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Allergic rhinitis (AR) has a high prevalence and substantial impact on quality of life (QoL). The traditional classification of AR as either seasonal or perennial is being superseded in many countries by the ARIA (Allergic Rhinitis and its Impact on Asthma) definitions, in which the term intermittent AR denotes the presence of symptoms for <4 days a week or <4 weeks, and the term persistent AR denotes the presence of symptoms for >4 days a week for >4 weeks. These definitions, particularly that of persistent AR, may better reflect the true pattern of AR as it is experienced by patients. Desloratadine has been approved by the European Medicines Evaluation Agency for the treatment of intermittent and persistent AR, as defined by the ARIA classification.
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The central effects of a newly developed, long-acting H1 antihistamine, loratadine (10 and 40 mg), were compared with those of a standard H1 antihistamine, diphenhydramine (50 mg three times a day) with measures of performance and daytime sleepiness (multiple sleep latency test). Sixteen healthy adults (six women and 10 men), 19 to 35 years of age, received each of the drugs and placebo for 2 days, separated by 5 days at home. Each day, the drug or placebo was administered at 8 A.M. and 12 and 4 P.M. Diphenhydramine was administered in three equal doses (50 mg), and loratadine was administered in a single dose followed by two placebo doses. Mean latency to sleep on tests done at 9 and 11 A.M. and 1, 3, and 5 P.M. was reduced significantly with diphenhydramine compared to placebo, whereas neither loratadine dose reduced sleep latency. Performance measured at 9:30 P.M. and 1:30 P.M. with a battery of tests, including reaction time, vigilance, digit symbol substitution, and symbol copying tasks demonstrated a significant reduction in symbols copied and digits substituted after diphenhydramine compared to both loratadine doses. These results demonstrate that loratadine (10 and 40 mg doses) did not have clinically significant central nervous system activity, whereas diphenhydramine increases sleepiness and disrupts performance efficiency.
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A murine graft versus host (GVH) model was developed as a tool for drug discovery. A pharmacological survey revealed that as a class the anti-rheumatics (e.g., auranofin, azathioprine, and methotrexate) were the most potent inhibitors of GVH induced splenomegaly. The immunosuppressants, cyclophosphamide and cyclosporine A, and the glucocorticoids (e.g., dexamethasone, hydrocortisone, and corticosterone) were all able to suppress the GVH response. Anti-inflammatory agents (e.g., indomethacin and piroxicam), and a series of central nervous system affecting drugs, including serotonin agonists (e.g., trifluromethylphenylpiperazine (tfMPP), 1-(3-chlorophenyl)piperazine (mCPP), and quipazine), and tricyclic antidepressants (e.g., amitriptyline, desipramine, imipramine, and nortriptyline) typically were ineffective at doses up to 10 mg/kg. However, at high dose levels (30 mg/kg) piroxicam enhanced while amitriptyline and cyproheptadine (a mixed serotonin and histamine antagonist) suppressed GVH induced splenomegaly. These data provide a pharmacological profile for a series of immunomodulator, anti-inflammatory, and central nervous system active compounds in a classic immunologic model.
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A case of disseminated cryptococcosis with oral, pulmonary, and cutaneous manifestations is described in an eleven-year-old Siamese cat. Marked clinical improvement was noted 2-months following appropriate antifungal therapy. A review of disseminated cryptococcosis and the oral manifestations of fungal disease are provided.
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These data suggest that treatment with DL reduces systemic eosinophilia and prevents the increase in circulating eosinophils after NP. DL also significantly reduces the early bronchial clinical response to NP. However, airway mucosal inflammation is not altered by 1 week of treatment.
