From the Guidelines
Appetite stimulants are medications that increase appetite, such as megestrol acetate, dexamethasone, and olanzapine.
Types of Appetite Stimulants
- Megestrol acetate: improves appetite and body weight in patients with cancer cachexia, but the type of weight gain is primarily adipose tissue, rather than skeletal muscle 1
- Dexamethasone: a corticosteroid that improves appetite, but its role as an appetite stimulant is often limited to patients with a life expectancy of weeks to a couple months due to toxicities and decline in efficacy associated with long-term use 1
- Olanzapine: has shown potential as an appetite stimulant in patients with cancer cachexia, with improved appetite scores in a small study, but further evaluation is recommended to better understand its potential role 1
Use of Appetite Stimulants
Appetite stimulants are considered for patients with months-to-weeks or weeks-to-days life expectancy, if increased appetite is an important aspect of quality of life 1.
Important Considerations
- The primary outcome of appetite stimulants is to increase appetite, and secondary outcomes such as improved quality of life, increase in body weight, and increased food consumption are also considered 1
- The choice of appetite stimulant depends on the individual patient's needs and circumstances, and clinicians should be aware of the potential adverse effects and benefits of each medication 1
From the Research
Definition and Examples of Appetite Stimulants
- Appetite stimulants are medications used to increase appetite in individuals who have a decreased appetite due to various medical conditions, such as cancer, cystic fibrosis, or other chronic illnesses 2, 3, 4.
- Examples of appetite stimulants include dronabinol, megestrol acetate, mirtazapine, and cyproheptadine hydrochloride 2, 3, 5, 4.
Mechanism of Action and Effects
- Appetite stimulants work by interacting with hormonal signals that regulate appetite, such as ghrelin and leptin, and can produce long-term alterations in the ability to monitor and compensate energy deficits 6.
- These medications can improve appetite, meal intake, and weight gain in individuals with decreased appetite due to medical conditions 2, 3, 4.
- However, the efficacy of appetite stimulants in hospitalized adults is limited, and current data lack standardization, generalizability, and comparability 5.
Specific Appetite Stimulants and Their Uses
- Megestrol acetate is a progestational agent used to stimulate appetite in patients with cancer anorexia/cachexia syndrome 3.
- Cyproheptadine hydrochloride is an appetite stimulant used in children and adults with cystic fibrosis, with a suitable side-effect profile for prolonged use 4.
- Dronabinol, megestrol acetate, and mirtazapine are used to stimulate appetite in hospitalized adults, but their efficacy is limited and requires further research 2, 5.