From the Guidelines
Megestrol acetate suspension (400-800mg daily) is the most effective prescription appetite stimulant for increasing appetite, particularly in patients with cancer-related or HIV-related weight loss, as it has been shown to improve appetite and weight gain in several studies 1. When considering prescription food additives for increasing appetite, several options are available, including:
- Megestrol acetate suspension (400-800mg daily)
- Dronabinol (2.5mg twice daily before lunch and dinner)
- Cyproheptadine (2-4mg before meals)
- Mirtazapine (15-30mg daily, usually taken at bedtime) These medications work through different mechanisms, such as affecting serotonin pathways, histamine receptors, or cannabinoid systems, to trigger hunger signals in the brain. However, the evidence for the use of appetite stimulants, particularly dronabinol, is limited and inconsistent, and its use is not recommended as a first-line treatment 1. In contrast, megestrol acetate has been shown to be effective in improving appetite and weight gain in patients with cancer-related anorexia/cachexia, and its use is recommended in certain clinical situations 1. It is essential to note that the use of appetite stimulants should be individualized and monitored closely by a healthcare provider to assess effectiveness and adjust dosing as needed, while also being aware of potential side effects, such as drowsiness, dizziness, dry mouth, and mood changes 1.
From the FDA Drug Label
In U. S. controlled clinical studies, appetite increase was reported in 17% of patients treated with mirtazapine tablets, compared to 2% for placebo. The FDA-approved prescription medication mirtazapine may be used to increase appetite, as it has been shown to cause an increase in appetite in 17% of patients treated with the medication.
- Key points:
- Mirtazapine is a prescription medication that may increase appetite.
- It is not specifically approved as a food additive, but rather as an antidepressant medication.
- The medication should only be used under the guidance of a healthcare professional, as it can have serious side effects and interactions with other medications 2.
From the Research
Prescription Food Additives for Increasing Appetite
- The use of appetite-stimulating medications such as dronabinol, megestrol, and mirtazapine has been studied in various settings, including inpatient and outpatient care 3, 4, 5, 6.
- A retrospective cohort study found that mirtazapine was the most commonly used medication for appetite stimulation in hospitalized patients, with 42% of patients experiencing improvement in diet after starting the medication 3.
- Another study compared the efficacy of megestrol acetate and dronabinol in persons with anorexia and weight loss, suggesting that megestrol acetate should be tried at a dose of 800 mg per day for no longer than 3 months, while dronabinol should be used for most anorectic patients 4.
- A review of recent evidence on the efficacy of appetite-stimulating medications in hospitalized adults found that these medications have limited efficacy on improving appetite and meal intake, with no significant change in weight 5.
- A randomized, double-blind trial compared mirtazapine and megestrol acetate in the treatment of anorexia-cachexia in advanced cancer patients, finding that mirtazapine improved anorexia significantly after 4 to 8 weeks of treatment, although the improvement was not statistically significant compared to megestrol acetate 6.
- Another study compared megestrol acetate therapy with oxandrolone therapy for HIV-related weight loss, finding similar results in 2 months, with both treatments resulting in significant weight gain and being safe and well-tolerated 7.
Medications Used for Appetite Stimulation
- Dronabinol: a medication used to stimulate appetite, particularly in patients with anorexia and weight loss 3, 4, 5.
- Megestrol acetate: a medication used to stimulate appetite and improve weight gain, particularly in patients with anorexia and weight loss 3, 4, 5, 6, 7.
- Mirtazapine: an antidepressant medication that has been used to stimulate appetite, particularly in patients with depression and anorexia 3, 4, 6.
- Oxandrolone: an anabolic agent used to promote weight gain and improve body composition, particularly in patients with HIV-related weight loss 7.