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Part II Nutrition Assessment, Consequences, and Implications

TABLE 7.3 Medications Used to Stimulate Appetite Medication

Information

Megestrol acetate (Megace)

Has been tested with cancer and AIDS patients and has been shown to stimulate appetite and enhance weight gain. In the older adult it has been shown to increase appetite but has minimal effect on weight. One study indicated that megestrol acetate increases food intake, BMI, albumin, prealbumin, hemoglobin, and lymphocyte count. Appears on the 2012 Beers List as a medication to avoid using in the older adult.

Megestrol acetate ES

“Indicated for the treatment of appetite loss, severe malnutrition, or unexplained, significant weight loss in AIDS patients.” According to the product information, the drug is absorbed more quickly and completely than the original formula (Megace) in people who have not eaten. The drug is approved by the FDA as an appetite stimulant for people with AIDS. Appears on the Beers List as a medication to avoid using in the older adult.

Dronabinol (Marinol)

An effective appetite stimulant and antiemetic. Contains the principal psychoactive ingredient found in marijuana. Has been shown to have antiemetic effects in HIV and chemotherapy patients, appetite stimulation in HIV patients, and mood and behavior improvement in Alzheimer’s patients. Acts as an antispasmodic in multiple sclerosis and Tourette’s syndrome patients.

Side Effects and Contraindications Dose/Duration

Deep vein thrombosis, adrenal crisis, and decreased testosterone levels in men. Contraindicated in nonambula- tory individuals. Weight gain is primarily adipose tissue, not lean body mass (partly due to decreased testos- terone levels).

Use with caution in people with a history of thromboembolic disease. Dose modification may be necessary for older adults and people with compromised renal function.

Dosage and duration are unclear for older adults; however, 800 mg/d for 3 months duration is recommended.

One tsp daily for 30 days (less viscous than megestrol acetate, easier to swallow).

Ideally suited to palliative care due to the side effects of euphoria, decreased pain, and sleepiness. Other potential side effects include paranoid reactions, depression, tachycardia, GI effects, and CNS effects.

Dosage recommendations: Start at 2.5 mg/d for 1 week given at bedtime; the next week, the 2.5 mg is provided before supper. After 2 weeks if there are no adverse effects, give 2.5 mg before lunch and dinner. Dosage may be increased gradually based on response. Maximum dosage is 20 mg/d, given in divided doses before lunch and dinner. May take up to 4 weeks for appetite to improve. For people who cannot tolerate more than 2.5 mg, dronabinol should be taken in the evening or before bedtime.