What are effective appetite stimulants in hospitalized patients with decreased appetite?

From the Guidelines

Megestrol acetate is the most effective appetite stimulant for hospitalized patients, particularly those with cancer-related anorexia/cachexia, as it has been shown to improve appetite and weight gain in patients with advanced cancer 1.

Key Considerations

• The use of megestrol acetate should be considered for patients with months-to-weeks or weeks-to-days life expectancy, where increased appetite is an important aspect of quality of life 1.
• A combination therapy approach, including medroxyprogesterone, megestrol acetate, eicosapentaenoic acid, and L-carnitine supplementation, and thalidomide, may yield the best possible outcomes for patients with cancer cachexia 1.
• Corticosteroids, such as dexamethasone, can also be used to increase appetite in patients with advanced disease, but their use should be limited to a restricted period of time (1-3 weeks) due to potential side effects 1.

Additional Options

• Dronabinol, a cannabinoid-based intervention, may be helpful for some patients with cancer-related anorexia, but its use is not recommended as a first-line treatment due to limited data and potential side effects 1.
• Mirtazapine, an antidepressant with appetite-stimulating properties, may be considered as an alternative option, but its use in hospitalized patients requires careful monitoring due to potential side effects 1.

Nutritional Approaches

• Nutritional approaches, including offering smaller, frequent meals, ensuring food preferences are accommodated, and providing oral nutritional supplements between meals, should accompany medication to optimize appetite stimulation and overall nutritional status.
• Addressing underlying causes of poor appetite, such as pain, nausea, constipation, or depression, is essential for comprehensive management of anorexia/cachexia in hospitalized patients.

From the FDA Drug Label

The appetite stimulant effect of dronabinol capsules in the treatment of AIDS-related anorexia associated with weight loss was studied in a randomized, double-blind, placebo-controlled study involving 139 patients. A statistically significant difference between dronabinol capsules and placebo was seen in appetite as measured by the visual analog scale at weeks 4 and 6

• Dronabinol is an effective appetite stimulant in patients with AIDS-related anorexia associated with weight loss, as demonstrated by a statistically significant difference in appetite compared to placebo at weeks 4 and 6.
• The initial dosage of dronabinol was 5 mg/day, administered in doses of 2.5 mg one hour before lunch and one hour before dinner, but was reduced to 2.5 mg/day in some patients due to side effects.
• Key benefits of dronabinol include:
  • Improved appetite
  • Trends toward improved body weight and mood
  • Decreases in nausea 2

From the Research

Effective Appetite Stimulants in Hospitalized Patients

• The use of appetite-stimulating medications such as dronabinol, megestrol, and mirtazapine in hospitalized patients has been studied to some extent 3, 4.
• A retrospective cohort study found that these medications may show numerical improvements in meal intake, with a mean change from initiation to discontinuation of 17.12% 3.
• However, another review found that the current data on the efficacy of these medications in the inpatient setting lacks standardization, generalizability, and comparability, and higher quality evidence is needed before conclusions can be made 4.
• Megestrol acetate has been found to be a useful appetite stimulant for the prevention and treatment of HIV-associated wasting, particularly in women 5.
• A phase II randomized clinical trial found that megestrol acetate suspension increased prealbumin levels in elderly patients with reduced appetite after hospitalization, but did not confer benefit on other nutritional or clinical outcomes 6.
• Other studies have suggested that megestrol acetate, hydrazine sulfate, metoclopramide, and dronabinol may be promising pharmacologic approaches for managing anorexia-cachexia associated with cancer and HIV infection 7.

Medication-Specific Findings

• Dronabinol: may show numerical improvements in meal intake, but limited evidence is available on its efficacy in the inpatient setting 3, 4.
• Megestrol: may be effective in stimulating appetite and increasing prealbumin levels, particularly in elderly patients and those with HIV-associated wasting 5, 6.
• Mirtazapine: may show numerical improvements in meal intake, but limited evidence is available on its efficacy in the inpatient setting 3, 4.