What are appetite stimulants?

From the Guidelines

For patients with cancer-related anorexia, megestrol acetate (400-800mg daily) is the most effective appetite stimulant, as it has been shown to improve appetite and weight gain in these patients 1. When considering appetite stimulants, it's essential to evaluate the underlying cause of poor appetite and existing medical conditions.

• Megestrol acetate is a well-studied option for cancer-related anorexia, with a significant improvement in appetite and weight gain 1.
• Corticosteroids, such as dexamethasone, can also improve appetite, but their use is often limited to patients with a short life expectancy due to potential toxicities and decline in efficacy 1.
• Olanzapine has shown promise as an appetite stimulant, but further evaluation is needed to fully understand its potential role in cancer cachexia 1.
• Non-medication approaches, such as eating smaller, more frequent meals, enhancing food flavor, ensuring adequate hydration, and light exercise before meals, should be tried first to naturally stimulate appetite. It's crucial to prioritize the patient's quality of life, morbidity, and mortality when selecting an appetite stimulant, and to carefully weigh the potential benefits and risks of each option 1.
• The choice of appetite stimulant should be individualized, taking into account the patient's specific needs and medical conditions.
• Regular monitoring of side effects and adjustment of the treatment plan as needed is essential to ensure the best possible outcomes for patients with cancer-related anorexia.

From the FDA Drug Label

The appetite stimulant effect of dronabinol capsules in the treatment of AIDS-related anorexia associated with weight loss was studied in a randomized, double-blind, placebo-controlled study involving 139 patients. A statistically significant difference between dronabinol capsules and placebo was seen in appetite as measured by the visual analog scale at weeks 4 and 6 Tachyphylaxis and tolerance do not appear to develop to the appetite stimulant effect of dronabinol capsules In clinical studies involving AIDS patients, the appetite stimulant effect of dronabinol capsules was sustained for up to five months at dosages ranging from 2.5 mg to 20 mg per day.

Dronabinol is an effective appetite stimulant. The studies demonstrate a statistically significant difference in appetite between dronabinol and placebo in patients with AIDS-related anorexia.

• The appetite stimulant effect is sustained for up to five months at dosages ranging from 2.5 mg to 20 mg per day.
• Key benefits of dronabinol include its ability to stimulate appetite without developing tachyphylaxis or tolerance.
• Clinical use: Dronabinol can be used to treat anorexia associated with weight loss in patients with AIDS, as supported by the study results 2.

From the Research

Appetite Stimulants

• The efficacy of appetite-stimulating medications, such as dronabinol, megestrol acetate, and mirtazapine, has been studied in various populations, including hospitalized adults and patients with cancer or HIV-associated anorexia 3, 4, 5, 6, 7.
• Megestrol acetate and dronabinol are two commonly used appetite stimulants, with megestrol acetate showing superior anorexia palliation in advanced cancer patients compared to dronabinol alone 5.
• Combination therapy of megestrol acetate and dronabinol did not appear to confer additional benefit compared to megestrol acetate alone 5.
• Oxandrolone, an anabolic agent, has been compared to megestrol acetate in patients with HIV-related weight loss, showing similar effects on body weight and composition 6.
• Cyproheptadine, another appetite stimulant, has been compared to megestrol acetate in patients with HIV-associated weight loss, with both treatments resulting in moderate weight gain 7.

Mechanism of Action

• The exact mechanism of action of these appetite stimulants is not fully understood, but they are thought to work by increasing appetite and food intake, as well as promoting weight gain 4.
• Megestrol acetate, for example, is believed to work by stimulating the appetite center in the brain, while dronabinol is thought to work by binding to cannabinoid receptors in the brain and increasing appetite 4.

Side Effects and Limitations

• These appetite stimulants can have side effects, such as impotence in men taking megestrol acetate, and may not be suitable for all patients 4, 7.
• The efficacy of these medications can also be limited by factors such as the underlying cause of anorexia, the presence of other medical conditions, and the patient's overall health status 3, 4.