[Table], Table 6. Commonly Prescribed Medications for Cachexia-Anorexia Syndromea - PDQ Cancer Information Summaries

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]

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