Anorexia
Methods of Managing Cancer Related Anorexia (Medications)

Megestrol Acetate - Megace^®
This hormone improves appetite and increases caloric intake. It provides body weight gain but that weight gain is more fat than muscle tissue. It increases the sensation of well being. Studies have found that even when body weight is not increased, there is a rapid improvement in appetite, decrease of fatigue, and an improved general feeling of well being. ¹⁴ The dose ranges from 160 to 1600 mg daily taken by mouth. Often 800 mg has good effects with fewer side effects than higher doses. ²⁷

Early trials have combined megestrol and nonsteroidal antiinflammatory drugs (NSAIDS) and have found stabilized weights and improved quality of life. ^23,24,28

Megace is generally well tolerated. The side effects can include blood clots in the veins, swelling of arms and legs, break through vaginal bleeding, and trouble with your adrenal glands. Altered glucose control in diabetic patients requiring insulin has been reported. ^14,25,29

Medroxyprogesterone Acetate - Provera^®, Depo-Provera^®, Amen^®, Curretab^®, Cycrin^®
This is another hormone that also stimulates the appetite. In limited studies this medication has increased appetite and food intake with stabilization of weight. ^24,28

Corticosteroids
Methylprednisolone - A-Methapred^®, depMedalone^®, Depoject^®, Depo-Medrol^®, Depopred^®, Depo-Predate^®, Duralone^®, Medralone^®, Medrol^®, Meprolone^®, Rep-Pred^®, Solu-Medrol^®

Prednisolone - Articulose^®, Delta-Cortef^®, Hydeltrasol^®, Key-Pred^®, Pediapred^®, Predaject^®, Predate^®, Predicort^®, Prelone^®

Dexamethasone - AK-Dex^®, Decadrol^®, Decadron^®, Decaject^®, Dalalone^®, Dexacen^®, Dexasone^®, Dexone^®, Hexadrol^®, Mymethasone^®, Solurex^®

The best dose and route of administration for corticosteroids have not been established by research. Cost, side effects, and ease of administration should be determining factors on which drug to use. An initial 1-week trial is suggested. The daily dose is usually given in the morning with breakfast or in divided doses after breakfast and lunch. This helps to prevent insomnia. These medications do not cause weight gain but they do benefit appetite and quality of life. Corticosteroids should not be used longer than several weeks because of the side effects. Side effects include swelling, muscle weakness, decreased potassium levels in the blood, elevated glucose levels in the blood, depression and unrest, and suppression of the immune system. ^12,25,30,31

Cannabinoids
Marinol^®, which is legally available synthetic marijuana, has been found to produce some appetite stimulation. Taking the drug at bedtime may avoid some of the unwanted effects. ^13,21

Other Agents
Eicosapentaenoic acid (EPA) is a fatty acid derived from fish oil. Studies are finding weight gain in cancer patients who take EPA. ^2,24,28 The side effects are diarrhea and abdominal bloating. ⁷ Abbot Nutrition has produced an EPA-enriched nuturitional supplement called ProSure. It is recommended that you take two cartons for at least 8 weeks if you are experiencing weight loss. ²²

Metoclopramide - Reglin^®, Clopra^®, Octamide^®, Reclomide^® is felt to decreased anorexia and feeling full after only eating a small amount of food. ²⁷

Thalidomide - Thalomid^® decreases anorexia and nausea, and results in weight gain for cancer patients. ^7,17 Potential side effects for thalidomide include neuropathy, low blood counts, drowsiness, and birth defects in offspring. ⁷

Melatonin has slowed weight loss in cancer patients. ^17,24,28,32 Recent studies have found that it increases appetite and promotes weight gain in patients with cancer. ²⁷

Granisetron - Kytril^® and Odansetron - Zofran^® are used to treat nausea during cancer treatment. They also improve your ability to eat. Further testing is needed to define their role in the treatment of anorexia. ²⁷

Branched-chain amino acids given orally have been used to decrease the severity of anorexia in cancer patients. ²⁷

Agents still being tested

Ghrelin is a hormone produced by the stomach and promotes food intake. It has been found to be at normal levels in cancer patients tested so may not be as helpful as researchers had hoped. ^7,22

Anadamide is similar to cannabinol and is being tested in animals. ⁷