INTRODUCTION

CYP L is a combination of Cyproheptadine and Tricholine Citrate which belongs to the group of medicines called Antihistamines and Bile acid-binding agents respectively. It is indicated for loss of appetite, weight loss and anorexia nervosa (eating disorder). It is used as an adjunct to anti-tubercular and antiretroviral regimens for weight gain.

It is also used to treat allergic rhinitis (allergic reaction that causes sneezing, congestion, itchy nose and sore throat), conjunctivitis (inflammation or infection of the conjunctiva), migraine (recurrent throbbing headache that typically affects one side of the head), asthma (airways become inflamed, narrow and swell and produce extra mucus and it causes breathing difficulty) and hepatic disorders. In children, it is indicated to gain weight who have an inadequate dietary intake or loss of appetite and who suffer from anemia, liver or digestive disorder.

CYP L is not recommended for use in patients who have or had angle-closure glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy (enlarged prostate), bladder neck obstruction, and pyloroduodenal obstruction. Avoid consumption of alcohol during treatment with CYP L, as it may increase the risk of stomach problems. Before taking CYP L, inform your doctor if you have a history of bronchial asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease, liver or kidney problems and high blood pressure.

CYP L is not recommended for use in pregnant and breastfeeding women. It is recommended for use in children and adolescents (below 18 years of age) after doctor’s advice. The most common side effects of taking CYP L are drowsiness, dizziness, insomnia, blurred vision, loss of coordination, skin rash, gastrointestinal upset, nausea, or vomiting. Consult your doctor if any of the symptom worsens.

USES OF CYP L

Treats following conditions:

• loss of appetite
• weight loss
• anorexia nervosa (eating disorder)
• migraine
• allergic rhinitis and conjunctivitis
• asthma
• hepatic disorders
• used as an adjunct to anti-tubercular and antiretroviral regimens to gain weight
• to gain weight in children (due to inadequate dietary intake or loss of appetite, and also in children suffering from anemia, liver, or digestive disorder)

HOW CYP L WORKS

CYP L contains cyproheptadine and tricholine citrate, where cyproheptadine works by reducing the effect of serotonin (a chemical messenger) in the hypothalamus which helps in regulating appetite thereby preventing weight loss and tricholine citrate is a bile acid-binding agent that works by removing the bile acids from the body and liver uses cholesterol to produce more bile acids resulting in decreased cholesterol level in the body.

DIRECTIONS FOR USE

Take CYP L as advised by your physician. Shake well before use. Your physician will decide the correct dose and duration for you depending upon your age, body weight and disease condition.

SIDE EFFECTS OF CYP L

HOW TO MANAGE SIDE EFFECTS

Dizziness:

Try to rest and get enough sleep. Try to avoid driving or operating any tools or machines while you feel dizzy. Limit consumption of alcohol, as it can aggravate dizziness. Consult your doctor if the symptom gets worse.
Nausea or vomiting:

Take this medicine with, or just after meals. Stick to simple meals. Avoid eating oily, fried or spicy foods. Do not perform strenuous activities or lie down or sleep immediately after eating. Consult your doctor if the symptom does not improve.

Constipation:

Take fiber rich foods in your diet such as fresh fruits, vegetables and whole grain cereals, and drink plenty of fluids. Exercise more regularly and stay active (going for daily walk or run). Consult your doctor if the symptom does not improve.

Dry mouth:

Sip water regularly and other sugar free liquids. Do not use mouthwashes that contain alcohol because they can make your mouth dry, use mouthwash that is used only for dry mouth. Limit your caffeine intake. Avoid smoking or using tobacco products. Consult your doctor if the symptom does not improve.

