What is the treatment for poor appetite (anorexia)?

From the Guidelines

Treatment for poor appetite (anorexia) should prioritize addressing reversible causes, relieving symptoms that interfere with food intake, and considering appetite stimulants like megestrol acetate or dexamethasone for patients with limited life expectancy, as these interventions can improve quality of life 1.

Key Considerations

• Identifying and addressing underlying causes of anorexia, such as oropharyngeal candidiasis, depression, pain, constipation, and nausea/vomiting, is crucial for effective management 1.
• For patients with advanced cancer, a combination therapy approach, including medications like medroxyprogesterone, megestrol acetate, eicosapentaenoic acid, and L-carnitine supplementation, may yield the best possible outcomes 1.
• Corticosteroids can be used to increase appetite in individuals with advanced disease for a restricted period (1-3 weeks), but their use should be cautious due to potential side effects like muscle wasting and insulin resistance 1.

Treatment Options

• Megestrol acetate (400-800mg daily) is a recommended appetite stimulant for patients with cancer-related anorexia/cachexia, as it has been shown to improve appetite and weight gain 1.
• Dexamethasone can also be considered for appetite stimulation, particularly in patients with limited life expectancy 1.
• Nutritional supplements, such as protein shakes, and oral nutritional supplements (ONS) can help maintain caloric intake and prevent nutritional deterioration, especially during radiotherapy or chemotherapy 1.

Lifestyle Interventions

• Encouraging regular physical activity and maintaining a healthy weight (BMI 18.5-25 kg/m2) can help improve appetite and overall quality of life 1.
• A healthy lifestyle, including a diet rich in vegetables, fruits, and whole grains, and low in saturated fat, red meat, and alcohol, is recommended for cancer survivors 1.

Important Considerations

• The use of cannabinoids for anorexia/cachexia in cancer patients is not recommended due to limited evidence and potential side effects like delirium in elderly patients 1.
• Nutritional interventions should be individualized and considered in the context of the patient's prognosis, expected benefit on quality of life, and potential burden associated with nutritional care 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. The treatment for poor appetite (anorexia) is mirtazapine as it has been shown to increase appetite in 17% of patients treated with it, compared to 2% for placebo 2.

• Key benefits: increased appetite and weight gain
• Important considerations: monitor for symptoms of serotonin syndrome, angle-closure glaucoma, QTc prolongation, and torsades de pointes.

From the Research

Treatment for Poor Appetite (Anorexia)

• The treatment for poor appetite (anorexia) may involve the use of appetite-stimulating medications such as megestrol acetate, dronabinol, and mirtazapine 3, 4, 5, 6.
• Megestrol acetate has been shown to increase weight gain in patients with anorexia, but its effectiveness in improving quality of life is unclear 3.
• A systematic review of megestrol acetate for the treatment of anorexia-cachexia syndrome found that it increased weight gain, but did not improve quality of life, and was associated with more adverse events 3.
• A retrospective cohort study of hospitalized patients initiated on dronabinol, megestrol, or mirtazapine for appetite found that there was no significant difference between groups in terms of change in meal intake or weight, but each agent showed numerical improvements in meal intake 4.
• A review of the efficacy of appetite-stimulating medications in hospitalized adults found that the current data lack standardization, generalizability, and comparability, and higher quality evidence is needed before conclusions can be identified on the efficacy of these medications 6.
• Appetite stimulants such as cyproheptadine hydrochloride and megestrol acetate may produce a larger increase in weight in patients with cystic fibrosis-related anorexia, but the certainty of the evidence is low due to the small number of participants and incomplete or selective outcome reporting 5.

Medications Used to Treat Poor Appetite

• Megestrol acetate: a medication that has been shown to increase weight gain in patients with anorexia, but its effectiveness in improving quality of life is unclear 3.
• Dronabinol: a medication that has been used to stimulate appetite in hospitalized patients, but its efficacy is limited and more research is needed 4, 6.
• Mirtazapine: a medication that has been used to stimulate appetite in hospitalized patients, but its efficacy is limited and more research is needed 4, 6.
• Cyproheptadine hydrochloride: a medication that may produce a larger increase in weight in patients with cystic fibrosis-related anorexia, but the certainty of the evidence is low 5.