Appetite stimulant explained

An orexigenic, or appetite stimulant, is a drug, hormone, or compound that increases appetite and may induce hyperphagia. This can be a medication or a naturally occurring neuropeptide hormone, such as ghrelin, orexin or neuropeptide Y,^{[1] [2]} which increases hunger and therefore enhances food consumption. Usually appetite enhancement is considered an undesirable side effect of certain drugs as it leads to unwanted weight gain,^{[3] [4] [5]} but sometimes it can be beneficial and a drug may be prescribed solely for this purpose, especially when the patient is suffering from severe appetite loss or muscle wasting due to cystic fibrosis, anorexia, old age, cancer or AIDS.^{[6] [7] [8] [9] [10]} There are several widely used drugs which can cause a boost in appetite, including tricyclic antidepressants (TCAs), tetracyclic antidepressants, natural or synthetic cannabinoids, first-generation antihistamines, most antipsychotics and many steroid hormones. In the United States, no hormone or drug has currently been approved by the FDA specifically as an orexigenic, with the exception of Dronabinol, which received approval for HIV/AIDS-induced anorexia only.

List of orexigenics

• 5-HT_2C receptor antagonists/inverse agonists — mirtazapine, olanzapine, quetiapine, amitriptyline, cyproheptadine, lurasidone
• H₁ receptor antagonists/inverse agonists — mirtazapine, olanzapine, quetiapine, amitriptyline, cyproheptadine, pizotifen
• Dopamine antagonists — haloperidol, chlorpromazine, olanzapine, risperidone, quetiapine
• Adrenergic antagonists:
  • β blockers — propranolol, etc.
• Paradoxically, β-adrenergic agonists are also listed.^[11]

Not ephedra/clenbuterol (which is an appetite suppressant), but salbutamol, flerobuterol, Zilpaterol, and related drugs.

• • α₂ adrenergic antagonists — mirtazapine, mianserin
  • Mixed α₁/β blockers — carvedilol
• α2 Adrenergic agonists — clonidine
• CB₁ receptor agonists (cannabinoids — THC/dronabinol (a component of Cannabis), nabilone
• Corticosteroids — dexamethasone, prednisone, hydrocortisone
• Certain pregnene steroids — megestrol acetate, medroxyprogesterone acetate
• Anabolic steroids — oxandrolone, boldenone undecylenate, testosterone
• Other steroids such as Prednisolone
• Sulfonylurea antidiabetic drugs such as glibenclamide, chlorpropamide and tolbutamide
• Mood stabilizers such as lithium
• Some anti-epileptic drugs such as valproate, carbamazepine and gabapentin^[12]
• α₂δ VDCC ligands — gabapentin, pregabalin^[13]
• Ghrelin receptor agonists such as anamorelin, GHRP-6, ibutamoren, ipamorelin, and pralmorelin
• MC₄ receptor antagonists
• Insulin
• Sugars, such as fructose^[14]
• Alcohol beverages^[15]
• Benzodiazepines, such as diazepam^[16]

See also

• Anorectic (anorexigenic)
• Anorexia
• Eating disorder
• Obesity
  • Organic feeding disorder Polydipsia

Further reading

• Agents Used as Appetite Stimulants: Drug Class; University of Utah College of Pharmacy, 2014

Notes and References

1. Diepvens K, Häberer D, Westerterp-Plantenga M . Mar 2008 . Different proteins and biopeptides differently affect satiety and anorexigenic/orexigenic hormones in healthy humans . Int J Obes (Lond) . 32 . 3. 510–8 . 18345020 . 10.1038/sj.ijo.0803758.
2. Akimoto S, Miyasaka K . Age-associated changes of hunger-regulating peptides . Geriatrics & Gerontology International . 10 Suppl 1 . S107–19 . July 2010 . 20590826 . 10.1111/j.1447-0594.2010.00587.x . 33227343 . free .
3. Purnell JQ, Weyer C . Weight effect of current and experimental drugs for diabetes mellitus: from promotion to alleviation of obesity . Treatments in Endocrinology . 2 . 1 . 33–47 . 2003 . 15871553 . 10.2165/00024677-200302010-00004. 8088326 .
4. Hermansen K, Mortensen LS . Bodyweight changes associated with antihyperglycaemic agents in type 2 diabetes mellitus . Drug Safety . 30 . 12 . 1127–42 . 2007 . 18035865 . 10.2165/00002018-200730120-00005. 19877584 .
5. Maayan L, Correll CU . Management of antipsychotic-related weight gain . Expert Review of Neurotherapeutics . 10 . 7 . 1175–200 . July 2010 . 20586697 . 10.1586/ern.10.85 . 3501406.
6. Strasser F, Bruera ED . Update on anorexia and cachexia . Hematology/Oncology Clinics of North America . 16 . 3 . 589–617 . June 2002 . 12170570 . 10.1016/s0889-8588(02)00011-4.
7. Nasr SZ, Drury D . use in cystic fibrosis . Pediatric Pulmonology . 43 . 3 . 209–19 . March 2008 . 18219690 . 10.1002/ppul.20766 . 2027.42/57930 . 43667706 . free .
8. Morley JE . Weight loss in older persons: new therapeutic approaches . Current Pharmaceutical Design . 13 . 35 . 3637–47 . 2007 . 18220800 . 10.2174/138161207782794149.
9. Fox CB, Treadway AK, Blaszczyk AT, Sleeper RB . 6695434 . Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly . Pharmacotherapy . 29 . 4 . 383–97 . April 2009 . 19323618 . 10.1592/phco.29.4.383 .
10. Holmes S . A difficult clinical problem: diagnosis, impact and clinical management of cachexia in palliative care . International Journal of Palliative Nursing . 15 . 7 . 320, 322–6 . July 2009 . 19648846 . 10.12968/ijpn.2009.15.7.43421.
11. Lang F, Perrier E, Pellet J. [Noradrenergic hypothesis in anorexia nervosa: prospective study using beta-stimulant therapy]. Ann Med Psychol (Paris). 1983;141(8):918-25.
12. Ness-Abramof R, Apovian CM . Aug 2005 . Drug-induced weight gain . Drugs of Today . 41 . 8. 547–55 . 10.1358/dot.2005.41.8.893630 . 16234878 . 34960274 .
13. LYRICA (pregabalin), CV. Full Prescribing Information, Section 5.7 (Weight Gain). Pfizer, Inc. Revised June, 2013. http://labeling.pfizer.com/ShowLabeling.aspx?id=561
14. Web site: Fructose Metabolism: Relation to Food Intake & Metabolic Dysfunction. themedicalbiochemistrypage.org. 14 April 2018.
15. Caton SJ, Nolan LJ, Hetherington MM . Alcohol, Appetite and Loss of Restraint. . Curr Obes Rep.. 2015 . 4 . 1 . 99–105 . 10.1007/s13679-014-0130-y. 26627094 . 36018101 .
16. Palatability-dependent appetite and benzodiazepines: new directions from the pharmacology of GABA(A) receptor subtypes. Appetite. 2005. 15808888. 14 April 2018. Cooper. S. J.. 44. 2. 133–150. 10.1016/j.appet.2005.01.003. 1394424.