From the Guidelines
Mirtazapine can be prescribed for poor appetite, particularly in patients with depression or anxiety, as it may stimulate appetite as a side effect, as noted in a study published in 2024 1. When considering mirtazapine for poor appetite, it's essential to weigh the potential benefits against the risks, especially in patients with dementia, where the evidence for appetite stimulants is limited 1.
- The medication is typically started at a dose of 15 mg taken once daily at bedtime, with appetite-enhancing effects often occurring at lower doses (7.5-15 mg) 1.
- Patients should be aware of potential side effects, including drowsiness, weight gain, dry mouth, and constipation, and improvement in appetite may be noticed within the first few weeks of treatment.
- A small retrospective non-controlled open label study in 22 participants with dementia given a daily dose of 30 mg mirtazapine reported a mean weight gain of 1.9 kg after three months and 2.1 kg after six months, with about 80% of patients experiencing weight gain 1.
- However, for patients without depression, the use of mirtazapine for weight loss cannot be recommended due to the lack of placebo-controlled trials 1.
- Mirtazapine may be particularly useful for individuals who need both mood improvement and appetite stimulation, though it's crucial to prescribe it as part of a comprehensive treatment plan addressing the underlying cause of poor appetite.
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. Mirtazapine can be prescribed for poor appetite because it has been shown to increase appetite in some patients. However, it is essential to weigh the potential benefits against the potential risks and consider alternative treatment options.
- Key considerations:
- Mirtazapine is not explicitly approved for the treatment of poor appetite.
- The decision to prescribe mirtazapine for poor appetite should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.
- Patients should be closely monitored for potential side effects, including increased appetite and weight gain 2.
From the Research
Mirtazapine for Poor Appetite
- Mirtazapine can be prescribed for poor appetite, as it is known to promote appetite and weight gain, decrease nausea and vomiting, and improve gastric emptying 3.
- Studies have shown that mirtazapine is effective in stimulating appetite in various patient populations, including those with avoidant and restrictive food intake disorder (ARFID) and hospitalized patients 3, 4.
- A retrospective cohort study found that mirtazapine was the most commonly used appetite-stimulating medication in hospitalized patients, with 42% of patients experiencing improvement in diet after starting the medication 4.
- However, another study found that mirtazapine had limited efficacy in improving appetite and meal intake in hospitalized adults, with no significant change in weight 5.
- A case study reported that abrupt discontinuation of mirtazapine can lead to a discontinuation syndrome, characterized by anxiousness, nausea, tremor, loss of appetite, and weight loss 6.
- A review of the efficacy of appetite-stimulating medications, including mirtazapine, found that current data lack standardization, generalizability, and comparability, and higher quality evidence is needed to conclude its efficacy in the inpatient setting 5.
- An open trial study found that mirtazapine was effective in controlling nausea in cancer patients, but its efficacy for appetite loss was not clear 7.