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Adv Exp Med Biol. 1972;27:399-405.

The use of antiserotonin-cyproheptadine HCL in pregnancy: an experimental and clinical study.



Habitual abortion of psychogenic origin may be associated with increased serotonin production. Serotonin is metabolized by monoamin oxidase (MAO) to hydroxyindole acetic acid (5-HIAA) which is excreted in the urine. When this metabolic system is inadequate excess serotonin may cause contractions of the estrogen-sensitized myometrium and, thus, abortion. In normal pregnancy and in nonpregnant women urinary 5-HIAA is 5.6 mg/day. Women suffering from habitual abortion os psychogenic origin showed 5-HIAA excretion of 10.6 mg/day during pregnancy with high amounts of nonmetabolized serotonin. In rats injection of pargyline HC1, a MAO inhibitor, produced abortion in 84%; a serotonin antagonist, cyproheptadine HC1, injected sc 4-8 hours prior to MAO inhibitor treatment preserved 42% of fetuses. No toxicity was shown in 92.8% of rat fetuses in a teratogenic study. Later 29 women with a total of 31 pregnancies were given 4 to 16 mg/day cyproheptadine HC1 for several months starting early in pregnancy. Previous study had revealed no other causes to explain their spontaneous abortions and treatments with progesterone, antibiotics, and vitamins in earlier pregnancies had been unsuccessful. After cyproheptadine HC1 treatment there were 3 spontaneous abortions, 23 normal infants delivered at term, and 5 premature deliveries of which 1 was a stillbirth. No teratogenic effects were observed. Reports by others in similar cases and results in a control group of 19 women in this study all give much higher rates of spontaneous abortion. Side effects were few and yielded to reduced dosage. It is recommended that patients suffering habitual abortion be examined for serotonin and 5-HIAA excretion. When indicated, treatment with antiserotonin drugs should be given. Observations indicate serotonin production or metabolism may be the decisive factor relating emotional stress to abortion.

[Indexed for MEDLINE]

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