Drug therapy for anorexia in palliative care
For patients with a life-limiting illness, improvement of appetite may be a worthwhile goal early in their disease, as there is often a significant link between appetite and quality of life for both patients and carers. For patients distressed by anorexia, consider drug therapy.
If poor gastric emptying is contributing to poor appetite, a prokinetic drug may allow more food intake. Consider:
1metoclopramide 10 mg orally, 8-hourly1 metoclopramide
OR
1domperidone 10 mg orally, 8-hourly2. domperidone
Corticosteroids may improve appetite (and give a feeling of improved wellbeing) for a few weeks. In patients who are deteriorating, if lack of appetite is significantly affecting quality of life, consider a trial of dexamethasone. Use:
dexamethasone 2 to 4 mg orally, daily. Assess after 5 days and stop if there is no benefit. If there is benefit, adjust to the lowest effective dose and stop after 2 weeks. For advice on stopping dexamethasone, see Rationalising corticosteroids used for symptom or complication management in palliative care. dexamethasone
Anorexia can accompany depression, and may improve if the depression is effectively treated (see Depressive symptoms in palliative care). Use of mirtazapine to treat depression may have a secondary effect of increasing appetite and weight gain.
Cannabinoids have been used to try and improve cancer-induced anorexia, but at the time of writing there is no evidence to suggest any significant benefit. See Cannabinoids for pain in palliative care for general considerations regarding cannabinoid use.