Cyproheptadine Periactin and low milk supply

[tcs710]

Hi,
I noticed that your site and Lactmed both say that cyproheptadine could be used with caution due to possible sedation of newborn. But Lactmed cautions against the use of this medication due to the fact that it lowers serum prolactin levels.

"Unless it is intentionally being used to lower maternal serum prolactin levels, cyproheptadine should be avoided during lactation because it may interfere with lactation, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives."

We have noticed that our OB's have started prescribing this frequently for our postpartum patients and before speaking with them, I wanted to reach out to you and get more information. Why does Lactmed feel it lowers milk supply and I cannot find any mention of its effect on milk production in Dr. Hale's book? Here is one of the studies from the other site. Apparently it is used to treat galactorrhea?

Wortsman J, Soler NG, Hirschowitz J. Cyproheptadine in the management of the galactorrhea-amenorrhea syndrome. Ann Intern Med. 1979;90:923–5.

Thank you,
Tricia S. RN, MSN, IBCLC

[nicholec]

Hi Tricia,

It seems that cyproheptadine may impact prolactin levels, but not in every case.

Unfortunately, there is not a lot of data specifically related to cyproheptadine and prolactin levels other than the article that you have referenced. On a positive note, if you refer to the chart on page 2 (924 on the actual article), we see some reassuring information. The use of cyproheptadine only stopped lactation in 2 of 15 women. It did not impact 4 of the 15 women. Levels of prolactin stayed the same in 2 of the 15 women. 7 of the women did have decreases in prolactin levels but did not stop producing milk.

The dose used in this study was 24 mg daily. The most common prescribed dosage is 4 mg q8hr (half of the studied dosage).

Overall, this isn't much data to support cyproheptadine to inhibit prolactin. Plus, we know that a certain amount of prolactin is necessary to promote lactogenesis; however, it is not necessarily a dose-proportional response, which makes things tricky. We will update the next version of Medications and Mothers' Milk with this data.

Do you know what dosages these women are being prescribed? What is the indication that they are using it for? If cyproheptadine is being used in the first few days after delivery I doubt the prolactin reduction would be enough to prohibit milk production.

Nichole Campbell, APRN, NP-C


Referenced article:

Wortsman J, Soler NG, Hirschowitz J. Cyproheptadine in the management of the galactorrhea-amenorrhea syndrome. Ann Intern Med. 1979;90:923–5.