Chapter 7 Unintended Weight Loss

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TABLE 7.3 cont. Medications Used to Stimulate Appetite Medication

Information

Mirtazapine (Remeron)

Commonly used to treat depression. Known to promote weight gain. May be more effective in promoting weight gain than serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil) but less effective than the tricyclic antidepressants.

Periactin

Antihistamine with appetite-stimulating side effects that has been used with older adults.

Side Effects and Contraindications Dose/Duration

Weight gain, drowsiness, decreased alertness, dry mouth, constipation and edema

Dosage is often 15 mg prior to bedtime, with a maximum dosage of 45 mg.

Not approved by the FDA for this purpose and it is generally not recommended for use with older adults due to its side effects of delirium, dizziness, and drowsiness.

Eldertonic

A liquid that has been prescribed for older adults to combat lack of energy or appetite, weight loss, or other signs of low energy. Its components include vitamins and minerals, especially B vitamins. However, its main ingredient is sherry.

Human growth hormone

Along with nutrition support has been shown to improve nitrogen balance and fat and protein metabo- lism. Appears on the 2012 Beers List of medications to avoid using in the elderly.

Anabolic agents Derived from the hormone testosterone and have been used to reduce catabolic effects during stress. Are effective in restoring lean body mass and improving the body’s ability to utilize amino acids for protein synthesis (instead of energy use). Individuals with protein-energy malnutrition and a pressure ulcer may benefit from anabolic hormone therapy to promote weight gain in the form of lean body mass. Oxan- drolone (Oxandrin) is the only oral anabolic agent that is FDA approved for UWL and protein catabolism associated with corticosteroid use.

Studies indicate that there is an increased incidence of death in malnourished older people who are critically ill. Other major side effects include hyperglycemia due to anti-insulin effects, hypermetabolism, and fluid retention.

Contraindications include prostate cancer, breast cancer in males or females, nephrosis, hypercalcemia, and pregnancy.

NA

Usual dosage is 1 tablespoon 3 times a day with or prior to meals.

NA

Individuals who take it must have some nutritional intake for the drug to be effective. If oral intake is poor, evaluate for appropriateness of an appetite stimulant or enteral feeding. Oxan- drolone has not been studied extensively in the long-term care population.

Source: Reprinted with permission from Dorner B. Diet and Nutrition Care Manual. Naples, FL: Becky Dorner and Associates, Inc; 2013.