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Volume 2014, Issue 1
  • EISSN: 2223-506X

Abstract

Approximately one-fifth of paediatric intracranial tumors result in hypertension. The condition is difficult to treat in this population, particularly if it is refractory, since there is little guidance on patient management beyond first-line therapy with IV labetalol. A 20-month-old patient was hospitalized with cerebral herniation-induced loss of consciousness and a posterior fossa mass was found. Although several first-line treatments including IV labetalol, furosemide, amlodipine, clonidine, and atenolol were administered, the patient's hypertension persisted. With few options left, positive findings from previously published case reports led the team to administer cyproheptadine. Cyproheptadine resulted in improved blood pressure and allowed for a dose reduction in other antihypertensives, but elevated liver transaminases and suspected hepatotoxicity several weeks later resulted in the discontinuation of this treatment. Despite the safety concerns associated with using cyproheptadine to treat paediatric central hypertension, this treatment holds promise for persistent refractory hypertension as a last-line agent when all other treatment options are exhausted. Clinical use of this agent should be investigated in future studies, under careful supervision.

© 2014 Filler, Hart, Chan, Cairney, Prasad, licensee Bloomsbury Qatar Foundation Journals.
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2014-05-01
2024-04-25
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References

  1. Weinblatt ME, Heisel MA, Siegel SE. Hypertension in children with neurogenic tumors. Pediatrics. 1983; 71:6:947–951.
     [Google Scholar]
  2. Julius S. The evidence for a pathophysiologic significance of the sympathetic overactivity in hypertension. Clin Exp Hypertens. 1996; 18:3-4:305–321.
     [Google Scholar]
  3. Mann SJ. Drug therapy for resistant hypertension: simplifying the approach. J Clin Hypertens. 2011; 13:2:120–130.
     [Google Scholar]
  4. Thomas CA, Moffett BS, Wagner JL, Mott AR, Feig DI. Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children. Pediatr Crit Care Med. 2011; 12:1:28–32.
     [Google Scholar]
  5. Healthline: Atenolol. [http://www.healthline.com/ahfscontent/amlodipine.] Accessed 8/04/2014.
  6. Healthline: Clonidine. [http://www.healthline.com/ahfscontent/clonidine/] Accessed 8/04/2014.
  7. Healthline: Labetalol. [http://www.healthline.com/ahfscontent/labetalol] Accessed 8/04/2014.
  8. Healthline: Atenolol. [http://www.healthline.com/ahfscontent/atenolol] Accessed 8/04/2014.
  9. Prattichizzo FA. Arterial hypertension in Cushing's disease: the 24-hour pressure profile without and during treatment with beta-blockers or cyproheptadine. G Ital Cardiol. 1994; 24:5:533–538.
     [Google Scholar]
  10. Tajiri K, Shimizu Y. Practical guidelines for diagnosis and early management of drug-induced liver injury. W J Gastroenterol. 2008; 14:44:6774–6785.
     [Google Scholar]
  11. Hussaini SH, Farrington EA. Idiosyncratic drug-induced liver injury: an overview. Expert Opin Drug Saf. 2007; 6:6:673–684.
     [Google Scholar]
  12. Acelajado MC, Pisoni R, Dudenbostel T, Dell'Italia LJ, Cartmill F, Zhang B, et al., Refractory hypertension: definition, prevalence, and patient characteristics. J Clin Hypertens. 2012; 14:1:7–12.
     [Google Scholar]
  13. Filler G, Lepage N. Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol. 2003; 18(10):981-5:2003/08/16.
     [Google Scholar]
  14. Wong H, Hadi M, Khoury T, Geary D, Rubin B, Filler G. Management of severe hypertension in a child with tuberous sclerosis-related major vascular abnormalities. J Hypertens. 2006; 24:3:597–599.
     [Google Scholar]
  15. Watemberg NM, Roth KS, Alehan FK, Epstein CE. Central anticholinergic syndrome on therapeutic doses of cyproheptadine. Pediatrics. 1999; 103:1:158–160.
     [Google Scholar]
  16. Solares G, Blanco E, Pulgar S, Diago C, Ramos F. Carcinoid syndrome and intravenous cyproheptadine. Anaesthesia. 1987; 42:9:989–992.
     [Google Scholar]
  17. Salazar ML, Eiland LS. Intrathecal baclofen withdrawal resembling serotonin syndrome in an adolescent boy with cerebral palsy. Pediatr Emerg Care. 2008; 24:10:691–693.
     [Google Scholar]
  18. Larrey D, Geneve J, Pessayre D, Machayekhi JP, Degott C, Benhamou JP. Prolonged cholestasis after cyproheptadine-induced acute hepatitis. J Clin Gastroenterol. 1987; 9:1:102–104.
     [Google Scholar]
  19. Henry DA, Lowe JM, Donnelly T. Jaundice during cyproheptadine treatment. Br Med J. 1978; 1:6115:753.
     [Google Scholar]
  20. Danan G, Benichou C. Causality assessment of adverse reactions to drugs–I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol. 1993; 46:11:1323–1330.
     [Google Scholar]
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Cyproheptadine for central hypertension?
QScience Connect 2014, 12 (2014); https://doi.org/10.5339/connect.2014.12
/content/journals/10.5339/connect.2014.12
/content/journals/10.5339/connect.2014.12
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  • Article Type: Research Article
Keyword(s): anti-hypertensive agents, cyproheptadine, hypertension and sympathetic nervous system

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