Effective Appetite Stimulants for Hospitalized Patients
Megestrol acetate (400-800 mg/day) is the most effective first-line pharmacological appetite stimulant for hospitalized patients with decreased appetite, followed by dexamethasone (2-8 mg/day) as an alternative with faster onset of action. 1
Pharmacological Interventions
First-Line Options
- Megestrol acetate (400-800 mg/day) improves appetite in approximately 25% of patients and results in modest weight gain in about 8% of patients 1, 2
- Dexamethasone (2-8 mg/day) offers similar appetite improvement to megestrol acetate with faster onset of action, making it particularly suitable for patients with shorter life expectancy 1
- Mirtazapine (7.5-30 mg at bedtime) can be effective for patients with concurrent depression and appetite loss 1, 3
Second-Line Options
- Olanzapine (5 mg/day) may be considered, particularly for patients with concurrent nausea/vomiting 1
- Cannabinoids have limited evidence but may increase meal consumption in certain populations 1, 2
Non-Pharmacological Approaches
Nutritional Support Strategies
- Oral nutritional supplements (ONS) should be provided when food intake is between 50-75% of usual intake 1
- Protein-enriched foods and drinks can improve protein intake in hospitalized patients 1
- Energy-dense meals can help patients meet nutritional requirements without increasing meal volume 1
Mealtime Interventions
- Protected mealtimes to minimize interruptions during meals 1, 4
- Mealtime assistance from volunteers or dietary staff to promote food intake 5, 4
- Improved meal presentation significantly increases food intake and can reduce hospital readmission rates 6
Food Service Improvements
- Point-of-care food selection allowing patients to choose meals at the bedside 5
- Multiple small, protein-rich meals (6 per day) provided directly at the bedside rather than traditional 3-meals-a-day service 7
- Nutritional assistants providing proactive dietary advice at the bedside 7
Special Considerations
For Patients with Dementia
- Drugs to stimulate appetite are NOT recommended for persons with dementia due to limited evidence and potential risks 1
- Focus on non-pharmacological approaches such as:
For Cancer Patients
- Appetite stimulants should focus on improving quality of life rather than just weight gain 8
- Consider concurrent symptoms like nausea/vomiting when selecting an agent 1
Important Caveats
- Regular reassessment is essential to evaluate benefit versus harm of pharmacological interventions 2
- Lower starting doses should be used for elderly patients with close monitoring for side effects, particularly sedation and thromboembolic events 2
- Megestrol acetate can cause fluid retention and increased risk of thromboembolic events 1
- Dexamethasone has significant side effects with prolonged use including hyperglycemia, muscle wasting, and immunosuppression 1