Megestrol Acetate and Mirtazapine for the Treatment of Unplanned Weight Loss in the Elderly

@article{Fox2009MegestrolAA,
  title={Megestrol Acetate and Mirtazapine for the Treatment of Unplanned Weight Loss in the Elderly},
  author={Caroloine Fox and Angela K Treadway and Amie T Blaszczyk and Rebecca B. Sleeper},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  year={2009},
  volume={29}
}
A rising concern among clinicians is treatment of unplanned weight loss in the elderly, especially given the predicted growth of this population over the next few decades. [...] Key Method In a comprehensive search of the MEDLINE and International Pharmaceutical Abstracts databases, we identified all published reports on the use of megestrol acetate or mirtazapine for the treatment of weight loss and on any adverse events associated with these drugs.Expand
Megestrol acetate for treatment of anorexia-cachexia syndrome.
TLDR
This review shows that MA improves appetite and is associated with slight weight gain in cancer, AIDS and in patients with other underlying pathology, and lack of benefit in the same patients when MA was compared to other drugs.
Orexigenic agents in geriatric clinical practice
TLDR
The focus of this article has been limited to reviewing the evidence for current orexigenic agents that are used to treat elderly individuals who are experiencing IWL, and maintaining a healthy weight is an essential element of well-being and decreased morbidity and mortality.
Appetite Stimulants in Long Term Care: A Literature Review
TLDR
Current research related to the use of appetite stimulants in long term care, including mirtazepine, oxandrolone, dronabinol, and megesterol acetate is identified, with mixed results.
Polypharmacy and nutritional status in elderly people
TLDR
The role of polypharmacy on nutritional status among elderly people is unclear and some diseases promote malnutrition; thus, the independent role of drugs for nutritional status is challenging to determine.
Polypharmacy and Rational Prescribing: Changing the Culture of Medicine One Patient at a Time
TLDR
Physiatrists are well positioned to have a positive impact on rational prescribing and polypharmacy given their emphasis on function, familiarity with non-medication treatment modalities, and an embrace of a biopsychosocial orientation.
Older Adults With Unintended Weight Loss: The Role of Appetite Stimulants.
TLDR
Understanding the dosage, side effects, and proper usage of appetite stimulants, such megestrol acetate, mirtazapine, and dronabinol, is crucial in order to provide safe and effective patient care.
Unintentional weight loss in older adults
TLDR
Treatment focuses on the underlying cause, and nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered.
Histamine-1 receptor antagonism for treatment
TLDR
Over-the-counter antihistamines may have a role for short-term insomnia treatment in younger adults, but tolerance develops rapidly, and mirtazapine should not be used solely for the treatment of insomnia.
Assessment and Treatment of the Anorexia of Aging: A Systematic Review
TLDR
Appetite loss in older people, the ‘Anorexia of Aging’ (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention, so standardized assessment is important for future research.
Histamine-1 receptor antagonism for treatment of insomnia.
TLDR
Over-the-counter antihistamines may have a role for short-term insomnia treatment in younger adults, but tolerance develops rapidly, and mirtazapine should not be used solely for the treatment of insomnia.
...
1
2
3
4
...

References

SHOWING 1-10 OF 75 REFERENCES
Anticachectic efficacy of megestrol acetate at different doses and versus placebo in patients with neoplastic cachexia.
TLDR
This trial supports the efficacy of megestrol acetate at 480 mg/day in the treatment of cancer-related cachexia and anorexia, with mild toxicity, however, performance status and quality of life were not influenced by this treatment.
Megestrol acetate therapy in geriatric patients: case reviews and associated deep vein thrombosis.
  • L. Marshall
  • Medicine
    The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
  • 2003
TLDR
Caution should be observed in using megestrol acetate in geriatric patients, especially nursing facility residents who often have impaired mobility, and deep vein thrombosis and pulmonary embolism are potential adverse events associated with megestro acetate therapy.
Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia.
TLDR
This study convincingly demonstrated that megestrol acetate can stimulate appetite and food intake in patients with anorexia and cachexia associated with cancer, leading to significant weight gain in a proportion of such patients.
A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss.
TLDR
MA treatment of elderly nursing home residents with significant weight loss was associated with a significant increase in all-cause mortality without asignificant increase in weight.
Retrospective review of megestrol use for weight loss in an elderly veteran population.
TLDR
Patients both gained and lost weight when receiving megestrol therapy and there was no difference between the patients who did or did not gain weight using objective measures of weight loss.
Phase III evaluation of four doses of megestrol acetate as therapy for patients with cancer anorexia and/or cachexia.
TLDR
A positive dose-response effect for megestrol acetate on appetite stimulation supports both the prestudy hypothesis and other available literature and it is reasonable to use 160 mg/d for the initial treatment of cancer anorexia/cachexia in routine clinical practice.
Megestrol Acetate in Patients with AIDS-related Cachexia
TLDR
This multicenter, double-blind, placebo-controlled study was designed to assess the safety and efficacy of megestrol acetate for the treatment of AIDS-related anorexia and cachexia in patients with AIDS-associated weight loss.
Safety of mirtazapine: a review
  • S. Montgomery
  • Medicine
    International clinical psychopharmacology
  • 1995
TLDR
The clinical trial development programme of mirtazapine (Org3770), performed in Europe and the United States, demonstrated an outstanding safety profile of this compound and offers clinicians a unique combination of strong efficacy and good safety.
Effect of mirtazapine treatment on body composition and metabolism.
TLDR
The antidepressant therapy with mirtazapine was associated with a significant increase in body weight, body fat mass, and leptin concentration, and in contrast to other psychotropic medications inducing weight gain, mirtzapine treatment did not influence the glucose homeostasis.
The science of megestrol acetate delivery: potential to improve outcomes in cachexia.
  • R. Femia, R. E. Goyette
  • Medicine
    BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy
  • 2005
TLDR
Preclinical pharmacokinetic data suggest that the new megestrol acetate formulation has the potential to significantly shorten the time to clinical response and thus may improve outcomes in patients with anorexia-cachexia.
...
1
2
3
4
5
...