Long-Term Use of Appetite Stimulants

  1. Hello-
    I am so glad that I found this website. I am a registered dietitian working with a hospice organization in Athens, GA. I have been with the organization for a few months and have been doing mostly patient and family educations (high cal, high pro; diet strategies to reduce N/V and constipation, etc). I am trying to become more involved with the organization and thought looking at the use of appetite stimulants (cost effective?) might be a good idea. My question to you is how long should a hospice pt. be on an appetite stimulant? Our appetite stimulant of choice is Megace, however several are on Decardron for mets, and bone pain and receive the added benefit of appetite stimulation. Many of our patients are admitted to hospice on Megace with continued poor po intake and are left on it for months and months. Does anyone have a standard of practice for these meds or just guidelines that you go by for the use and duration. I appreciate all your help.
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  2. 13 Comments

  3. by   saribeth
    Megace...that's a tough one...as you know it is very expensive and once a pt is on Hospice, Medicare will not pay for it. While it does stimulate the pts appetite, in my experience it is more important for the families! We have had pts on it for a few months until they are no longer able to have any intake...all the best :Ball:
  4. by   lvngme
    Quote from mmelvin
    Hello-
    I am so glad that I found this website. I am a registered dietitian working with a hospice organization in Athens, GA. I have been with the organization for a few months and have been doing mostly patient and family educations (high cal, high pro; diet strategies to reduce N/V and constipation, etc). I am trying to become more involved with the organization and thought looking at the use of appetite stimulants (cost effective?) might be a good idea. My question to you is how long should a hospice pt. be on an appetite stimulant? Our appetite stimulant of choice is Megace, however several are on Decardron for mets, and bone pain and receive the added benefit of appetite stimulation. Many of our patients are admitted to hospice on Megace with continued poor po intake and are left on it for months and months. Does anyone have a standard of practice for these meds or just guidelines that you go by for the use and duration. I appreciate all your help.

    I have seemed Remeron also used as an appetite stimulant as well.
  5. by   xmaxiex
    I was speaking with our dietican the other day and he showed me a recent study on use of megace . It seems that it really doesnt work as well as everyone thinks and the cost is very high . Look into it . He got this info from a recent conference he attended .
  6. by   aimeee
    I remember reading that megace had very little effect on overall QOL.
  7. by   z's playa
    Our appetite stimulus.........? A joint of pot. (Honestly..gotta love Canada) Seems to work from what I can see.
    Last edit by z's playa on Dec 24, '04
  8. by   mmelvin
    I appreciate all the feedback. I went through all our patients' charts and found 4 people on Megace (one for 2 years and the rest for 6 months or under-well that's how long they have been our patients-who knows how long before. I found several on Elder Tonic and one on peractin. I don't know how to present this to my group. I don't want to seem heartless. Most of the patients I am talking about are admitted with FFT. Anyway, thanks for all your input. Happy Holidays.
  9. by   aimeee
  10. by   aimeee
    Also found this:

    Pharmacologic therapy should be considered an adjunct to general nonpharmacologic measures; a drug should be discontinued if no benefit occurs after two to six weeks of treatment.

    Information from Module 10: Common physical symptoms. In: Education for physicians on end-of-life care. Chicago: EPEC Project, The Robert Wood Johnson Foundation, 1999.
  11. by   PMHNP10
    Quote from z's playa
    Our appetite stimulus.........? A joint of pot. (Honestly..gotta love Canada) Seems to work from what I can see.
    Funny you should mention pot because it would certainly be a fairly inexpensive option if not for the legality issue. All is not lost though, because in the US you can legally give Marinol. It is a synthetic form of THC and produced as a tablet. I have given this and combined with a few volts of electricity to the noggin (ECT) the pt was eating like a real champ within a week or so. I guess we don't hear much about it because of it being linked to mary jane.
  12. by   z's playa
    Quote from psychrn03
    Funny you should mention pot because it would certainly be a fairly inexpensive option if not for the legality issue. All is not lost though, because in the US you can legally give Marinol. It is a synthetic form of THC and produced as a tablet. I have given this and combined with a few volts of electricity to the noggin (ECT) the pt was eating like a real champ within a week or so. I guess we don't hear much about it because of it being linked to mary jane.

    hmmm...well you learn something everyday. Never heard of Marinol. Or Mary Jane for that matter. Had to ask around on that one.
  13. by   momcats3
    AT what point are you talking about using Megace? From my humble POV, I wouldn't really use Megace at all. If the patient doesn't want to eat, they don't have to. At EOL, their body is shutting down, right? Why would you do that to them? As for the family, a little teaching about EOL s/sx is what I'd do. Isn't that what hospice is all about?
  14. by   mmelvin
    Quote from momcats3
    AT what point are you talking about using Megace? From my humble POV, I wouldn't really use Megace at all. If the patient doesn't want to eat, they don't have to. At EOL, their body is shutting down, right? Why would you do that to them? As for the family, a little teaching about EOL s/sx is what I'd do. Isn't that what hospice is all about?
    You are absolutely right. I agree. I try to talk the nurses and MDs out of Megace everytime. It's just that many of our patient are admitted to our hospice already on it and unfortuately some of the nurses have the mind set that anyone admitted with failure to thrive should have an appetite stimulant. From reading the feedback from this list I now have some research to back up my proposition to evaluate the use of appetite stimulants with our patients. You guys have given me the knowledge and support that I needed to try to go forward. Now that Medicare has stopped paying for appetitie stimulants many of our patients are going to be in trouble with the high cost. Thanks for your help.

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