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A possibility of inducing immobility in rats immersed in a cylinder filled with water from which they cannot escape was confirmed. The period of active attempts to escape from the cylinder was lengthened by injecting the animals with the following antidepressants: imipramine (IMI), amitriptyline (AMI), doxepin (DOS), mianserin (MIA), danitracen (DAN), iprindole (IPR), as well as cyproheptadine (CYP), even if they were administered only once. Femoxetine (FEM) produces no effect,. The swimming activity of rats diminished gradually to ca 15% of the initial value if experiments were repeated during 7-8 consecutive days. A chronic administration of IMI in a dose of 10mg/kg daily counteracted this phenomenon, and when the drug had been given for 10 days before the immersions were started, it presented the decrease in the activity.
Analytical method validation is a mandatory step at the end of the development in all analytical laboratories. It is a highly regulated step of the life cycle of a quantitative analytical method. However, even if some documents have been published there is a lack of clear guidance for the methodology to follow to adequately decide when a method can be considered as valid. This situation has led to the availability of several methodological approaches and it is therefore the responsibility of the analyst to choose the best one. The classical decision processes encountered during method validation evaluation are compared, namely the descriptive, difference and equivalence approaches. Furthermore a validation approach using accuracy profile computed by means of beta-expectation tolerance interval and total measurement error is also available. In the present paper all of these different validation approaches were applied to the validation of two analytical methods. The evaluation of the producer and consumer risks by Monte Carlo simulations were also made in order to compare the appropriateness of these various approaches. The classical methodologies give rise to inadequate and contradictory conclusions which do not allow them to answer adequately the objective of method validation, i.e. to give enough guarantees that each of the future results that will be generated by the method during routine use will be close enough to the true value. It is found that the validation methodology which gives the most guarantees with regards to the reliability or adequacy of the decision to consider a method as valid is the one based on the use of the accuracy profile.
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The effect of the diterpene forskolin on vascular permeability alone and in combination with bradykinin, prostaglandin E1, adenosine or histamine has been investigated in rats. Vascular permeability in rat skin was measured using [125I]-labelled bovine serum albumin ([125I]BSA) as a tracer. In addition, the effect of forskolin on footpad edema induced by the injection of a mixture of 2% carrageenin was determined. Forskolin caused a marked potentiation of the increase in vascular permeability in rat skin elicited by the intradermal injection of histamine or bradykinin. However, forskolin caused a significant suppression of the prostaglandin E1-induced vascular permeability response and at a low concentration suppressed the response to adenosine. Forskolin greatly potentiated the footpad edema induced with carrageenin in rats. Intravenous administration of the enzyme bromelain, which reduces plasma kininogen levels, inhibited the footpad edema induced with carrageenin or with a mixture of carrageenin and forskolin. Parenteral administration of a prostaglandin synthetase inhibitor, indomethacin, suppressed the footpad edema induced with carrageenin, but did not inhibit the footpad edema induced with a mixture of carrageenin and forskolin. An antihistamine, cyproheptadine, had no effect on carrageenin-induced footpad edema either in the presence or absence of forskolin. These results suggest that both bradykinin and prostaglandins are essential for the development of carrageenin-induced footpad edema and that bradykinin plays an important role in the potentiative effect of forskolin on footpad edema induced with carrageenin in rats.
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Treatment with desloratadine 5 mg daily for 7 days reduced allergic ocular symptoms following allergen challenge.
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The cytotoxicity of 5,6-dihydroxytryptamine (5,6-DHT), 5,7-dihydroxytryptamine (5,7-DHT), bromolysergic acid diethylamide (BOL), methysergide, and cyproheptadine, and also of 5,6-DHT together with either BOL, methysergide, or cyproheptadine in dimethylhydrazine-induced (DMH) carcinomata of rat colon was evaluated by estimating the percentage of necrotic cells in histological sections of tissues taken 15 h after injection of each of the drugs. In addition, the influence of methysergide and cyproheptadine on the tumour cell mitotic rate was estimated by means of a stathmokinetic technique. Both 5,6-DHT and 5,7-DHT were cytotoxic at each dose tested and for each of these agents the percentage of necrotic cells was directly correlated with the dose of drug used. BOL was not found to be cytotoxic to the colonic carcinomata, whereas both methysergide and cyproheptadine did cause detectable tumour cell necrosis. Methysergide was also found to accelerate tumour cell proliferation, whereas cyproheptadine did not. BOL competitively inhibited the cytotoxicity of 5,6-DHT and neither methysergide nor cyproheptadine potentiated the effect of 5,6 DHT.
