From the Guidelines
Treatment for poor appetite (anorexia) should prioritize addressing reversible causes and implementing supportive measures, with consideration of appetite stimulants like megestrol acetate for patients with advanced disease and limited life expectancy, as evidenced by 1 and 1. When managing anorexia, it is crucial to address underlying causes such as depression, oropharyngeal candidiasis, and symptoms that interfere with food intake, including pain, constipation, and nausea/vomiting.
Key Considerations
- Addressing reversible causes of anorexia is essential for improving appetite and overall quality of life.
- For patients with limited life expectancy, appetite stimulants such as megestrol acetate may be considered to improve appetite and quality of life, as shown in 1.
- Combination therapy approaches, including medications like medroxyprogesterone, megestrol acetate, eicosapentaenoic acid, and L-carnitine supplementation, may yield better outcomes for patients with cancer cachexia, as demonstrated in 1.
- Corticosteroids can be used to increase appetite in individuals with advanced disease for a short period, but their use should be cautious due to potential side effects like muscle wasting and insulin resistance, as noted in 1.
Supportive Measures
- Eating smaller, more frequent meals throughout the day
- Choosing nutrient-dense, calorie-rich foods
- Making mealtimes pleasant social experiences
- Gentle exercise before meals to stimulate hunger
- Avoiding excessive fluids during meals to prevent feeling full too quickly
- Considering nutritional supplements like protein shakes between meals to maintain caloric intake
Medications
- Megestrol acetate (Megace) at 400-800mg daily
- Mirtazapine (Remeron) at 15-30mg before bed
- Dronabinol (Marinol) at 2.5mg twice daily, although its use is less supported by evidence for cancer-related anorexia, as discussed in 1 and 1. It is essential to weigh the benefits and risks of these interventions, considering the patient's prognosis, quality of life, and potential survival, as emphasized in 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Poor Appetite (Anorexia)
- The treatment for poor appetite (anorexia) may involve the use of appetite-stimulating medications, such as multivitamin and multimineral containing appetite-stimulating preparations, as preferred by 54% of physicians 2.
- Appetite stimulants, including cyproheptadine hydrochloride and megestrol acetate, have been used to help patients with chronic anorexia attain optimal body mass index (BMI) and nutritional status, with low-certainty evidence suggesting they may produce a larger increase in weight at three and six months 3.
- However, the efficacy of appetite-stimulating medications, such as dronabinol, megestrol acetate, and mirtazapine, in hospitalized adults is limited, with current data lacking standardization, generalizability, and comparability 4.
- Nutritional therapy appears to be a logical step to combat inadequate nutrition, but clinical trial data demonstrating benefits are sparse, and there is no current established standard algorithm for use of nutritional support in malnourished, acutely ill medical inpatients 5.
- A range of strategies can be used to promote better appetite and increase food intake, including patient counseling and information leaflets, awareness campaigns to improve awareness 2.
- Improving nutritional deficiency is considered a reason to treat loss of appetite by 59% of physicians, with multivitamin and multimineral containing appetite-stimulating preparations being preferred 2.