App-Up

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What Is App-Up?

App-Up is an oral antihistamine containing cyproheptadine hydrochloride (4 mg), manufactured by WHO-GMP certified manufacturer. Supplied in packs of 30, 60, 90 or 180 tablets. Originator brand: Periactin (Merck, 1961).

cyproheptadine hydrochloride belongs to the first-generation H1 antihistamine class — the original antihistamines developed in the 1940s and 50s. They are effective but, unlike newer agents, cross the blood-brain barrier readily, which causes sedation and anticholinergic side effects. First-generation antihistamines are still useful for acute allergic episodes, short-term night-time itch, and specialised uses (motion sickness, certain migraine protocols, appetite stimulation).

What Is App-Up Used For?

Allergic rhinitis, urticaria, itchy skin, serotonin syndrome (antidote use), cyproheptadine is also widely used off-label as an appetite stimulant in poor-appetite states and failure-to-thrive. Historically used in migraine prevention, carcinoid syndrome (for diarrhoea/flushing), and SSRI-induced sexual dysfunction.

How Does App-Up Work?

cyproheptadine hydrochloride blocks histamine H1 receptors throughout the body. Histamine is released from mast cells and basophils during allergic reactions and causes the classic symptoms: sneezing, runny nose, itchy eyes, vasodilation, urticaria, bronchoconstriction, and mucus secretion. Blocking H1 receptors interrupts these effects.

Unlike newer (2nd-generation) antihistamines, first-generation agents readily cross the blood-brain barrier and bind central H1 receptors — producing sedation. They also have appreciable affinity for muscarinic acetylcholine receptors, causing classic anticholinergic effects (dry mouth, urinary hesitancy, blurred vision, constipation). Cyproheptadine additionally blocks serotonin 5-HT₂ receptors, giving it unique uses in serotonin syndrome, carcinoid syndrome, and appetite stimulation.

Dosage and Administration

Dose: Adults: 4 mg 3 times daily (usual range 4–20 mg/day; max 32 mg/day). Children 7–14: 4 mg 2–3 times daily. Children 2–6: 2 mg 2–3 times daily.

• Onset of action: 30–60 minutes.
• Duration: 4–6 hours — this is why 2–3 doses per day are needed, compared with once-daily dosing for 2nd-generation antihistamines.
• Take with or without food; food may reduce early drowsiness slightly.
• A bedtime dose is useful when drowsiness and night-time itch are issues; daytime doses may impair concentration.
• Miss a dose — take as soon as you remember unless the next dose is due; do not double up.
• Not intended for long-term daily use when 2nd-generation alternatives are available.

Side Effects

Sedation: Cyproheptadine is markedly sedating and commonly causes drowsiness. Most patients experience sedation at standard doses; tolerance may develop partially over 1–2 weeks.

Anticholinergic: Moderate — dry mouth, blurred vision, urinary hesitancy, constipation. Avoid in narrow-angle glaucoma, bladder-outflow obstruction, and elderly with falls risk.

Weight: Significant appetite stimulation and weight gain are characteristic effects — cyproheptadine is routinely prescribed off-label as a weight-gain aid in children with anorexia or failure to thrive. Can be a desired or undesired effect depending on context.

Other common side effects:

• Headache, dizziness
• Impaired concentration, slowed reaction time
• Photosensitivity (occasional)
• Thickened bronchial secretions (relevant in asthma)

Uncommon but important:

• Paradoxical CNS stimulation in children (hyperactivity, irritability, rarely seizures at high doses)
• Urinary retention in men with prostate enlargement
• Precipitation of narrow-angle glaucoma
• Falls in older adults (from sedation + anticholinergic delirium risk)
• Hypersensitivity reactions

Drug Interactions

• Alcohol, benzodiazepines, opioids, hypnotics — additive CNS depression. Avoid or use with great caution.
• Tricyclic antidepressants, MAO inhibitors — additive anticholinergic effect; MAOIs may prolong and intensify antihistamine effects — avoid within 14 days.
• Other anticholinergic drugs (oxybutynin, scopolamine, atropine) — additive dry mouth, urinary retention, constipation, cognitive blunting.
• SSRIs / SNRIs — cyproheptadine is sometimes used to treat SSRI-induced sexual dysfunction but may reduce SSRI antidepressant effect; use under medical advice.
• Metoclopramide, prochlorperazine — additive sedation and extrapyramidal effects.

