Effective Prophylactic Therapy for Cyclic Vomiting Syndrome in Children Using Amitriptyline or Cyproheptadine

Andersen, John M.; Sugerman, Kathryn S.; Lockhart, Jennifer R.; Weinberg, Warren A.

doi:10.1542/peds.100.6.977

Cited by 108 publications

(76 citation statements)

References 17 publications

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“…In abdominal migraine, though the predominant symptom is abdominal pain; whereas in cyclic vomiting, the predominant symptom is the vomiting 16 . Patients with high frequency and greater severity of symptoms may benefit from prophylaxis with antimigraine medications, such as TCA, cyproheptadine, and propranolol 4,5 . Sumatriptan is a 5HT 1D1B agonist, FDA approved for acute treatment of migraine headaches in adults.…”

Section: Migraine/sumatriptanmentioning

confidence: 99%

“…However, it also occurs in adults and often goes undiagnosed for years due to a general lack of knowledge and understanding of the condition among physicians [1][2][3] . Treatment of patients depends on the frequency and severity of the vomiting episodes and may include the following: 1) prophylactic medications and 2) medications to help abort an episode 4,5 . Based on small case series, experts recommend sumatriptan during early stages of vomiting in children with cyclic vomiting syndrome 6 .…”

Section: Introductionmentioning

confidence: 99%

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Adult Cyclic Vomiting Syndrome Successfully Treated with Intranasal Sumatriptan

2009

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Section: Migraine/sumatriptanmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adult Cyclic Vomiting Syndrome Successfully Treated with Intranasal Sumatriptan

2009

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“…There have been three reports [14][15][16] of children (n = 65) who received cyproheptadine for CVS. Response rates ranged from 40% to 83%.…”

Section: Cyclic Vomiting Syndromementioning

confidence: 99%

“…8 Its efficacy in children with FAP has been reported in a double-blind, placebo-controlled trial, 9 as well as in retrospective studies for treatment of FAP, FD, IBS, and AM. [10][11][12][13][14][15][16] 5-HT is a polyfunctional signaling molecule that serves as a paracrine factor, endocrine hormone, neurotransmitter, and growth factor. 17 Various 5-HT receptor subtypes regulate gut motility, secretion, and visceral sensitivity.…”

mentioning

confidence: 99%

Cyproheptadine: A Potentially Effective Treatment for Functional Gastrointestinal Disorders in Children

Krasaelap¹,

Madani²

2017

Pediatr Ann

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Functional gastrointestinal disorders (FGIDs) negatively affect children's quality of life and health care costs. It has been proposed that alteration of gut serotonin leads to gastrointestinal dysmotility, visceral hypersensitivity, altered gastrointestinal secretions, and brain-gut dysfunction. Cyproheptadine, a serotonin antagonist, has been shown to be a potentially effective and safe treatment option in children who meet the clinical criteria for FGIDs. Well-designed multicenter trials with long-term follow-up are needed to further investigate its efficacy. [Pediatr Ann. 2017;46(3):e120-e125.]

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“…Tricyclic antidepressants (TCAs) have been reported to be effective as prophylactic agents in children with CVS. 12 An open-label treatment group of 17 adult patients with CVS noted that 17% of patients had a complete remission with TCA therapy and almost 60% had a partial response. 3 More recently, a retrospective case series of patients who had failed TCAs as maintenance therapy reported that 15 out of the 20 patients studied had improvement in the frequency of their vomiting episodes with the newer antiepileptic drugs zonisamide and levetiracem.…”

mentioning

confidence: 99%

Cyclic vomiting syndrome in an adult patient

Duckett

Pride

2010

Journal of Hospital Medicine

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We present a 26-year-old white male with a chief complaint of nausea and vomiting. The patient described prodromal nausea followed by intractable vomiting for 2 days. Over the past 2 years he has experienced similar episodes occurring every 3 to 6 months. He has been hospitalized 5 times for this problem with no diagnosis given. There are no obvious precipitants. The symptoms consistently last 2 to 3 days and resolve with supportive care including intravenous fluids and antiemetics. The patient enjoys good health between the periods of sickness. He has never experienced coffeeground emesis or hematemesis. His past medical history is significant for attention deficit disorder and cholecystectomy. He takes no prescription medications. Social history is remarkable for tobacco abuse, binge drinking on weekends, and daily marijuana use. He is unemployed. His family history is unremarkable.Physical examination at the time of admission was notable for tachycardia, orthostatic hypotension, and hypoactive bowel sounds. Otherwise physical examination was normal.Diagnostic testing done on admission was notable for white blood cell count of 25,000, hemoglobin of 17.3, blood urea nitrogen 18, creatinine 1.4, aspartate aminotransferase (AST) 64, and alanine aminotransferase (ALT) 55. Pancreatic enzymes and acute abdominal series were normal.The patient was admitted to the hospital with the presumptive diagnosis of viral gastroenteritis. Initial therapy included intravenous fluids and promethazine. Throughout hospital day 1, he remained nauseated and had multiple bouts of emesis. Records from the patient's hospitalization 5 months ago were obtained and reviewed. During this previous hospitalization, computed tomography (CT) scans of the abdomen and esophagogastroduodenoscopy (EGD) were performed, both of which were negative. Upon review of this recent workup, the diagnosis of cyclic vomiting syndrome (CVS) was entertained and the patient received a therapeutic trial of subcutaneous sumatriptan. His symptoms abated dramatically. Subsequently, he was able to keep oral liquids down and his orthostatic hypotension resolved. On hospital day 2, his white blood cell count normalized without intervention. Blood, urine, and stool cultures remained negative, and workup for acute intermittent porphyria was negative. Upon discharge from the hospital he was counseled to discontinue all marijuana use and was scheduled for follow-up in the residents' clinic. He failed to keep this appointment. After being lost to follow-up for 17 months, he presented to the emergency department with nausea and vomiting. As before, his symptoms promptly improved with sumatriptan. Discussion CVS, initially described in 1861 as a pediatric illness, is being increasingly recognized in adults. 1 It has been estimated that up to 1.6% of children experience symptoms consistent with this disorder, but the prevalence in adults is unknown. 2 The essential features of CVS, as noted in our patient, are multiple discrete episodes of nausea and vomiting lasting less than ...

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Effective Prophylactic Therapy for Cyclic Vomiting Syndrome in Children Using Amitriptyline or Cyproheptadine

Abstract: The antimigraine prophylactic drugs, amitriptyline and cyproheptadine, represent effective prophylactic agents for the management of CVS in the vast majority of patients fulfilling the diagnostic criteria for this syndrome.

Cited by 108 publications

References 17 publications

Adult Cyclic Vomiting Syndrome Successfully Treated with Intranasal Sumatriptan

Adult Cyclic Vomiting Syndrome Successfully Treated with Intranasal Sumatriptan

Cyproheptadine: A Potentially Effective Treatment for Functional Gastrointestinal Disorders in Children

Cyclic vomiting syndrome in an adult patient

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