What medications can be used to stimulate appetite and promote weight gain in patients without an underlying condition?

From the Guidelines

Medications such as cyproheptadine, mirtazapine, dronabinol, megestrol acetate, and low-dose corticosteroids like prednisone can be used to stimulate appetite and promote weight gain in patients without an underlying condition, but their use should be carefully considered due to potential side effects and risks. When considering medications to stimulate appetite, it's crucial to weigh the benefits against the potential risks, especially in otherwise healthy individuals. The most recent guidelines, such as those from 1, emphasize the importance of reviewing concomitant medications that may promote weight gain, but they do not directly recommend medications for appetite stimulation in healthy individuals. However, based on clinical practice and older guidelines like 1, several medications have been used off-label for this purpose.

Medication Options

• Cyproheptadine, an antihistamine with appetite-stimulating properties, is typically used at a dose of 4mg three to four times daily.
• Mirtazapine, an antidepressant that can increase appetite as a side effect, is usually started at 15mg at bedtime.
• Dronabinol, a synthetic cannabinoid, can stimulate appetite but may cause psychoactive effects, and is used at a dose of 2.5mg twice daily.
• Megestrol acetate, a progestin, can significantly increase appetite and weight but carries risks of adrenal suppression and thromboembolic events, and is used at a dose of 400-800mg daily.
• Low-dose corticosteroids like prednisone can temporarily boost appetite but are not recommended for long-term use due to serious side effects, and are used at a dose of 5-10mg daily for short courses. These medications work through various mechanisms, including affecting hunger hormones, altering neurotransmitter activity, or reducing early satiety signals. It's essential to combine medication use with nutritional counseling and addressing any psychological factors affecting eating, and to monitor regularly for side effects, limiting treatment duration to 3-6 months while developing sustainable eating habits.

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. Oxandrin is indicated as adjunctive therapy to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma, and in some patients who without definite pathophysiologic reasons fail to gain or to maintain normal weight

Medications for Increased Appetite and Weight Gain:

• Dronabinol (PO): may be used to stimulate appetite and promote weight gain in patients with AIDS-related anorexia associated with weight loss 2.
• Oxandrolone (PO): is indicated as adjunctive therapy to promote weight gain in patients who have experienced weight loss due to various conditions, including extensive surgery, chronic infections, or severe trauma, and in some patients who fail to gain or maintain normal weight without a definite pathophysiologic reason 3.

Key Considerations:

• These medications may have side effects and should be used under medical supervision.
• The use of these medications for appetite stimulation and weight gain in patients without an underlying condition should be approached with caution and carefully evaluated on a case-by-case basis.

From the Research

Medications for Increased Appetite and Weight Gain

Medications that can be used to stimulate appetite and promote weight gain in patients without an underlying condition include:

• Megestrol acetate: a synthetic progesterone that has been shown to increase appetite and weight gain in various studies 4, 5, 6, 7
• Dronabinol: a cannabinoid that has been used to stimulate appetite, although its efficacy is limited compared to megestrol acetate 4, 5, 8, 7
• Mirtazapine: an antidepressant that has been used to stimulate appetite, particularly in patients with depression and anorexia 4, 8
• Oxandrolone: an anabolic steroid that has been used to promote weight gain, particularly in combination with megestrol acetate and dietary advice 6

Dosage and Administration

The dosage and administration of these medications vary depending on the specific study and patient population:

• Megestrol acetate: typically administered at a dose of 800 mg per day, although lower doses may be used in combination with other medications 4, 5, 6, 7
• Dronabinol: typically administered at a dose of 2.5 mg twice a day, although higher doses may be used in some cases 4, 5, 8, 7
• Mirtazapine: typically administered at a dose of 15-30 mg per day, although the optimal dose for appetite stimulation is not well established 4, 8
• Oxandrolone: typically administered at a dose of 10 mg twice a day, although the optimal dose for weight gain is not well established 6

Efficacy and Safety

The efficacy and safety of these medications vary depending on the specific study and patient population:

• Megestrol acetate: has been shown to be effective in increasing appetite and weight gain in various studies, although it may be associated with adverse effects such as deep vein thrombosis and impotence 4, 5, 6, 7
• Dronabinol: has been shown to be less effective than megestrol acetate in increasing appetite and weight gain, although it may be associated with fewer adverse effects 4, 5, 8, 7
• Mirtazapine: has been shown to be effective in increasing appetite in some studies, although its efficacy and safety in promoting weight gain are not well established 4, 8
• Oxandrolone: has been shown to be effective in promoting weight gain in combination with megestrol acetate and dietary advice, although its efficacy and safety as a single agent are not well established 6