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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.
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
Oxandrolone is given BID orally, starting at 2.5 mg. The maximum dose is 20 mg/day. The side effects of oxandrolone include hepatitis and hepatic failure as well as edema and polycythemia (Prescriber’s Digital Reference). As an anabolic agent, oxandrolone is easier to prescribe to men than to women, who may develop hirsutism. It is interesting to note that this is the precise opposite of the concern for megestrol acetate.
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Megestrol acetate causes similar side effects to other progestogens including GI disturbances (e.g., nausea, vomiting, diarrhea, constipation, weight increase), asthenia, alopecia, adrenal insufficiency, fluid retention, vaginal bleeding, hypertension, hyperglycemia, lethargy, menorrhagia, Cushing’s syndrome, diabetes mellitus, thrombosis hypercalcemia, edema, skin reactions, and tumor flare. It should not be used during conception or pregnancy, as there is a known risk of abnormalities in a developing fetus.
Progestin or anti-estrogen treatment for endometrial cancer: choosing the best option for selected patients
Published in Gynecological Endocrinology, 2021
Marta Caretto, Tommaso Simoncini
Fertility-sparing treatments should be restricted to women with atypical hyperplasia/endometrioid intra-epithelial neoplasia (AH/EIN) or grade 1 endometrioid carcinoma without myometrial invasion. Hysteroscopic resection followed by the progestin therapy achieve the highest complete remission rate according to recent literature. The progestin therapy includes oral progestin as well as intrauterine progestin application. Medroxyprogesterone acetate (400–600 mg/day) or megestrol acetate (160–320 mg/day) are the recommended oral treatments [3]. Only patients undergoing oral treatment should be informed of major risks or the presentation of systemic adverse effects. Instead, in case of the intrauterine progestin therapy such as levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone receptor agonist or progestin a satisfactory pregnancy rate and a low recurrence rate have been reported. The combination of levonorgestrel intrauterine device with oral progestins with or without gonadotropin-releasing hormone analogs can also be considered. There is a lack of evidence for anti-estrogenic treatment in women who wish to preserve fertility [4].
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)
FAACT-Anorexia Cachexia Scale: Cutoff Value for Anorexia Diagnosis in Advanced Non-Small Cell Lung Cancer Patients
Published in Nutrition and Cancer, 2019
Jenny Georgina Turcott, Luis F. Oñate-Ocaña, Giovanny Soca-Chafre, Laura-Alejandra Ramírez-Tirado, Diana Flores-Estrada, Zyanya Lucia Zatarain-Barrón, Oscar Arrieta
CACS treatment modalities include early nutritional intervention, physical activity, and pharmacological treatment (23). Currently used therapeutic drugs include megestrol acetate, which increases appetite and body weight; however, it carries the risk of potential side effect such as thrombo-embolic phenomena, edema, poor response to chemotherapy, and a tendency to lower survival compared with placebo in LC patients (25). Other agents that have proven their effectiveness in patients with NSCLC include anamorelin, which has shown a significant improvement in appetite according to A/CS, incresed body weight and fat-free mass compared with placebo (26). Anamorelin is a ghrelin receptor agonist, but is not available worldwide, including Mexico. On the other hand, cannabinoids have been proposed as a valuable treatment option for treating cancer-related anorexia, particularly nabilone has been associated with increased energy consumption and quality-of-life in LC patients (24).