Objective: To provide a brief review of the literature discussing treatment of unplanned weight loss in geriatric patients, focusing on megestrol acetate and to report two cases of deep vein thrombosis (DVT) associated with megestrol acetate therapy in geriatric nursing facility residents.
Data sources: Biomedical literature accessed through MEDLINE and PubMed (1990-2003); product manufacturer information.
Discussion: Unplanned weight loss, a common problem among frail geriatric nursing facility residents, is associated with increased morbidity and mortality. Once reversible causes of weight loss are identified and addressed, dietary changes, including the addition of nutritional supplements, may be of benefit. In some cases, medications are prescribed. Megestrol acetate oral suspension is approved by the Food and Drug Administration for the treatment of anorexia, cachexia, or unexplained significant weight loss in patients with AIDS. Megestrol acetate tablets are FDA-approved for palliative treatment of advanced breast or endometrial cancer. In recent years, several published prospective and retrospective reports have described the use of megestrol acetate for unplanned weight loss in geriatric patients. While clinical efficacy trials reported diarrhea, impotence, and rash as the most commonly occurring adverse events, post-marketing reports have included deep vein thrombosis and pulmonary embolism. DVP has occurred in geriatric patients.
Case summaries: Case #1: An 86-year-old female with Alzheimer's disease and decreased oral intake was prescribed megestrol acetate suspension 400 mg po bid after a 30-day weight loss of 4.8 kg. Ten days later she developed DVT. Megestrol acetate was discontinued, and she was hospitalized and treated, recovering successfully. Case #2: An 85-year old female with Alzheimer's disease who had stopped eating was prescribed megestrol acetate tablets 40 mg po bid. Four months later she developed DVT. Megestrol acetate was discontinued and she was hospitalized and treated, recovering successfully.
Conclusion: Thromboembolic events are potential adverse events associated with megestrol acetate therapy. Caution should be observed in using megestrol acetate in geriatric patients, especially nursing facility residents who often have impaired mobility.
Deep Vein Thrombosis as a Complication of Megestrol Acetate Therapy Among Nursing Home ResidentsJC Bolen et al. J Am Med Dir Assoc 1 (6), 248-52. PMID 12812608.A high incidence of deep vein thrombosis was identified among nursing home residents treated with megestrol acetate, even among ambulatory individuals with no other known …
A Retrospective Study of the Association Between Megestrol Acetate Administration and Mortality Among Nursing Home Residents With Clinically Significant Weight LossD Bodenner et al. Am J Geriatr Pharmacother 5 (2), 137-46. PMID 17719516.MA treatment of elderly nursing home residents with significant weight loss was associated with a significant increase in all-cause mortality without a significant increa …
Megestrol Acetate and Mirtazapine for the Treatment of Unplanned Weight Loss in the ElderlyCB Fox et al. Pharmacotherapy 29 (4), 383-97. PMID 19323618. - ReviewA rising concern among clinicians is treatment of unplanned weight loss in the elderly, especially given the predicted growth of this population over the next few decades …
Recent Results With MegaceN Flynn. J Physicians Assoc AIDS Care 2 (1), 22-3. PMID 11362197.HIV-related weight loss can be broken into four categories: 1) episodic weight loss accompanying acute infections or malignancies; 2) intermittent anorexia; 3) the late, …
Megestrol Acetate for the Palliation of Anorexia in Advanced, Incurable Cancer PatientsF Mateen et al. Clin Nutr 25 (5), 711-5. PMID 16867306. - ReviewAnorexia, or loss of appetite, is a troubling symptom for many patients with advanced cancer. The early observation that breast cancer patients, who were prescribed meges …
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