[e-drug] Appetite stimulants

E-DRUG: Appetite stimulants
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[See comment at the end. Moderator]

Dear E-Druggers,

Is there Medicine for appetite, especially in HIV disease or any other condition? Secondly, may I know wether it is wise to use Pizotifen side effect for appetite, if so, would one use it in HIV disease?

Kind regards,

Dr. Mulenga Joseph.
docmulengajo@zamtel.zm

Moderator:
Information can e.g. be found here on the UK Cancer Research website: http://www.cancerhelp.org.uk/help/default.asp?page=10540:

'Appetite stimulants
These are mainly for people who have lost a lot of weight or have cachexia. They work well in some people but not in everyone. The appetite stimulating drugs used most often in people with cancer are hormone drugs called

- Megesterol acetate (also called Megace)
- Medroxyprogesterone acetate (also called Depo-Provera, Farlutal and Provera)

Both drugs increase appetite and food intake in people with cancer who have nutritional problems. And they do help some people put on weight. But you are unlikely to see any weight gain for the first 4 to 6 weeks. And there is some doubt about how beneficial the weight gain really is. Most of it seems to be fat and fluid with these drugs and not muscle mass.

These drugs are also known to increase your sense of well being, which can be a great benefit to people with cancer who may be feeling very low, anxious or depressed.'

Moderator: megestrol is approved in the US for AIDS with cachexia.

Another drug which has been used is cyproheptadine. Quote from Martindale The Extra Pharmacopoeiae:
Appetite disorders.
Cyproheptadine has been widely used as an appetite stimulant, including for anorexia nervosa and cachexia (see under Megestrol, Megestrol Acetate), but in the long-term appears to have little value in producing weight gain and such use is no longer generally recommended. There has been concern that cyproheptadine was being promoted and used inappropriately as an appetite stimulant in some developing countries.1
1. Anonymous. Cyproheptadine: no longer promoted as an appetite stimulant. WHO Drug Inf 1994; 8: 66.

I assume using pizotifen would be similar to using cyproheptadine, both are antihistamines. And seem to have little value in the longterm. Patients need to be given well prepared, tasty nourishing food. KM, moderator.

E-DRUG: Appetite stimulants (2)
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Dr Mulenga,

The following can be used in HIV for appetite
- Megestrol (Megace)
-Marinol (Dronabinol)

Dr Otieno Aduma
USA
otienoaduma@hotmail.com

E-DRUG: Appetite stimulants (3)
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Dear colleagues, dear E-druggers,

If any drug carried such an indication it would be a remnant of past
beliefs in drug registration. When I worked in drug registration in
Holland we had the same problems with anabolic steroids, especially
with identical claims for nandrolone and stanazolol. I asked two
academic oncologists to assess the clinical data, and they rejected
the evidence. The claim was only suspended many years later, and now
the only comment in the reimbursement formulary states that such
drugs "are used" without mentioning specific indications. They have
been deleted from the BNF. Merck dropped the indication many years
ago for cyproheptadine. It is remarkable that such claims persist so
many years after our moderator Dr.Bannenberg won the case against
Organon in Thailand, where these drugs were marketed as appetite
stimulants for children! Therefore, forget about such drugs and treat
AIDS, cancer and hunger instead.

Leo Offerhaus, Bussum, The Netherlands.
offerhausl@euronet.nl