From the Guidelines
Mirtazapine is the better option to stimulate appetite, particularly in patients with depression, anxiety, or conditions causing weight loss, due to its ability to block certain serotonin receptors and histamine H1 receptors, leading to increased appetite. The choice of medication depends on the patient's underlying condition, and mirtazapine is particularly suitable for patients with concurrent depression or anxiety 1.
Some key points to consider when using mirtazapine for appetite stimulation include:
- Typical dosage: 15-45 mg taken at bedtime, with lower doses (7.5-15 mg) having stronger appetite-stimulating effects than higher doses
- Side effects: sedation, dry mouth, constipation, and increased cholesterol levels
- Monitoring: patients should be monitored for excessive weight gain or metabolic changes
- Alternative options: certain antipsychotics like olanzapine and quetiapine, cyproheptadine (an antihistamine), and dronabinol (a cannabinoid) may also be effective in increasing appetite 1.
It's essential to note that the evidence for using appetite stimulants in patients with dementia is limited, and their use is not generally recommended 1. However, in specific clinical situations, such as concurrent depressive syndrome, mirtazapine may be an option 1.
In patients with cancer-related anorexia/cachexia, megestrol acetate, olanzapine, and dexamethasone may be considered as appetite stimulants, but the evidence is mixed, and their use should be individualized based on patient preferences and goals 1.
Ultimately, the decision to use mirtazapine or other appetite stimulants should be based on a thorough assessment of the patient's underlying condition, medical history, and individual needs, with careful monitoring of potential side effects and benefits 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. Increased appetite and weight gain. Table 3: Adverse Reactions (≥5% and twice placebo) in 6-Week U. S. Clinical Trials of Mirtazapine Tablets in Patients with MDD Mirtazapine Tablets (n=453) Placebo (n=361) Somnolence 54% 18% Increased Appetite 17% 2% Weight Gain 12% 2%
Mirtazapine is associated with an increased appetite in 17% of patients, compared to 2% for placebo, and weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo 2. There is no information about "tablet practin" in the provided drug labels, therefore, no comparison can be made between "tablet practin" and Mirtazapine regarding their effects on appetite stimulation 2, 2, 2.
From the Research
Comparison of Mirtazapine and Other Medications for Appetite Stimulation
- Mirtazapine is considered a potential alternative to megestrol acetate for stimulating appetite, as shown in a study where mirtazapine improved anorexia significantly in cancer patients 3.
- However, another study found that mirtazapine appears to be inferior to megestrol in weight and appetite improvement, with 52% of participants in the megestrol group experiencing weight gain compared to 38% in the mirtazapine group 4.
- A study comparing mirtazapine with megestrol acetate in the treatment of anorexia-cachexia syndrome in patients with advanced cancer found that appetite improved in 92% of participants in the megestrol group and 56% in the mirtazapine group after eight weeks 4.
- In terms of other medications, megestrol acetate and dronabinol are commonly used to stimulate appetite, with megestrol acetate recommended for persons with a large excess cytokine production and dronabinol recommended for most anorectic patients 5.
- Oxandrolone has also been compared to megestrol acetate, with similar effects on body weight and composition in patients with HIV-related weight loss 6.
Specifics of Mirtazapine and Megestrol Acetate
- Mirtazapine has been shown to improve anorexia in cancer patients, but its effectiveness compared to megestrol acetate is still being studied 3, 4.
- Megestrol acetate is recommended for persons with a large excess cytokine production and has been shown to be effective in improving appetite and weight gain in various patient populations 5, 4, 6.
- The dosage of mirtazapine used in studies ranges from 15mg to 30mg per day, while megestrol acetate is typically used at a dose of 160mg to 320mg per day 3, 4.
Limitations and Future Research
- Current data on the efficacy of appetite-stimulating medications, including mirtazapine and megestrol acetate, lack standardization, generalizability, and comparability, and higher quality evidence is needed before conclusions can be drawn 7.
- Further research is needed to fully understand the effectiveness of mirtazapine and other medications for appetite stimulation in different patient populations and settings 7, 3, 4.