Management of cachexia

 

Progestogens

 

 

•  Progestogens include megestrol acetate (initial starting dose of 160mg a day, with

maximum daily dose of 800mg)

•  There is no defined optimal dose but higher doses do not appear to be any different in terms of effect for increasing appetite. However, if the desired effect is weight gain, then it is possible that higher doses may lead to improved outcomes.

•  After 3 weeks on this type of medication, the dose should be tapered gradually to minimise the risk of adrenal suppression and review after 2-3 weeks.

•  This class of drugs is more suitable for those that intend to take it over an extended period of time.

• It can help to increase appetite and possible weight gain but the onset of action is longer (takes several weeks for effect) than corticosteroids, However, the therapeutic effect persists for a longer duration. Side effects includ nausea, fluid retention.

 

 

 

 

 

 

Prokinetic

 

 Prokinetic such as metoclopramide (10mg taken 30 minutes before meals) or

domperidone (10mg three times daily taken 30 minutes before meals) .

•  Effective in providing temporary relief for early satiety, delayed gastric emptying or nausea. 

 

 

 

Non- pharmacological advice:

•  Education about cachexia should be provided to the families and relatives to minimise pressure on patients to eat large quantities of food which do not benefit and may cause harm.

 

•   If possible, patients should attempt to participate in some form of exercise because evidence has shown beneficial effects such as reduced fatique and improvement in mood.