Comparing the Effects of Folic Acid and Cyproheptadine on Appetite, Weight, and ADHD Symptoms in Children with ADHD: A Randomized Clinical Trial

Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) treated with methylphenidate may lose their appetite and body weight. In this study, an attempt was to compare the effects of folic acid with cyproheptadine on appetite, weight, and symptoms of attention deficit and hyperactivity in children with ADHD who are taking methylphenidate. Methods: This was a randomized clinical trial performed on 7-12 year old children who were diagnosed with ADHD, treated with methylphenidate, and complained of appetite loss. In the first visit, anthropometric measurements were performed and then mothers completed the ADHD rating scale, Sleep Disturbance Scale for Children, and visual analogue scale for appetite. Then, the participants were randomly assigned to receive either cyproheptadine (4 mg/day), or folic acid (1 mg/day). All assessments were repeated after 8 weeks. Results: Twenty-four children in the cyproheptadine group and 23 in the folic acid group (19 boys in each group) completed the study and statistical analyses were performed. The hyperactivity score significantly decreased in the folic acid group compared with the cyproheptadine group (p=0.035). However, the change in attention deficiency scores between groups was not significant. During the study, only girls in the folic acid group had significant body weight increase in contrast to other subgroups. Conclusion: Improving hyperactivity symptoms in the folic acid group along with better growth especially in girls reveals the clinical superiority of folic acid over cyproheptadine.