From: Nutrition in Cancer Care (PDQ®)
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PDQ Cancer Information Summaries [Internet].
Bethesda (MD): National Cancer Institute (US); 2002-.
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Drug | Dose | Comments | Reference/Level of Evidence |
---|---|---|---|
Progestational agents | |||
Megestrol acetate | 160–800 mg daily (most-common dose: 400 or 800 mg) | Doses >160 mg/d associated with better weight gain; 800 mg may be optimal. More benefit seen than with dronabinol in comparative study. Addition of thalidomide to megestrol increased benefit. | [56][Level of evidence: I]; [46][Level of evidence: I] |
Medroxyprogesterone | 500 mg bid | Improved appetite and stimulated weight gain. Notable for a VTE-related death. | [52][Level of evidence: I] |
Glucocorticoids | |||
Dexamethasone | 0.75 mg qid | Benefit similar to that seen with megestrol. | [84][Level of evidence: I] |
Methylprednisolone | 16 mg bid | Small trial (N = 40); increased appetite, but negligible change in weight. | [43][Level of evidence: I] |
Prednisolone | 5 mg tid | Provided short-term appetite improvement over placebo, with no increase in weight. | [85][Level of evidence: I] |
Cannabinoids | |||
Dronabinol | 2.5 mg bid, maximum 20 mg daily | Given in divided doses; twice daily most common. No benefit seen when added to megestrol. One study showed as equal to placebo. | [56][Level of evidence: I]; [57][Level of evidence: I] |
Antihistamines | |||
Cyproheptadine | 2 mg qid, maximum 16 daily | Has been used up to 24 mg daily. Enhances appetite but may not decrease weight loss in adults. Improved both appetite and weight gain in children. | [58][Level of evidence: I]; [60][Level of evidence: II]; [59][Level of evidence: II] |
Antidepressants/antipsychotics | |||
Mirtazapine | 15–30 mg daily | 24% of patients gained ≥1 kg. | [76][Level of evidence: II] |
Olanzapine | 20 mg daily | Dose escalation trial; modest effect on reducing weight loss. | [79][Level of evidence: II] |
Anti-inflammatory agents | |||
Melatonin | 20 mg daily | Trial stopped for futility. Significantly fewer patients with >10% weight loss on melatonin vs. placebo. | [78][Level of evidence: I]; [86][Level of evidence: I] |
Omega-3 fatty acids | EPA, 1.09 g bid | No improvement in weight or appetite vs. megestrol vs. both. | [87][Level of evidence: I] |
10 capsules daily (EPA, 1.8 g daily) | No improvement in appetite vs. placebo. | [88][Level of evidence: I] | |
EPA, 4.4 g daily | Poor compliance with treatment. Post-hoc dose-response analysis suggests improved lean body mass with EPA supplement. | [89][Level of evidence: I] | |
Pentoxifylline | 400 mg tid | No effect on weight gain or arm circumference. | [90][Level of evidence: I] |
No improvement in appetite. | [91][Level of evidence: I | ||
Thalidomide | 100 mg daily | No significant difference vs. placebo. | [71][Level of evidence: I] |
200 mg daily | At 8 wk, patients receiving thalidomide had lost significantly less weight than had patients receiving placebo. | [73][Level of evidence: I] | |
Anabolic agents | |||
Oxandrolone | 2.5–20 mg in divided doses, 2–4 times daily | Not studied in cancer patients. | [92][Level of evidence: IV] |
Fluoxymesterone | 10 mg bid | Inferior to dexamethasone and megestrol acetate. | [84][Level of evidence: I] |
bid = twice a day; EPA = eicosapentaenoic acid; qid = 4 times a day; tid = 3 times a day; VTE = venous thromboembolism.
aAdapted from Lexicomp Online [83] and other references.
From: Nutrition in Cancer Care (PDQ®)
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.