orexigenic agents should occur only after their benefit-to-risk ratio has been carefully considered.
Adrenal Cortex Hormones ; Aged ; Aging ; Anorexia ; Appetite Stimulants* ; Appetite* ; Cyproheptadine ; Diethylpropion ; Dronabinol ; Frail Elderly ; Growth Hormone ; Humans ; Korea ; Malnutrition ; Mass Screening ; Megestrol Acetate ; Mortality ; Motor Activity ; Steroids ; Testosterone ; United States Food and Drug Administration ; Weight Loss

Cancer-related anorexia-cachexia syndrome (CACS) is a hypercatabolic state, characterized by reduced appetite and weight loss due to ongoing loss of skeletal muscle mass and adipose tissue. CACS occurs mainly in patients with advanced cancer; thus, weight loss in CACS is often associated with poor prognosis and decreased survival. A large number of studies have been conducted on various pharmacologic agents for palliation of cancer-related anorexia. The purpose of this article is to review the pre-existing pharmacologic agents used for CACS and to evaluate the evidence from current studies on each pharmacologic agent. First, appetite stimulants such as corticosteroids, progestins, cyproheptadine, and cannabinoid have been shown to be beneficial by improving appetite and helping with weight changes even if they had no effect on survival rate. Several other agents with anti-inflammatory effects (e.g., eicosapentaenoic acid, thalidomide, and melatonin), prokinetic agents (e.g., metoclopramide), anabolic agents (e.g., androgens and growth hormone), antipsychotics (e.g., mirtazapine and olanzapine), and antiemetics have also been studied in patients in CACS; however further investigations would be required to confirm the beneficial effects.
Adipose Tissue ; Adrenal Cortex Hormones ; Anabolic Agents ; Androgens ; Anorexia ; Antiemetics ; Antipsychotic Agents ; Appetite ; Appetite Stimulants ; Cachexia ; Cyproheptadine ; Eicosapentaenoic Acid ; Glucocorticoids ; Humans ; Muscle, Skeletal ; Progestins ; Prognosis ; Survival Rate ; Thalidomide ; Weight Loss

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.
Amitriptyline ; Benzodiazepines ; Brain ; Child ; Clonidine ; Cyproheptadine ; Dehydration ; Endoscopy, Gastrointestinal ; Hematemesis ; Humans ; Irritable Bowel Syndrome ; Magnetic Resonance Imaging ; Migraine Disorders ; Mortality ; Mothers ; Mucous Membrane ; Ondansetron ; Propranolol ; Sumatriptan ; Sympathetic Nervous System ; Vomiting*

A 54-year-old male patient who was suffering from bipolar I disorder for 19 years and was admitted to the National Bugok Mental Hospital due to a depressive episode, was referred to the Kosin University Gospel Hospital. On arrival at the emergency room, he had confused mentality with disorientation, memory impairment, hypomania, marked anxiety and hyperirritability. The change of neuromuscular activity such as ataxia, gait disturbance, tremor, shivering, myoclonus and epileptic seizures was also shown. In addition, the symptoms and signs of autonomic instability including diaphoresis, tachycardia, hypotension, fever and facial flushing were noticed. The above symptoms developed after the administration of sertraline successive to the discontinuation of fluoxetine without any washout period. The degree of severity seemed to be severe because he had epileptic seizures, fever and hypotension. He was recovered from the severe serotonin syndrome by the supportive symptomatic treatment with sodium valproate, clonazepam, lorazepam and cyproheptadine after cessation of the selective serotonin reuptake inhibitors during hospitalization. Therefore, this rare case of severe serotonin syndrome was reported and related literatures were also reviewed.
Anxiety ; Clonazepam ; Cyproheptadine ; Emergency Service, Hospital ; Epilepsy ; Fever ; Fluoxetine* ; Flushing ; Gait Ataxia ; Hospitalization ; Hospitals, Psychiatric ; Humans ; Hypotension ; Lorazepam ; Male ; Memory ; Middle Aged ; Myoclonus ; Serotonin Syndrome* ; Serotonin Uptake Inhibitors ; Serotonin* ; Sertraline* ; Shivering ; Tachycardia ; Tremor ; Valproic Acid