What medications are used to stimulate appetite?

From the Guidelines

Megestrol acetate is the most effective medication for increasing appetite, with a minimum efficacious dose of 160 mg per day, and should be considered for patients with cancer-related anorexia/cachexia. The use of megestrol acetate has been studied in several trials, including a randomized phase III trial in 332 patients with cancer-related anorexia/cachexia, which revealed superior outcomes for patients receiving a combination regimen that included medroxyprogesterone, megestrol acetate, eicosapentaenoic acid and L-carnitine supplementation, and thalidomide, versus therapy with any of the previously discussed single agents 1. Other medications, such as dronabinol and mirtazapine, may also be considered, but the evidence for their use is less strong. For example, a randomized clinical trial comparing megestrol acetate to dronabinol in treating cancer-associated anorexia revealed megestrol acetate to be superior for promoting weight gain and appetite in patients with advanced cancer 1. It's also important to note that the use of appetite stimulants in patients with dementia is not recommended, as the evidence for their effectiveness is limited and they may have potentially harmful side effects 1. In general, the use of appetite stimulants should be individualized and based on the specific needs and medical conditions of each patient, and should be used under medical supervision. Some key points to consider when using appetite stimulants include:

• Megestrol acetate is the most effective medication for increasing appetite in patients with cancer-related anorexia/cachexia
• The minimum efficacious dose of megestrol acetate is 160 mg per day
• Other medications, such as dronabinol and mirtazapine, may also be considered, but the evidence for their use is less strong
• The use of appetite stimulants in patients with dementia is not recommended
• The use of appetite stimulants should be individualized and based on the specific needs and medical conditions of each patient, and should be used under medical supervision.

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. In these same trials, weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo. 5.7 Increased Appetite and Weight Gain

Mirtazapine may increase appetite and is associated with weight gain in some patients 2, 2, 2.

• Increased appetite was reported in 17% of patients treated with mirtazapine tablets, compared to 2% for placebo.
• Weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo.

From the Research

Medication for Appetite

• Medications such as megestrol acetate and dronabinol are commonly used to stimulate appetite in patients with anorexia 3.
• Megestrol acetate should be tried at a dose of 800 mg per day for no longer than 3 months, while dronabinol should be initially given in a low dose (2.5 mg) in the evening and increased to 5 mg per day if no improvement in appetite is seen after 2 to 4 weeks 3.
• Mirtazapine may be used to stimulate appetite in patients with depression and anorexia, and taste enhancers can be considered in patients who complain that food does not taste good 3.

Efficacy of Appetite-Stimulating Medications

• The efficacy of appetite-stimulating medications such as dronabinol, megestrol acetate, and mirtazapine in hospitalized adults is limited, with no significant change in weight 4.
• A meta-analysis of clinical trials found that megestrol acetate did not appear to be effective in providing symptomatic improvement of anorexia/cachexia in patients with advanced cancer 5.
• A randomized clinical trial found that megestrol acetate suspension increased prealbumin levels in recently hospitalized older persons, but did not confer benefit on other nutritional or clinical outcomes 6.

Comparison of Medications

• A randomized, double-blind trial found that mirtazapine improved anorexia significantly in cancer patients, but the improvement was not statistically significant when compared with megestrol acetate 7.
• The study suggests that mirtazapine may be a potential alternative to megestrol acetate for the treatment of anorexia-cachexia in advanced cancer patients 7.