A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia

Kardinal, Carl G.; Loprinzi, Charles L.; Schaid, Daniel J.; Hass, A. Curtis; Dose, Ann Marie; Athmann, Laureen M.; Mailliard, James A.; McCormack, G; Gerstner, James B.; Schray, Mark F.

doi:10.1002/1097-0142(19900615)65:12<2657::aid-cncr2820651210>3.0.co;2-s

Cited by 196 publications

(64 citation statements)

References 22 publications

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“…Cyproheptadine was commonly associated with an increase in appetite, unsurprisingly because it has been prescribed in other populations as an appetite stimulant. 28,29 The most commonly reported side e ect during the baclofen period was a feeling of drowsiness or somnolence, consistent with other reports. 30,31 The side e ects of drowsiness and fatiguability with any of the drugs were not visible to the experimenters, nor did they interfere with performing evaluations, except when the drug period could not be completed.…”

Section: Subjects With Functional Overground Reciprocal Walkingsupporting

confidence: 80%

Effects of drugs on walking after spinal cord injury

1998

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Clonidine, a noradrenergic agonist, and cyproheptadine, a serotonergic antagonist, have each been associated with improved walking in SCI subjects. Baclofen, a GABA agonist, is frequently prescribed for spasticity but its e ects on walking have not been well quanti®ed. The objective of this study was to compare the e ects of clonidine, cyproheptadine and baclofen on walking in SCI subjects with incomplete injuries. A motorized treadmill was used and harness support provided when necessary. A repeated single-subject design was employed for the twelve subjects. The greatest e ects were found in more severely disabled subjects. Cyproheptadine was associated with greatly reduced need for assistance, increases in maximum treadmill speed (MTS) and reduced clonus. Clonidine was associated with increases in MTS and a generally more upright posture. Baclofen was associated with minor changes in walking. In many cases of drug e ects, MTS increases and other changes were retained following washout of drugs. The signi®cance and implications of the drug e ects and the retention of e ects during washout periods are discussed. It is concluded that clonidine and cyproheptadine have di erent e ects but both appear useful for severely disabled SCI subjects. The e ects of baclofen on walking after spinal cord injury remains unclear.

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Section: Subjects With Functional Overground Reciprocal Walkingsupporting

confidence: 80%

Effects of drugs on walking after spinal cord injury

1998

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“…Clinical studies have also shown that it is not possible to reverse the wasting process in cancer patients by nutritional supplementation. These studies include dietary counseling (198), total parenteral nutrition (TPN) (69) or appetite stimulants such as cryoheptadine (127), a histamine antagonist with antiserotonergic and appetite stimulatory effects, or dronabinol, the active ingredient in marijuana (267). Moreover, with TPN, any weight gain is transient, and body composition analysis shows that this is fat and water rather than lean body mass (69).…”

Section: A Anorexiamentioning

confidence: 99%

“…Thus cyproheptadine, a histamine antagonist with antiserotonergic and appetite-stimulating effects, produced only a slight improvement in appetite and did not significantly prevent progressive weight loss in anorectic cancer patients (127). Marijuana is known to stimulate appetite and weight gain, but a clinical study of dronabinol, the active ingredient, failed to halt the progressive loss of body weight of cachectic cancer patients, although a subjective improvement in mood and appetite was observed (267).…”

Section: A Agents Affecting Appetitementioning

confidence: 99%

Mechanisms of Cancer Cachexia

Tisdale

2009

Physiological Reviews

994

1,061

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Up to 50% of cancer patients suffer from a progressive atrophy of adipose tissue and skeletal muscle, called cachexia, resulting in weight loss, a reduced quality of life, and a shortened survival time. Anorexia often accompanies cachexia, but appears not to be responsible for the tissue loss, particularly lean body mass. An increased resting energy expenditure is seen, possibly arising from an increased thermogenesis in skeletal muscle due to an increased expression of uncoupling protein, and increased operation of the Cori cycle. Loss of adipose tissue is due to an increased lipolysis by tumor or host products. Loss of skeletal muscle in cachexia results from a depression in protein synthesis combined with an increase in protein degradation. The increase in protein degradation may include both increased activity of the ubiquitin-proteasome pathway and lysosomes. The decrease in protein synthesis is due to a reduced level of the initiation factor 4F, decreased elongation, and decreased binding of methionyl-tRNA to the 40S ribosomal subunit through increased phosphorylation of eIF2 on the α-subunit by activation of the dsRNA-dependent protein kinase, which also increases expression of the ubiquitin-proteasome pathway through activation of NFκB. Tumor factors such as proteolysis-inducing factor and host factors such as tumor necrosis factor-α, angiotensin II, and glucocorticoids can all induce muscle atrophy. Knowledge of the mechanisms of tissue destruction in cachexia should improve methods of treatment.

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“…88 Both medications are associated with significant side effects, particularly central nervous system toxicity. 88,94,95 Among anabolic agents, a 4-week randomized trial of human growth hormone in 20 undernourished elderly people demonstrated slightly faster weight gain and improved walking time in those receiving the hormone. After 4 weeks, between-group differences in weight were no longer statistically significant.…”

Section: Pharmacologic Therapy To Reverse Weight Lossmentioning

confidence: 99%

An approach to the management of unintentional weight loss in elderly people

Alibhai

Greenwood²,

Payette³

2005

Canadian Medical Association Journal

230

143

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UNINTENTIONAL WEIGHT LOSS, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed.

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A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia

Cited by 196 publications

References 22 publications

Effects of drugs on walking after spinal cord injury

Effects of drugs on walking after spinal cord injury

Mechanisms of Cancer Cachexia

An approach to the management of unintentional weight loss in elderly people

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