From the Guidelines
Megestrol acetate is the most effective medication for stimulating appetite, particularly in cancer patients, due to its ability to improve appetite and weight gain, as evidenced by a recent systematic review and meta-analysis 1. When considering medications to stimulate appetite, several options are available.
- Megestrol acetate (Megace) at 400-800mg daily is a commonly prescribed medication for cancer-related appetite loss, with studies showing improved appetite and weight gain in patients with cancer cachexia 1.
- Dronabinol (Marinol), a synthetic cannabinoid, can be taken at 2.5mg twice daily, though it may cause drowsiness, and has shown some efficacy in improving chemosensory perception and appetite in patients with cancer anorexia 2.
- Other medications, such as cyproheptadine (Periactin) and mirtazapine (Remeron), may also be effective in stimulating appetite, but the evidence is less robust compared to megestrol acetate. It is essential to note that the choice of medication should be individualized, taking into account the patient's underlying condition, potential side effects, and quality of life.
- Patients should combine medication with small, frequent, nutrient-dense meals and address any underlying conditions causing poor appetite for best results.
- Additionally, a combination therapy approach, including medications such as medroxyprogesterone, megestrol acetate, eicosapentaenoic acid, and L-carnitine supplementation, may yield the best possible outcomes for patients with cancer cachexia 1.
From the FDA Drug Label
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. A statistically significant difference between dronabinol capsules and placebo was seen in appetite as measured by the visual analog scale at weeks 4 and 6
- Dronabinol can be used to stimulate appetite, particularly in patients with AIDS-related anorexia associated with weight loss 3.
- The medication has been shown to have a statistically significant effect on appetite in clinical trials.
- It is essential to weigh the potential benefits against the risks, considering the patient's medical history and potential for abuse or misuse.
From the Research
Medications for Stimulating Appetite
- Dronabinol, megestrol, and mirtazapine are used to stimulate appetite in various settings 4
- These medications have been studied in both inpatient and outpatient settings to evaluate their effectiveness in improving appetite and weight gain
Specific Medications
- Megestrol acetate has been shown to increase appetite and food intake, leading to weight gain in patients with cachexia-anorexia syndrome 5
- A nanocrystal-containing megestrol acetate formulation has been developed to improve bioavailability, particularly in a fasting state 6
- Dronabinol and mirtazapine have also been used to stimulate appetite, although their effectiveness in hospitalized adults is limited 4, 7
Dosage and Efficacy
- The optimal dose of megestrol acetate for stimulating appetite is unclear, with studies showing varying results for different doses 5
- A moderate dose of megestrol acetate (400 mg/day) has been shown to improve nutritional state and inflammation in maintenance dialysis patients 8
- Higher quality evidence is needed to determine the efficacy of dronabinol, megestrol acetate, and mirtazapine in the inpatient setting 7
Safety and Adverse Effects
- No serious adverse effects were observed in a study of hospitalized patients initiated on dronabinol, megestrol, or mirtazapine for appetite stimulation 4
- Megestrol acetate has been associated with side effects, particularly at higher doses 5, 8
- The incidence of adverse events was not significantly different between test and reference formulations of megestrol acetate in a study of healthy Korean subjects 6