Does Hydroxyurea Decrease Appetite?
Yes, hydroxyurea can decrease appetite (anorexia) as a recognized adverse effect of the medication. 1
Evidence for Appetite Loss
Anorexia is explicitly listed among the known side effects of hydroxyurea in multiple sources:
Anorexia is documented as a side effect alongside nausea and vomiting in patients treated with hydroxyurea for sickle cell disease. 1
In a case report of an 82-year-old male with polycythemia vera, the patient developed anorexia within 8 days of starting hydroxyurea 500 mg three times weekly, which resolved within 2 days of discontinuation. When the drug was restarted, anorexia recurred after 10 days. 2
Clinical Context and Associated Symptoms
The appetite suppression typically occurs as part of a constellation of gastrointestinal symptoms:
Anorexia frequently presents together with nausea and vomiting in patients experiencing hydroxyurea-related adverse effects. 2, 1
These gastrointestinal symptoms may appear acutely within the first 1-2 weeks of initiating therapy or after dose escalation. 2
Symptoms are generally reversible upon discontinuation of the medication, with resolution typically occurring within 2 days. 2
Monitoring Considerations
While anorexia is a recognized side effect, the comprehensive adverse effect profile requires broader monitoring:
Complete blood counts should be performed every 2-4 weeks during dose titration to detect myelosuppression, which is the most common dose-limiting toxicity. 3
Patients should be counseled at initiation that gastrointestinal symptoms including decreased appetite, nausea, and vomiting may occur, though these are less common than hematologic effects. 2, 1
Important Clinical Pitfall
Do not confuse appetite loss with the mandatory hematologic discontinuation criteria. While anorexia is uncomfortable and may warrant dose adjustment or symptomatic management, the absolute indications for stopping hydroxyurea are hematologic: absolute neutrophil count <1.0 × 10⁹/L, platelet count <100 × 10⁹/L, or hemoglobin <10 g/dL. 3, 4