Hydroxyurea and Decreased Appetite
Yes, hydroxyurea does cause decreased appetite (anorexia), which is listed as a recognized gastrointestinal adverse effect of this medication. 1, 2
Evidence from Guidelines
The most authoritative evidence comes from the American Academy of Dermatology-National Psoriasis Foundation guidelines, which explicitly list anorexia (decreased appetite) among the gastrointestinal toxicities of hydroxyurea, alongside stomatitis, nausea, vomiting, diarrhea, and constipation. 1 This guideline represents expert consensus based on established clinical experience with the drug.
Supporting Clinical Evidence
Case reports document anorexia as a presenting symptom in patients experiencing hydroxyurea toxicity. In one published case, an 82-year-old male developed anorexia along with nausea, vomiting, and fever within 8 days of starting hydroxyurea 500 mg three times weekly for polycythemia vera. 3
When the drug was discontinued, symptoms resolved within 2 days, and when restarted, the patient again developed nausea and anorexia 10 days later, establishing a clear temporal relationship. 3
Multiple reviews confirm anorexia as a recognized side effect of hydroxyurea therapy across different indications, including sickle cell disease and myeloproliferative disorders. 2, 4
Clinical Context and Mechanism
The gastrointestinal effects, including decreased appetite, likely result from hydroxyurea's mechanism as a ribonucleotide reductase inhibitor that affects rapidly dividing cells, including those in the gastrointestinal mucosa. 4, 5 These effects are generally dose-dependent and reversible with drug discontinuation or dose reduction. 3
Important Clinical Considerations
Anorexia may be an early warning sign of hydroxyurea toxicity, particularly when accompanied by other gastrointestinal symptoms (nausea, vomiting) or constitutional symptoms (fever, fatigue). 3
The symptom is typically reversible upon discontinuation of the medication, with resolution occurring within days. 3
Patients should be counseled about this potential side effect when initiating therapy, as it may affect medication adherence and nutritional status during treatment. 3