Buclizine- old wine in new bottle?

Abstract

Buclizine is a first generation antihistaminic with some anticholinergic potential. This drug has specific pharmacological indications in allergy, morning sickness, migraine, motion sickness and insomnia with some or doubtful success. It is an obsolete drug of decline use due to better availability of second and third generation antihistamines.
Buclizine, a forgotten drug used in past is now re-introduced as an appetite stimulant. Previously one of the counterpart “cyproheptadine” was used but currently banned from most part of the world due to untoward effects.
The standard textbook of pediatrics has not mentioned buclizine as an appetizer. On the other side, no article published (Pub med search) in last few decades to favors this claim. This drug has no space in WHO essential medicine list probably due to doubtful safety.
A scientific issue arises- Does children require appetite stimulant? Appetizers are never be a rational solution. They can be used as adjunct because of their placebo effect. Meanwhile placebo has limited role in children on behalf of other party (parents) involvement. Misperception about diet, feeding practice, dysfunctional ‘parent child interaction’ etc. needed proper counselling rather than prescribing an appetite stimulant.
There may be risk, that buclizine to become “OTC” appetizer in future due to current promotional spurt by pharmaceutical. However, large scale multicentric clinical trials are needed before promotion of buclizine as pediatric appetite stimulant, with careful watch of pharmacovigilance perspective.