Medications
Methods to support weight gain and muscle anabolism include meeting the body’s protein and energy requirements, resistance exercise, various medications that can aid in protein retention and either increase protein synthesis and/or decrease protein breakdown.
In the case of anorexia, which can lead to progressive weight loss, an obvious approach is to increase protein and calorie intake to meet the body’s requirements. Medications that improve a patient’s food intake include corticosteroids, and US Food and Drug Administration (FDA) approved agents for appetite stimulation. Corticosteroids may be associated with short-term increases in appetite (two to four weeks) for people with disease-related weight loss. However, any weight gain is generally related to fluid retention and the use of corticosteroids is associated with progressive loss of Lean Body Mass (LBM).
Two oral medications approved for appetite stimulation in AIDS-related weight loss include megestrol acetate and dronabinol. Megestrol acetate is a synthetic derivative of the female hormone progesterone and dronabinol is a synthetic derivative of tetrahydrocannabinol, the active ingredient of marijuana. Both have been shown to improve appetite in people with involuntary weight loss (IWL) associated with AIDS or cancer. However, the use of dronabinol has not been shown to be associated with weight gain. Megestrol acetate is an effective appetite stimulant and its use has been associated with increased weight and an improved sense of well-being in patients with either AIDS or cancer. If weight gain and quality of life were the only issues, this would be a successful approach to IWL.
Megestrol acetate is used for weight gain with either little or no increase in LBM at recommended doses. The use of megestrol acetate may also cause loss of LBM if not combined with replacement of testosterone combined with resistance exercise. No published data have addressed the effect of dronabinol on LBM.
Recombinant human growth hormone is an injectable medication approved for AIDS wasting or cachexia. It has both anabolic and anticatabolic effects and its use is associated with an increase in weight and LBM. However, routine use of recombinant human growth hormone is limited by the fact that it must be injected on a daily basis, is significantly more expensive than appetite stimulants, and can be associated with such side effects as joint stiffness, fluid retention, and various changes in blood chemistries i.e. blood glucose levels, liver function tests and blood lipids such as cholesterol and triglycerides.
The oral medication oxandrolone is indicated as adjunctive therapy to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma, and in some patients who, without definite pathophysiologic reasons, fail to gain or to maintain normal weight and to offset the protein catabolism associated with prolonged administration of corticosteroids.
Oxandrolone is a synthetic derivative of testosterone. Derivatives of testosterone are known as anabolic-androgenic steroids and, while generally well tolerated in men or women, can have side effects that can include fluid retention and various changes in blood chemistries i.e. liver function tests and blood lipids such as cholesterol and triglycerides.
Studies of oxandrolone in either healthy volunteers or in people with a variety of conditions associated with IWL have demonstrated the following:
- Oxandrolone increased muscle protein synthesis,
- Increased nitrogen (a breakdown product of protein) retention,
- Increased weight, and
- Increase in LBM.
Interestingly, many of the studies performed using oxandrolone have used an integrated approach to weight gain in IWL, including actively addressing protein requirements as well as including a variety of different types of resistance exercise. In a randomized double-blind, placebo-controlled study performed in HIV+ subjects at the University of California at Berkeley and published in the Journal of the American Medical Association (JAMA) in 1999, both gain in total body weight and lean body mass weight was significantly greater in subjects treated with oxandrolone compared with placebo. Similar results have been demonstrated in community-based clinical settings in cancer, HIV/AIDS, and chronic obstructive pulmonary disease as well as in other academic studies in geriatric sarcopenia.
The goal of any program in the treatment of involuntary weight loss is to successfully prevent the continued loss of lean body mass, help the patient add lean body mass, and allow the patient to become self-sufficient with the highest quality of life and the greatest chance of survival.
The following related links will help the reader learn more about the medications described above. Remember that the patient’s physician should be consulted to help the patient and the physician work together as a team to make decisions regarding which treatments are best and most appropriate for their individual condition.
