Drug Category	Common Drugs Used	Comments
EPA = eicosapentaenoic acid; TNF-alpha = tumor necrosis factor-alpha; U.S. FDA = United States Food and Drug Administration.
Progestational agents	megestrol acetate	Multiple investigations report appetite stimulant activity and weight gain with use. Body composition of weight gain indicates increased body fat stores instead of lean body tissue. Increased risk of thromboembolism with doses >800 mg/day is an apparent trend. Studies suggest improved effectiveness in patients with better digestive function; therefore, targeted nutritional strategies such as digestive enzymes or elemental diets may be useful.[13,15]
	medroxyprogesterone
Glucocorticoids	dexamethasone	Mechanism of appetite stimulation is unknown but likely related to anti-inflammatory and euphoric actions. Studies report positive but short-lived effects on clinical outcomes such as appetite and quality of life, with minimal or no effect on weight gain. Risk of adverse effects such as muscle wasting and immunosuppression limit use for long-term use for appetite stimulation.[13,16]
	methylprednisolone
	prednisolone
Cannabinoids	dronabinol	Inconsistent evidence of clinical effectiveness in cancer patients. Studies of dronabinol alone or with megestrol acetate have not shown superior benefit in promoting weight gain and appetite.[13,17-20]
Antihistamines	cyproheptadine	Not studied well in cancer patients. A randomized placebo-controlled trial in patients with advanced cancer reported no difference in weight changes and progressive weight loss in both groups. Sedation is a frequent adverse effect that may limit usefulness in cancer patients.[13,21]
Antidepressants/ antipsychotics	mirtazapine	Clinical data supporting routine use in cancer patients are lacking. Further studies are needed.[16]
	olanzapine
Anti-inflammatory agents	thalidomide	All have been shown to decrease TNF-alpha. Mixed results in clinical trials regarding weight gain and appetite stimulation. One published randomized placebo-controlled trial evaluated the safety and efficacy of thalidomide, 200 mg daily, in patients with advanced pancreatic cancer and weight loss of at least 10% of premorbid weight. Thalidomide group showed a significant difference in weight loss compared with the placebo group, indicating the drug's ability to safely decrease weight loss and loss of lean body mass in the patients studied.[22] Preliminary clinical studies and laboratory studies of the polyunsaturated fatty acid EPA have suggested a benefit to cancer patients; however, subsequent large comparative studies failed to reproduce this benefit.[23,24]
	pentoxifylline
	melatonin
	omega 3 fatty acids (EPA)
Metabolic inhibitors	hydrazine sulfate	Not approved by the U.S. FDA for marketing in the United States.[16]
Anabolic agents	oxandrolone	Used in an attempt to stimulate muscle anabolism. Limited published reports of successful appetite stimulation in cancer patients.[16]
	nandrolone decanoate
	fluoxymesterone

References

13. Murphy S, Von Roenn JH: Pharmacological management of anorexia and cachexia. In: McCallum PD, Polisena CG, eds.: The Clinical Guide to Oncology Nutrition. Chicago, Ill: The American Dietetic Association, 2000, pp 127-33. 
    
    
15. Deutsch J, Kolhouse JF: Assessment of gastrointestinal function and response to megesterol acetate in subjects with gastrointestinal cancers and weight loss. Support Care Cancer 12 (7): 503-10, 2004.  [PUBMED Abstract]
    
    
16. Mattox TW: Treatment of unintentional weight loss in patients with cancer. Nutr Clin Pract 20 (4): 400-10, 2005.  [PUBMED Abstract]
    
    
17. Jatoi A, Yamashita J, Sloan JA, et al.: Does megestrol acetate down-regulate interleukin-6 in patients with cancer-associated anorexia and weight loss? A North Central Cancer Treatment Group investigation. Support Care Cancer 10 (1): 71-5, 2002.  [PUBMED Abstract]
    
    
20. Strasser F, Luftner D, Possinger K, et al.: Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol 24 (21): 3394-400, 2006.  [PUBMED Abstract]
    
    
21. Kardinal CG, Loprinzi CL, Schaid DJ, et al.: A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer 65 (12): 2657-62, 1990.  [PUBMED Abstract]
    
    
22. Gordon JN, Trebble TM, Ellis RD, et al.: Thalidomide in the treatment of cancer cachexia: a randomised placebo controlled trial. Gut 54 (4): 540-5, 2005.  [PUBMED Abstract]
    
    
23. Jatoi A: Fish oil, lean tissue, and cancer: is there a role for eicosapentaenoic acid in treating the cancer anorexia/weight loss syndrome? Crit Rev Oncol Hematol 55 (1): 37-43, 2005.  [PUBMED Abstract]
    
    
24. Fearon KC, Barber MD, Moses AG, et al.: Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. J Clin Oncol 24 (21): 3401-7, 2006.  [PUBMED Abstract]