title: A comparison of the pharmacokinetics of oral and sublingual cyproheptadine.
abstract: BACKGROUND
  Cyproheptadine is reported to be effective in treating serotonin syndrome. It is only available as an oral preparation and administration after SSRI overdose treated with activated charcoal is problematic. Sublingual administration may circumvent this problem. The pharmacokinetics of sublingual cyproheptadine are not characterized. This study compares the pharmacokinetics of cyproheptadine following oral and sublingual administration.
  
  
  METHODS
  Cross-over, non-blinded, volunteer study using five healthy males. Eight milligrams of oral and sublingual cyproheptadine were administered on separate occasions with a one-week washout period. Sublingual arm subjects were pretreated with 50 g of oral activated charcoal 30 min prior to cyproheptadine, to prevent any gut absorption. Serum cyproheptadine concentration was measured at baseline, 30 min, and 1, 2, 3, 4, 6, 8, and 10 h by liquid chromatography and mass spectroscopy.
  
  
  RESULTS
  Mean C(max) for oral and sublingual were 30.0 microg/L and 4.0 microg/L respectively: mean T(max) were 4 h and 9.6 h; mean AUC were 209 and 25 microg x hr/L. Mean +/- SEM within-subject difference between oral and sublingual C(max) was 25.9 +/- 4.1 (p = 0.003) and AUC was 184 +/- 31 (p = 0.004).
  
  
  CONCLUSIONS
  Serum concentrations after sublingual cyproheptadine are significantly less than after oral administration. At these concentrations, the sublingual route is unlikely to be effective in treating serotonin syndrome.
authors.affiliation: Emergency Department, Westmead Hospital, Sydney, Australia. naren@primus.com.au
authors.forename: Narendra
authors.initials: N
authors.lastname: Gunja
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Andis
authors.initials: A
authors.lastname: Graudins
mesh_terms: D000284:Administration, Oral; D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D002853:Chromatography, Liquid; D018592:Cross-Over Studies; D003533:Cyproheptadine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000493:pharmacokinetics*; D020230:Serotonin Syndrome / Q000188:drug therapy / Q000378:metabolism
chemical_list: D012702:Serotonin Antagonists; D003533:Cyproheptadine