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Oral Nutritional Supplements and Appetite Stimulation Therapy
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
In our practice, we have utilized megestrol, dronabinol, mirtazapine, oxandrolone and cyproheptadine as appetite stimulants, sometimes in combination with one another. However, it is important to note that FDA approval for this indication is only available for megestrol acetate, dronabinol and oxandrolone. There is no FDA approval for the combination of these agents.
Treatment – Chronic Illness-Related Malnutrition
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Jennifer Doley, Michelle Bratton
Perhaps the most commonly used appetite stimulant is megestrol acetate, as it is FDA approved for the treatment of cachexia, anorexia, or unexplained weight loss in individuals with AIDS and cancer.38 In a systematic review of its effectiveness and safety, the authors concluded that megestrol acetate did result in increased appetite and slight weight gain of approximately two kilograms. However, several adverse side effects were reported, including thromboembolic events and edema. While 400–800 mg/d is most typically prescribed,38 there is insufficient evidence to suggest an ideal dosage, although weight gain appeared to be associated with higher doses more than lower doses.39 These factors should be considered when decisions are made regarding the use of this medication.
Cystic Fibrosis and Pancreatic Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Elissa M. Downs, Jillian K. Mai, Sarah Jane Schwarzenberg
The medication list should be carefully reviewed to determine potential effects on appetite and growth. It is important to recognize medications that may be used off-label as appetite stimulants (including, but not limited to cyproheptadine, mirtazapine, megestrol acetate, dronabinol) or medications with weight gain as possible side effects (corticosteroids, new highly effective CFTR modulators, certain antidepressants). Medications may also contribute to appetite suppression (stimulant medications for attention-deficit hyperactivity disorder, certain antidepressants, metformin) or affect taste or sense of smell (antibiotics, antifungals, antivirals, antihistamines, bronchodilators, thyroid hormone, diuretics). The primary CF therapy should be noted; if the patient is on one of the CFTR modulators (Table 19.3), these should be taken with fat (recommendations vary between 10 and 20 g/dose) and PERT to optimize absorption.
Challenges with optimizing nutrition in cystic fibrosis
Published in Expert Review of Respiratory Medicine, 2019
Carla Colombo, Rita Maria Nobili, Gianfranco Alicandro
The use of appetite stimulants is still controversial because of doubts concerning their efficacy and also due to possible side effects. A recent meta-analysis examined the efficacy and safety of megestrol acetate and of cyproheptadine hydrochloride in a total of 47 patients [21]. In the short term (six months) in adults and children, appetite stimulants improved weight (or weight z score) and appetite, with no difference between the two drugs; side effects were insufficiently reported to fully establish safety [21]. All studies were small in size and offered only a moderate amount of evidence, making it impossible to provide evidence-based recommendations on the use of appetite stimulants for CF patients. Lastly, the beneficial effects of CFTR modulators on nutritional status have been related to several factors including improved appetite and food intake [22] (Figure 2)
New developments in investigational HDAC inhibitors for the potential multimodal treatment of cachexia
Published in Expert Opinion on Investigational Drugs, 2019
Another strategy to improve caloric intake relies on ghrelin. This is an orexigenic peptide that is also able to regulate energy metabolism and that has been proposed as an approach to treat cancer cachexia. In this regard, ghrelin administration to tumor-bearing animals results in improved food intake, as well as body and muscle weight both in the presence and in the absence of chemotherapy [21]. These observations have led to design a number of clinical trial to test ghrelin effectiveness also in cancer patients. The most relevant ones are those investigating the effects of anamorelin, a ghrelin analog. The results of these trials do not provide clear-cut evidence about anamorelin effectiveness to treat cancer cachexia. Indeed, while positive results have been reported in non-small cell lung cancer patients, the ROMANA trials have shown that while anamorelin improves body weight loss and FAACT score in lung cancer patients, it is not able to rescue the loss of hand grip strength [22,23]. Subsequent investigations have shown that, in selected groups of patients, anamorelin also leads to improved performance status [24]. Other appetite stimulants, such as macimorelin and a synthetic human ghrelin are actually under investigation [20].
Brucea javanica oil emulsion alleviates cachexia induced by Lewis lung cancer cells in mice
Published in Journal of Drug Targeting, 2018
Cancer cachexia is often seen in advanced stages of cancer. It is a wasting syndrome characterised by a continuous loss of skeletal muscle mass (with or without loss of fat), resulting in progressive functional impairment [1–3]. It significantly damages the quality of life, accompanied by weight loss, anorexia, anaemia and prolonged depression [4,5]. It is estimated that 50–80% of cancer patients experience cachexia, and it accounts for up to 20% of all cancer deaths [6]. Commonly used treatments include appetite stimulants, anti-depressives and anti-emetics along with nutritional therapy as a part of the best supportive care regimen. However, the side-effects and intolerance limit the existing treatment application for cancer cachexia, and research on new therapies has become imperative. Traditional Chinese medicines are compliant, efficient and have lesser-toxicity in cancer patients, and hence have drawn more attention in clinical practice [7–11].