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Retronasal Olfaction
Published in Alan R. Hirsch, Nutrition and Sensation, 2023
Jason J. Gruss, Alan R. Hirsch
Appetite has been shown to be altered by several medications. Megestrol has been approved to treat unintended weight loss; some antidepressants have been used to stimulate weight gain, especially in elderly populations (Bellisle 1979; Fox, Treadway, Blaszczyk, and Sleeper 2012).
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
We can then continue this dose as a maintenance or decrease further to find the lowest effective dose. Because of the risk for deep vein thrombosis, we generally recommend that patients be given anticoagulation in order to remain on megestrol. Patients should be examined regularly and Doppler ultrasounds ordered for any suspicious symptoms. Other side effects of megestrol include fluid retention, glucose intolerance, adrenal insufficiency and osteoporosis. As a progestational agent, megestrol is easier to prescribe to women than to men, who may develop gynecomastia and other feminizing symptoms.
Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Megestrol is a synthetic oral progestational agent. The risk for virilization of female fetuses appears minimal with maternal use of large doses of this agent during pregnancy. No studies of congenital anomalies among infants whose mothers were treated with megestrol during pregnancy have been published. External genitalia of female rats born to mothers treated with very large doses of megestrol during pregnancy were virilized (Kawashima et al., 1977). The Swedish Birth Defects Registry include only two infants exposed to megestrol during the first trimester (Kallen, 2019).
A focused report on progestogen hypersensitivity
Published in Expert Review of Clinical Immunology, 2023
Diti H. Patel, Lauren M. Fine, Jonathan A. Bernstein
While PH has a similar clinical presentation to that of catamenial anaphylaxis, they differ in that the timing of symptoms in that catamenial anaphylaxis correlates with the onset of menses rather than the progesterone surge of the luteal phase and persists throughout the menstrual cycle [29]. While PH would naturally be most common in females with either endogenous or exogenous etiologies, it should be recognized that it has also been reported in male patients. One case study identified PH in a male patient taking Megestrol acetate, an orally active form of progesterone used for appetite stimulation [30]. Several case reports detail the development of PH after exposure to exogenous progestin, including progesterone injections and pills made from soy, yam, and animal sources for IVF or the synthetic progestins used for emergency contraception, oral contraceptive pills (OCPs) and intrauterine devices [1,14,31–34].
Selinexor for the treatment of multiple myeloma
Published in Expert Opinion on Pharmacotherapy, 2020
Klaus Podar, Jatin Shah, Ajai Chari, Paul G Richardson, Sundar Jagannath
The penetration of selinexor of the blood-brain barrier is believed to, at least in part, contribute to ‘gastrointestinal’ toxicities. Indeed, a combination of 5-HT3 antagonists, D2 antagonists, and antiemetic doses of dexamethasone with centrally acting agents such as olanzapine (10 mg daily) and megestrol acetate (400 to 800 mg daily) is able to mitigate nausea, anorexia, vomiting, dizziness, dysgeusia as well as changes of the mental status such as delirium and confusional state [61]. Selinexor-induced thrombocytopenia results from inhibition of thrombopoietin (TPO) signaling in early megakaryocytosis rather than from direct cytotoxic effects on platelets [93]. The application of thrombopoietin mimetics (e.g. romiplostim or eltrombopag) may therefore be considered. Data on the efficacy and optimal duration of TPO mimetics are missing. In case the platelet count needs to be increased more quickly, platelet transfusions are indicated. Due to the greater risk of hemorrhage caution should be used with patients undergoing invasive procedures or receiving anticoagulants [67,93]. Moreover, growth factors and blood transfusions should be initiated when needed. Unusual toxicities as hyponatremia and blurred-vision seem to be a class-phenomenon. Importantly, they are self-limiting and reversible in most patients. Frequent monitoring for the occurrence of hyponatremia and supportive therapy to normalize hyponatremia must be provided as needed and may include salt tablets and hydration (Table 1).
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)