From the Guidelines
The most effective treatment for decreased appetite (anorexia) in patients with chronic conditions is a multifaceted approach that includes the use of megestrol acetate as a first-line pharmacological option, due to its proven efficacy in improving appetite and weight gain, as demonstrated in a randomized phase III trial 1. This approach should be tailored to the individual, taking into account the underlying causes of anorexia, such as pain, depression, nausea, or medication side effects. Key aspects of this approach include:
- Pharmacological interventions: megestrol acetate (starting at 160-800 mg daily) is recommended as a first-line option due to its efficacy in improving appetite and weight gain 1.
- Nutritional interventions: offering small, frequent, nutrient-dense meals, incorporating favorite foods, and ensuring adequate protein intake (1.2-1.5 g/kg/day) are crucial for managing anorexia.
- Addressing underlying causes: treating pain, depression, nausea, or medication side effects that may contribute to poor appetite is essential for optimal results.
- Multidisciplinary approach: involving physicians, dietitians, and sometimes mental health professionals can help address the complex needs of patients with anorexia.
- Regular monitoring: weight, nutritional status, and medication effectiveness should be regularly monitored, with adjustments made as needed, and treatment duration should be reassessed every 2-4 weeks initially. While other options like dronabinol may have some benefits, the evidence is limited and inconsistent, and therefore, megestrol acetate remains the preferred choice 1.
From the FDA Drug Label
The effectiveness of dronabinol capsules has been established based on studies for the treatment of anorexia associated with weight loss in patients with AIDS and nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments. 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.
Dronabinol may be an effective treatment for decreased appetite (anorexia) in patients with chronic conditions, specifically AIDS-related anorexia associated with weight loss.
- The initial dosage of dronabinol is 5 mg/day, administered in doses of 2.5 mg one hour before lunch and one hour before dinner.
- Dronabinol has been shown to have a statistically significant difference in appetite as measured by the visual analog scale at weeks 4 and 6.
- Trends toward improved body weight and mood, and decreases in nausea were also seen. 2
From the Research
Treatment Options for Decreased Appetite
- Megestrol acetate is a commonly used treatment for anorexia-cachexia syndrome in patients with chronic conditions such as cancer and AIDS 3, 4, 5.
- Studies have shown that megestrol acetate improves appetite and weight gain in cancer patients 3, 5.
- In AIDS patients, megestrol acetate has been shown to increase appetite and weight gain, with significant improvements in body weight and lean body mass 4, 5.
- The optimal dose of megestrol acetate is not well established, but higher doses may be more effective for weight gain 5.
Benefits and Risks of Megestrol Acetate
- Megestrol acetate has been shown to improve quality of life in patients with cancer and AIDS, particularly with regard to appetite and weight gain 3, 5.
- However, megestrol acetate is associated with side effects such as oedema, thromboembolic phenomena, and deaths 5.
- The weight gain associated with megestrol acetate is mainly due to an increase in fat mass, and may not necessarily improve muscle mass or overall health 6.
Other Patient Populations
- Megestrol acetate has also been studied in maintenance dialysis patients, where it has been shown to improve nutritional state, inflammation, and anorexia at a moderate dose of 400 mg/day 7.
- Further research is needed to confirm the effectiveness of megestrol acetate in different patient populations and to establish the optimal dose and treatment duration 3, 5, 7.