WARNING & PRECAUTIONS

INTERACTIONS

A. Drug-Drug interactions:

Before taking CYP L, inform your doctor, if you are taking any of the following medicines:

• monoamine oxidase inhibitors (MAOIs) such as phenelzine, selegiline (used to treat depression)
• hypnotics (Ex. quazepam), sedatives (Ex. barbiturates such as phenobarbital) and tranquilizers (Ex. diazepam) (used to treat insomnia)
• antianxiety agents (Ex. alprazolam and chlordiazepoxide) (used to treat anxiety)

Overdosage:

If you or anyone else accidentally take too much of CYP L, consult your physician immediately or visit the nearby hospital. Symptoms of overdosage are hallucinations, depression and fits.

SYNOPSIS

MORE INFORMATION

• Keep CYP L out of reach of children
• Store at room temperature

FAQs ABOUT CYP L

Can I consume alcohol during treatment with CYP L?

Avoid consuming alcohol while taking CYP L as it has additive effects and may increase the risk of stomach problems. Consult your doctor for advice before taking CYP L.

Does CYP L cause dry mouth?

Yes, CYP L may cause dry mouth in some individuals. To manage this effect, try to sip water regularly and other sugar free liquids. Do not use mouthwashes that contain alcohol because they can make your mouth dry, use mouthwash that is used only for dry mouth. Limit your caffeine intake. Avoid smoking or using tobacco products. Consult your doctor if the symptom does not improve or gets worse.

Is CYP L safe to use in children?

CYP L can be given to children and adolescents (below 18 years of age) only if prescribed by the doctor. The dose may vary based on the child’s age, body weight and disease condition.

Can I take CYP L along with antidepressants?

No, CYP L should not be taken along with antidepressants especially with monoamine oxidase inhibitors (MAOIs) (such as phenelzine, selegiline) because it may prolong and increase the effects of CYP L. Consult your doctor before taking CYP L with any other medicines to avoid unwanted effects.

Can I drive after taking CYP L?

Avoid driving and operating any machines after taking CYP L because it may cause drowsiness and dizziness. Patients should be warned about engaging in activities requiring mental alertness and motor coordination. Consult your doctor for advice before taking CYP L.

REFERENCES

1. KD. Tripathi. 5-Hydroxytryptamine, its Antagonists and Drug Therapy of Migraine. Essentials of medical pharmacology. Seventh edition. 2013. Page – 174.

2. Randal A. Skidgel. Histamine, Bradykinin, and Their Antagonists. Goodman & Gilman’s The Pharmacological basics of Therapeutics. 13th Edition. New York McGraw Hill Medical 2018. Page – 711-726.

3. Mayuresh Dilip Kiran, Shaheen Naseem Sheikh, Lalit Jeevan Pawaskar. Safety and Efficacy of a Combination of Cyproheptadine and Tricholine Citrate: Phase IV Study. Annals of International Medical and Dental Research. December 2017. [Accessed on 17th June 2022] https://www.readcube.com/articles/10.21276%2Faimdr.2018.4.2.pe1

4. Khadijehsadat Najib, Mozhgan Moghtaderi, Zohreh Karamizadeh and Ebrahim Fallahzadeh.  Beneficial Effect of Cyproheptadine on Body Mass Index in Undernourished Children: A Randomized Controlled Trial. Iranian Journal of Pediatrics. NIH. National Library of Medicine, National center for biotechnology information. December 2014. [Accessed on 17th June 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442838/

5. Centaur Pharmaceutical Pvt. Ltd. Oraxin syrup and drop (Cyproheptadine and Tricholine citrate). [Revised in January 2021] [Accessed on 17th June 2022] https://www.centaurpharma.com/downloads/2021/pediatrics/nutritional-and-vitamins/Oraxin%20syrup%20and%20drop.pdf

6. Alaina Pharma. Cyproheptadine and Tricholine citrate syrup. [Accessed on 17th June 2022] http://alainapharma.com/Cyproheptadine%20and%20Tricholine%20Citrate%20Syrup.html

USEFUL DIAGNOSTIC TESTS

• Upper gastrointestinal (GI) endoscopy and biopsy
• Complete Blood Count