Appetite Stimulation Patches and Medications
Megestrol acetate is the most effective first-line medication for appetite stimulation, with a recommended starting dose of 160-200 mg daily, but there is no evidence supporting the use of patches for appetite stimulation. 1
First-Line Options for Appetite Stimulation
- Progestins, particularly megestrol acetate, are recommended as the most effective first-line medications for increasing appetite, with extensive high-quality evidence supporting their efficacy 1
- The minimum effective dose of megestrol acetate is 160 mg daily, which is considered the optimal starting dose 2
- The dose can be increased up to 480-800 mg daily if needed, though higher doses increase the risk of side effects, particularly thromboembolic events 2, 1
- Megestrol acetate increases appetite and body weight primarily through fat gain rather than lean muscle mass 1
Second-Line Options
- Cannabinoids such as dronabinol (THC) have limited and inconsistent evidence for effectiveness in appetite stimulation 3
- In a small phase II clinical trial, dronabinol at 5 mg/day reduced anorexia in 68% of patients with cancer cachexia, but had a high dropout rate due to adverse events 3
- A prospective randomized placebo-controlled trial showed that cannabis extract or THC at 5 mg per day for 6 weeks did not improve appetite or quality of life in patients with advanced cancer and anorexia-cachexia syndrome 3
- Dronabinol may improve chemosensory perception and pre-meal appetite compared to placebo but has significant side effects including euphoria, hallucinations, vertigo, psychosis, and cardiovascular disorders 3, 1
Other Medication Options
- Mirtazapine may cause weight gain as a side effect and could be beneficial when patients have both weight loss and depression 4
- Corticosteroids may be considered for very short-term use (1-3 weeks) in patients with advanced disease but are not recommended for long-term appetite stimulation due to significant adverse effects 1
- Ghrelin analogs such as anamorelin have shown promise in clinical trials, improving appetite, body weight, and lean body mass compared to placebo in patients with advanced non-small cell lung cancer, but are not yet approved for clinical use 3, 1
Inpatient Setting Considerations
- A retrospective cohort study of hospitalized patients found no significant difference between dronabinol, megestrol, or mirtazapine with regard to mean change in meal intake or weight, though all showed numerical improvements in meal intake 5
- Almost half (48%) of inpatients experienced improvement in diet after starting these medications 5
- Current data on appetite stimulants in the inpatient setting lack standardization and generalizability 6
Important Monitoring and Side Effects
- Patients on megestrol acetate should be monitored for thromboembolic events, which occur in approximately one in six patients 2, 1
- Other potential side effects of megestrol acetate include edema, impotence, and vaginal spotting 2
- Regular monitoring of weight gain, appetite improvement, and potential adverse effects is essential throughout treatment 2