Appetite Stimulation in Patients

Pharmacological Interventions

The American College of Physicians recommends against the use of lysine supplements as appetite stimulants due to lack of established evidence supporting their use for appetite enhancement in humans 1
Megestrol acetate has significant appetite stimulation and weight gain effects, with a minimum effective dose of 160 mg/day, and an optimal dose range of 480-800 mg/day, according to the National Comprehensive Cancer Network and other studies 1, 2
Medroxyprogesterone acetate (MPA) has significant appetite stimulation, with a minimum effective dose of 200 mg/day, as recommended by the American Society of Clinical Oncology 1
Corticosteroids are effective appetite stimulants but have limited duration of use (1-3 weeks) due to side effects such as muscle wasting, insulin resistance, infections, and immunosuppression, as stated by the European Society for Clinical Nutrition and Metabolism 1, 3
Cyproheptadine may stimulate appetite but has reported adverse effects, according to the American Academy of Hospice and Palliative Medicine 1
Progestins, including megestrol acetate and medroxyprogesterone acetate, increase appetite and body weight, potentially by decreasing cytokine levels, with high-quality evidence from multiple randomized clinical trials showing significant appetite stimulation and weight gain, but may cause serious side effects such as thromboembolism, impotence, and vaginal spotting 3, 4, 2

In patients with dementia, guidelines recommend against the systematic use of appetite stimulants due to limited evidence and potential side effects, and instead suggest providing feeding assistance, ensuring adequate time for meals, offering energy-dense meals, and addressing behavioral issues that may affect eating, as recommended by the American Geriatrics Society 5
Nutritional interventions, including appetite stimulation, should be part of a comprehensive approach to patient care, and may include the use of long-chain N-3 fatty acids (fish oil), which are best for patients with advanced cancer undergoing chemotherapy, but should be avoided in patients taking ibrutinib due to the risk of epistaxis 3, 6
Progestins are best for patients with short life expectancy or those who may benefit from other effects, such as pain or nausea relief, according to high-quality evidence from multiple randomized clinical trials 3, 4