Cyproheptadine as an Appetite Stimulant in Specific Populations

Evidence-Based Recommendations

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Cystic Fibrosis Society (ECFS) guidelines note moderate-grade evidence for cyproheptadine's effect on weight and BMI z-scores in cystic fibrosis patients 1, 2, 3
The American Society of Clinical Oncology (ASCO) 2020 guidelines state that cyproheptadine lacks sufficient benefit and has insufficient evidence for cancer-related cachexia, recommending megestrol acetate and corticosteroids instead 4
The French National Federation of Cancer Centres (FNCLCC) 2003 guidelines state that cyproheptadine may be an appetite stimulant, but adverse effects have been reported, with only Level C evidence, recommending its use only in clinical trials 5
The ESPEN 2015 dementia guidelines explicitly state that systematic use of appetite stimulants, including cyproheptadine, is not recommended in dementia patients, with very low grade evidence 6
Cyproheptadine has a more favorable side-effect profile than megestrol acetate, which carries risks of thromboembolic events, edema, and adrenal suppression, according to the ASCO 2020 guidelines 4

The ESPEN, ESPGHAN, and ECFS guidelines recommend considering cyproheptadine as a first-line treatment for cystic fibrosis patients with poor appetite and suboptimal nutritional status 1, 2, 3
The ASCO 2020 guidelines recommend avoiding cyproheptadine in cancer cachexia and using megestrol acetate or corticosteroids instead 4
The ESPEN 2015 guidelines recommend avoiding systematic use of cyproheptadine in dementia patients due to insufficient evidence and better alternatives 6