Sixteen healthy young volunteers took part in a crossover, randomized, double-blind, placebo controlled trial comprising two experimental periods (repeated administration for 7 days of rupatadine 10 mg or placebo as single oral daily doses, separated by a washout of 14 days). On days 5 and 7, according to a fully balanced design, a single oral dose of lorazepam 2 mg or placebo was added. CNS effects were evaluated on these days by seven objective tests of psychomotor performance and eight subjective visual analogue scales (VAS) at pre-dose and several times after drug intake. Four treatment conditions were evaluated: placebo, rupatadine 10 mg, lorazepam 2 mg and rupatadine 10 mg + lorazepam 2 mg.
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1. In fetal lambs in late gestation, systemic infusion of L-5-hydroxytryptophan (L-5-HTP) during normoxia greatly increases the incidence of fetal breathing movements (FBM) and high-voltage electrocortical activity (HV ECoG). It also induces FBM during HV ECoG and increases blood pressure. To investigate its mechanism of action, L-5-HTP was administered in conjunction with the 5-hydroxy-tryptamine (5-HT) antagonists ketanserin or cyproheptadine. L-5-HTP was also infused with or without the antagonists during hypoxia, to test whether it would overcome the inhibition of FBM by hypoxia. 2. When L-5-HTP was given in normoxia, cyproheptadine blocked and ketanserin reduced the increase in blood pressure, both drugs blocked the stimulation of FBM, but neither drug prevented the induction of prolonged episodes of HV ECoG. 3. In hypoxia, L-5-HTP similarly stimulated FBM. This effect was also blocked by cyproheptadine and was delayed by ketanserin. 4. The antagonism of the effects of L-5-HTP on blood pressure and the incidence of FBM in normoxia and hypoxia is consistent with the action of L-5-HTP via 5-HT receptors. At present there is no clear explanation of the mechanism by which L-5-HTP induces HV ECoG.
A total of 132 patients with symptoms associated with either upper respiratory allergies or the common cold was enrolled in this 5-day study. Azatadine maleate/pseudoephedrine sulfate syrup was compared to placebo using a double-blind design. Evaluation of efficacy was based on results in eighty patients and that of safety in 115. Onset of relief was significantly better (p = 0.03) with azatadine maleate/pseudoephedrine sulfate syrup than with placebo. However this was due mainly to the distribution of patients who indicated 'no relief': ten in the combination group as opposed to sixteen in the placebo group. Over-all evaluation of results indicated that a significantly greater degree of symptomatic relief was achieved with the active test formulation than with placebo on both Days 3 (p = 0.03) and 5 (p = 0.04) of therapy. Somnolence was the most frequently reported side-effect.
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The objective of this double-blind, randomized, placebo-controlled, 5-way crossover study was to compare the pharmacodynamic effects of the H1 antihistamine ebastine (10 mg once daily, E10) with those of cetirizine (10 mg once daily, C10), loratadine (10 mg once daily, L10), fexofenadine (60 mg, twice daily, F60 x 2) and placebo (P) after 6 days of treatment in healthy volunteers. The pharmacodynamic variable was the mean percent reduction from baseline (pretreatment) of the wheal area induced by intradermal histamine 0.1% on the morning after 6 days' treatment. A secondary variable was the concentration of histamine required to produce a wheal of area 150 mm2. E10 reduced wheal size more than did P (p < 0.001) or F60 x 2 (p < 0.019). No significant differences were found among E10, C10 and L10. After E10, a significantly greater concentration of histamine was needed to induce a wheal of 150 mm2 than after P (p < 0.001), L10 (p < 0.001) or F60 x 2 (p < 0.001). No significant differences were found between E10 and C10. In conclusion, this study shows that, at the end of the conventional dosing interval, ebastine 10 mg and cetirizine 10 mg once daily in repeated doses suppressed the histamine wheal more effectively than did loratadine 10 mg once daily or fexofenadine 60 mg twice daily.
