Comparison of the efficacy of amitriptyline and topiramate in prophylaxis of cyclic vomiting syndrome

Zahra Bagherian, Omid Yaghini, Hossein Saneian, Shervin Badihian



Objectives: Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder with no certain treatment. We aimed to compare the efficacy of amitriptyline and topiramate on prophylactic therapy of CVS.

Materials and Methods: This is a randomized clinical trial conducted during 2016 in Isfahan, Iran. The inclusion criteria were CVS patients (based on Rome III) aging 3-15 years with normal physical examination, no metabolic disorder, and no gastrointestinal obstruction or renal impairment. Recruited patients were divided into two groups of amitriptyline (1 mg/kg/daily) and topiramate (1-2mg/kg/daily) and were followed 3-months. The outcome was evaluated by comparing severity of attacks (monthly frequency and duration of attacks) before and after intervention.

Results: Thirty-six children entered each group and two patients left the amitriptyline group. Patients and disease characteristics were similar between groups before intervention (P-value>0.05). The frequency of attacks (standard deviation) after intervention in amitriptyline and topiramate group were 0.91 (0.40) and 1.07 (0.55), respectively (P-value=0.368) and the duration of attacks (SD) after intervention were 3.43 (2.46) and 4.90 (3.03), respectively (P-value=0.017). Twenty-three patients (68%) in amitriptyline group and 14 patients (39%) in topiramate group stopped having attacks after intervention (P-value=0.016).

Conclusion: Amitriptyline can be considered as the better choice for CVS therapy compared to topiramate considering the high response rate of patients to this drug.


Amitriptyline; Topiramate; Cyclic Vomiting Syndrome; RCT; Prophylaxis

Full Text:




Ölmez A, Köse G, Turanli G. Cyclic vomiting with generalized epileptiform discharges responsive to topiramate therapy. Pediatric neurology. 2006;35(5):348-51.

Boles RG. High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series. BMC neurology. 2011;11(1):102.

Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130(5):1527-37.

Fleisher DR, Matar M. The cyclic vomiting syndrome: a report of 71 cases and literature review. Journal of pediatric gastroenterology and nutrition. 1993;17(4):361-9.

Li BU, Lefevre F, Chelimsky GG, Boles RG, Nelson SP, Lewis DW, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. Journal of pediatric gastroenterology and nutrition. 2008;47(3):379-93.

Boles RG, Lovett-Barr MR, Preston A, Li BU, Adams K. Treatment of cyclic vomiting syndrome with co-enzyme Q10 and amitriptyline, a retrospective study. BMC neurology. 2010;10(1):1.

Fleisher DR. The cyclic vomiting syndrome described. Journal of pediatric gastroenterology and nutrition. 1995;21:S1-S5.

Venkatesan T, Tarbell S, Adams K, McKanry J, Barribeau T, Beckmann K, et al. A survey of emergency department use in patients with cyclic vomiting syndrome. BMC emergency medicine. 2010;10(1):1.

Li B, Murray RD, Heitlinger LA, Robbins JL, Hayes JR. Is cyclic vomiting syndrome related to migraine? The Journal of pediatrics. 1999;134(5):567-72.

Moses J, Keilman A, Worley S, Radhakrishnan K, Rothner AD, Parikh S. Approach to the diagnosis and treatment of cyclic vomiting syndrome: a large single-center experience with 106 patients. Pediatric neurology. 2014;50(6):569-73.

Sezer OB, Sezer T. A new approach to the prophylaxis of cyclic vomiting: Topiramate. Journal of Neurogastroenterology and Motility. 2016.

Kumar N, Bashar Q, Reddy N, Sengupta J, Ananthakrishnan A, Schroeder A, et al. Cyclic Vomiting Syndrome (CVS): is there a difference based on onset of symptoms-pediatric versus adult? BMC gastroenterology. 2012;12(1):1.

Boles RG, Powers AL, Adams K. Cyclic vomiting syndrome plus. Journal of child neurology. 2006;21(3):182-9.

Hejazi RA, Reddymasu SC, Namin F, Lavenbarg T, Foran P, McCallum RW. Efficacy of tricyclic antidepressant therapy in adults with cyclic vomiting syndrome: a two-year follow-up study. Journal of clinical gastroenterology. 2010;44(1):18-21.

Lee LY, Abbott L, Mahlangu B, Moodie SJ, Anderson S. The management of cyclic vomiting syndrome: a systematic review. European journal of gastroenterology & hepatology. 2012;24(9):1001-6.

Namin F, Patel J, Lin Z, Sarosiek I, Foran P, Esmaeili P, et al. Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy1. Neurogastroenterology & Motility. 2007;19(3):196-202.

Andersen JM, Sugerman KS, Lockhart JR, Weinberg WA. Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine. Pediatrics. 1997;100(6):977-81.

Haghighat M, Rafie SM, Dehghani SM, Fallahi GH, Nejabat M. Cyclic vomiting syndrome in children: experience with 181 cases from southern Iran. World Journal of Gastroenterology. 2007;13(12):1833.

Jackson JL, Cogbill E, Santana-Davila R, Eldredge C, Collier W, Gradall A, et al. A comparative effectiveness meta-analysis of drugs for the prophylaxis of migraine headache. PloS one. 2015;10(7):e0130733.



  • There are currently no refbacks.

Copyright (c) 2018 Iranian Journal of Child Neurology