Who Should Not Take App-Up?

• Newborns and premature infants
• Nursing mothers — first-generation antihistamines pass into breast milk and may cause irritability or feeding difficulty in the infant; 2nd-generation agents are preferred if treatment is needed
• Acute asthma attack — anticholinergic effect thickens secretions
• Narrow-angle glaucoma
• Bladder-outflow obstruction or symptomatic prostatic hypertrophy
• Peptic ulcer with pyloric obstruction
• Use of monoamine oxidase inhibitors (MAOIs) within 14 days
• Known hypersensitivity to cyproheptadine hydrochloride or similar antihistamines
• Older adults — avoid where 2nd-generation alternatives exist (falls, confusion, urinary retention risks)

Use in Pregnancy and Children

Pregnancy: first-generation antihistamines have been used for decades with a reasonable safety record, but 2nd-generation agents (loratadine, cetirizine) are preferred first-line. Discuss with your obstetrician before starting.

Breastfeeding: 1st-generation antihistamines pass into breast milk and may sedate the infant. They can also reduce milk supply. Prefer loratadine or cetirizine when treatment is needed in a breastfeeding mother.

Children: age cutoffs in the Dosage section. Paradoxical excitation can occur in young children.

Storage

Store App-Up below 25°C in a dry place, in the original blister. Keep out of reach of children.

Frequently Asked Questions

Is App-Up the same as cyproheptadine hydrochloride?

Yes — App-Up contains the active ingredient cyproheptadine hydrochloride. Bioequivalence to the originator brand (Periactin (Merck, 1961)) is required by regulatory authorities.

Is cyproheptadine used for weight gain?

Yes — cyproheptadine is one of the most commonly prescribed off-label appetite stimulants in children with failure-to-thrive, poor appetite, or cachexia, and sometimes in adults. Typical dose is 2–4 mg 2–3 times daily; weight gain of 1–3 kg over 4–8 weeks is typical. It is not approved as a weight-gain agent in most countries, and the effect is driven by H1 blockade and serotonin antagonism in the hypothalamic appetite centre. Discuss with a doctor before using for this purpose.

How drowsy will App-Up make me?

Cyproheptadine is markedly sedating and commonly causes drowsiness. Most patients experience sedation at standard doses; tolerance may develop partially over 1–2 weeks. Plan your first dose for a time when you do not need to drive or operate machinery for at least 6–8 hours. Effect is dose-dependent; smaller split doses often cause less sedation than a single large dose.

Can I take App-Up every day?

First-generation antihistamines are generally not recommended for long-term daily use when 2nd-generation agents are available — the anticholinergic burden and sedation add up. For chronic hay fever or urticaria, switch to loratadine, cetirizine, or fexofenadine. Short courses are safe for acute episodes.

Can I drink alcohol with App-Up?

No. Alcohol and first-generation antihistamines both depress the central nervous system; combining them significantly increases drowsiness, impaired coordination, and risk of accidents.

Can I give App-Up to my child?

Age cutoffs differ by formulation — see the dosage section. Paradoxical excitation (irritability, hyperactivity, trouble sleeping) is a recognised reaction in young children; if it occurs, stop and consult a doctor. For routine allergies in children, cetirizine or loratadine are preferred first-line.

Where can I buy App-Up online?

You can order App-Up (4 mg) from MedsBase in packs of 30, 60, 90 or 180 tablets. We ship worldwide with discreet packaging and genuine WHO-GMP certified manufacturer stock.

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