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Neuronal activities of the substantia nigra pars compacta (SNC) are known to be inhibited by noxious stimuli. Extracellular recording of spontaneous firing of SNC neurons were made to investigate how such inhibition would be influenced by treatment with 5,7-dihydroxytryptamine (5,7-DHT) or p-chlorophenylalanine (PCPA) or by IV injection of the serotonin antagonist, cyproheptadine. Noxious stimuli were produced by tail pinching (TP) and tail heating (HW). In 5,7-DHT-treated experiment, the inhibition indices were 62.8 +/- 4.4 (TP) and 63.4 +/- 4.6 (HW)% for vehicle-treated control, then the inhibition indices were 26.3 +/- 2.6 (TP) and 27.8 +/- 2.9 (HW)% for 5,7-DHT-treated animals. As to the PCPA-treated experiment, the inhibition indices were 63.1 +/- 2.6 (TP) and 64.8 +/- 2.5 (HW)% for saline control rats, while the inhibition indices were 30.3 +/- 1.6 (TP) and 30.1 +/- 1.6 (HW)% for the PCPA-treated ones. Furthermore, in another observation, the firing rates of SNC neurons were reduced from the saline (control) level by 53.2 +/- 2.12 and 52.1 +/- 2.07% during the application of stimulation of TP and HW, respectively. Following the intravenous injection of cyproheptadine, the firing rates of those were reduced by only 6.71 +/- 1.38 and 4.38 +/- 1.79% for TP and HW, respectively. That is, the TP- and HW-induced inhibition were attenuated about 47% by the injection of cyproheptadine. The results strongly suggested that the serotonergic mechanism would be involved in the mediation of the inhibition of SNC neurons by noxious stimuli.
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Thermal burn of irradiated rats increases the level and the length of the postirradiation enteroendotoxemia and aggravates the postirradiation impairment of the hematoenterocitic barrier. The pharmacological correction of the small intestine motility and introduction of ciproheptadine, an agent that blocks serotonin receptors, ameliorates the above phenomenon in radiation and thermal injuries.
Anorexia nervosa is characterised by a low body mass index (BMI), fear of gaining weight, denial of current low weight and its impact on health, and amenorrhoea. Estimated prevalence is highest in teenage girls, and up to 0.7% of this age group may be affected. While most people with anorexia nervosa recover completely or partially, about 5% die of the condition, and 20% develop a chronic eating disorder. Young women with anorexia nervosa are at increased risk of bone fractures later in life.
Cyproheptadine is safe and effective for treating dyspeptic symptoms in children, particularly in young children and those with early vomiting and retching after fundoplication.
Seventy patients were enrolled. Of the 66 evaluable patients, 50 demonstrated a response to CH (average weight gain 2.6 kg and mean weight-for-age z-score change of 0.35, P=0.001). Seven of the 16 nonresponders received MA. Six patients completed 4 weeks of MA, 5 responded (average weight gain of 2.5 kg). The most commonly reported side effect of CH was drowsiness. One patient on MA developed low cortisol levels and hyperlipidemia.
Antileukotrienes might play a significant role in controlling polyposis and symptoms due to sinonasal disease. They represent an alternative to conventional treatments with oral steroids as well as to operations in the long-term control.
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On average, patients who were dissatisfied with loratadine reported equal or better satisfaction with desloratadine as fexofenadine. Patients with severe allergic rhinitis reported greater satisfaction when converted from loratadine to desloratadine than fexofenadine for select satisfaction measures. These results suggest that if managed care intends to position prescription antihistamines as second line for OTC loratadine treatment dissatisfaction, desloratadine is a useful treatment alternative. These findings, while informative to formulary decision-makers, must be interpreted with caution. Only through head-to-head controlled clinical trials can differences in efficacy and safety be established.
