OPEN ACCESS Research article Cyproheptadine for central hypertension? Guido Filler1,2,*, Lara Hart1, April Chan3, Elizabeth Cairney4, Asuri N Prasad5 1Department of Paediatrics, Division of Paediatric Nephrology, Schulich School ABSTRACT of Medicine & Dentistry, London, ON, Background: Approximately one-fifth of paediatric intracranial tumors result in hypertension. Canada N6A 5W9 2Department of Pathology and The condition is difficult to treat in this population, particularly if it is refractory, since there is little Laboratory Medicine, Schulich School of guidance on patient management beyond first-line therapy with IV labetalol. Medicine & Dentistry, University of Western Ontario, London, Ontario, Methods: A 20-month-old patient was hospitalized with cerebral herniation-induced loss of Canada N5A 5A5 consciousness and a posterior fossa mass was found. Although several first-line treatments including 3 School of Pharmacy, University of IV labetalol, furosemide, amlodipine, clonidine, and atenolol were administered, the patient’s Western Ontario, London, ON, Canada 5A 5A5 hypertension persisted. With few options left, positive findings from previously published case reports 4Department of Paediatrics, Division of led the team to administer cyproheptadine. Hematology/Oncology, Schulich School of Medicine & Dentistry, London, ON, Results: Cyproheptadine resulted in improved blood pressure and allowed for a dose reduction in Canada N6A 5W9 other antihypertensives, but elevated liver transaminases and suspected hepatotoxicity several weeks 5 Department of Paediatrics, Division of later resulted in the discontinuation of this treatment. Neurology, Schulich School of Medicine & Dentistry, London, ON, Canada N6A Conclusions: Despite the safety concerns associated with using cyproheptadine to treat paediatric 5W9 central hypertension, this treatment holds promise for persistent refractory hypertension as a last-line *Email:
[email protected] agent when all other treatment options are exhausted.