From the Guidelines
Megestrol acetate (Megace) is the most effective medication for treating lack of appetite, particularly in patients with cancer cachexia, as it improves appetite and body weight, although its use is associated with potential side effects such as thromboembolic events, edema, and adrenal suppression 1.
Medication Options
- Megestrol acetate is typically prescribed at 400-800 mg daily for adults with appetite loss due to cancer or HIV/AIDS, with effects usually seen within 1-3 weeks of starting treatment.
- Mirtazapine, an antidepressant, is usually started at 15 mg taken at bedtime, with potential increases to 30-45 mg if needed, and has the added benefit of improving mood and sleep.
Key Considerations
- The use of megestrol acetate should be carefully considered, weighing its benefits against potential risks, particularly in patients with a history of thromboembolic events or adrenal insufficiency.
- Regular monitoring of side effects and effectiveness is crucial when using these medications, and they should be discontinued gradually when no longer needed.
- Combination therapy approaches, including the use of megestrol acetate with other agents such as L-carnitine and antioxidants, may yield the best possible outcomes for patients with cancer cachexia 1.
Patient Population
- These medications are effective in various patient populations, including those with cancer, HIV/AIDS, and other conditions associated with lack of appetite.
- However, the evidence for their use in patients with dementia is limited, and their effectiveness in this population is uncertain 1.
From the FDA Drug Label
Megestrol acetate oral suspension, USP is indicated for the treatment of anorexia, cachexia, or an unexplained, significant weight loss in patients with a diagnosis of acquired immunodeficiency syndrome (AIDS) 2. Increased Appetite/Weight Gain In US controlled studies, appetite increase was reported in 17% of patients treated with mirtazapine, compared to 2% for placebo and 6% for amitryptyline 3.
Medications for lack of appetite:
- Megestrol acetate (Megace): used to treat anorexia, cachexia, or significant weight loss in AIDS patients.
- Mirtazapine (Remeron): may increase appetite and weight gain as a side effect, but it is not specifically indicated for the treatment of lack of appetite.
From the Research
Medications for Lack of Appetite
- Megestrol acetate (Megace) is a medication used to treat lack of appetite, specifically in patients with AIDS-associated anorexia and cachexia 4, 5.
- Studies have shown that megestrol acetate induces appetite stimulation and nonfluid weight gain in patients with advanced hormone nonresponsive cancers and AIDS-related cachexia 4, 5.
- Mirtazapine (Remeron) is not mentioned in the provided studies as a treatment for lack of appetite, but other medications such as olanzapine, anamorelin, and cannabis have been researched for their potential to palliate loss of appetite in patients with cancer 6.
- A comparison between megestrol acetate and dronabinol (a cannabinoid) showed that megestrol acetate was superior in treating cancer-associated anorexia and HIV-associated wasting syndrome 7.
Mechanisms and Efficacy
- Megestrol acetate has been shown to be effective in treating lack of appetite in patients with AIDS-related cachexia, with significant improvements in body weight and appetite stimulation 4, 5.
- The exact mechanisms of megestrol acetate's appetite-stimulating effects are not fully understood, but it is thought to be related to its ability to stimulate the appetite center in the brain 4.
- Other medications, such as cannabinoids, have been shown to increase appetite in patients with HIV wasting syndrome, but megestrol acetate is generally considered more effective 7.
Safety and Tolerability
- Megestrol acetate has been shown to be well-tolerated in patients with AIDS-related cachexia, with few reported side effects 4, 5.
- However, megestrol acetate has been associated with impotence in some patients, and other side effects such as deep vein thrombosis have been reported 4, 8.
- The safety and tolerability of other medications, such as cannabinoids, are still being researched, and more studies are needed to fully understand their effects 7.