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All 21 participants completed the study. Skin/plasma fexofenadine ratios ranged from 1.2 +/- 0.5 at 1 hour to 110 +/- 74 at 24 hours, and skin fexofenadine concentrations exceeded loratadine and chlorpheniramine skin concentrations at each test time. This was reflected in significant wheal and flare suppression by fexofenadine in comparison with loratadine at 3 hours and in comparison with chlorpheniramine at 6 and 9 hours (wheal) and from 3 to 24 hours and at 192 hours (flare). Compared with fexofenadine, loratadine significantly suppressed the wheal at 192 hours, and compared with chlorpheniramine, it significantly suppressed the wheal at 9 hours and the flare at 24 and 192 hours. At no time did chlorpheniramine suppress the wheal or flare significantly more than fexofenadine or loratadine.
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48 healthy, nonsmoking volunteers (12 White men, 12 Black men, 12 White women, 12 Black women).
The GPR103 receptor is a G protein-coupled receptor, which plays a role in several physiological functions. However, the role of the GPR103 receptor in anxiety has not been clarified. The first aim of our study was to elucidate the involvement of the GPR103 receptor in anxious behavior. Mice were treated with peptide P550, which is the mouse homolog of neuropeptide 26RFa and has similar activity for the GPR103 receptor as neuropeptide 26RFa. The anxious behavior was investigated using an elevated plus-maze paradigm. The second aim of our study was to investigate the underlying neurotransmissions. Accordingly, mice were pretreated with a nonselective muscarinic acetylcholine receptor antagonist, atropine, a γ-aminobutyric acid subunit A (GABAA) receptor antagonist, bicuculline, a non-selective 5-HT2 serotonergic receptor antagonist, cyproheptadine, a mixed 5-HT1/5-HT2 serotonergic receptor antagonist, methysergide, a D2, D3, D4 dopamine receptor antagonist, haloperidol, a nonselective α-adrenergic receptor antagonist, phenoxybenzamine and a nonselective β-adrenergic receptor antagonist, propranolol. Our results demonstrated that peptide P550 reduces anxious behavior in elevated plus maze test in mice. Our study shows also that GABAA-ergic, α- and β-adrenergic transmissions are all involved in this action, whereas 5-HT1 and 5-HT2 serotonergic, muscarinic cholinergic and D2, D3, D4 dopaminergic mechanisms may not be implicated.
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The efficacy of loratadine and terfenadine in perennial allergic rhinitis was evaluated in a double-blind, selected cross-over study consisting of two phases. During the first phase, 76 patients with perennial allergic rhinitis, 8-67 years old, were included in the study. Of these, 41 patients received loratadine 10 mg daily, and 35 patients received terfenadine 60 mg twice daily, for 2 weeks. According to symptoms and side-effects, 32 patients were classified as responders to loratadine, and 28 patients as responders to terfenadine. All observed symptoms were significantly reduced in both treatment groups, but with no significant differences between the two groups. Side-effects were few and mild. In patients with normal IgE, loratadine was significantly superior to terfenadine in relieving nasal secretion, whereas terfenadine was significantly superior to loratadine in relieving nasal congestion. In patients with increased IgE, patients treated with loratadine showed significantly greater reduction in sneezing than patients treated with terfenadine. A positive correlation between total IgE and reduction in overall symptoms was found for patients treated with loratadine, whereas a negative correlation was found for patients treated with terfenadine. During the second study phase, the nonresponders received the other drug for 2 weeks. All seven nonresponders to terfenadine responded to loratadine after crossing over, whereas four of nine nonresponders to loratadine responded to terfenadine. Nonresponders to one drug may respond to the other drug. Thus, more than one antihistamine drug should be tried in perennial allergic rhinitis if the first fails.