There have been a small number of trials investigating the use of appetite stimulants to improve the dietary energy intake of patients with CF. Megestrol acetate improves weight gain and respiratory function (Eubanks et al, 2002). Cyproheptadine hydrochloride has also been reported to have a beneficial effect on appetite (Homnick et al, 2005). Because some of these drugs have undesirable side effects we do not recommend that they are used routinely. Their use may, however, be considered on an individual basis.
Anabolic drugs can stimulate the appetite, improve muscle bulk and lead to improved weight gain and body composition. A number of these drugs have been studied in small groups of patients with CF. The most positive results have been seen with the use of growth hormone (Darmaun et al, 2004; Hardin et al, 2005), creatine (Braegger et al, 2003) and early insulin therapy (Bizzarri et al, 2006). At the present time we feel that research regarding the use of these drugs in CF is in its early stages and therefore we recommend that their use is restricted to clinical trials.
• The use of appetite stimulants may be considered on an individual basis
• The use of anabolic agents should be restricted to clinical trials
Bizzarri C, Lucidi V, Ciampalini P, et al. Clinical effects of early treatment with insulin glargine in patients with cystic fibrosis and impaired glucose tolerance. J Endocrinol Invest 2006; 29: RC1-4. [PubMed]
Braegger CP, Schlattner U, Wallimann T, et al. Effects of creatine supplementation in cystic fibrosis: results of a pilot study. J Cyst Fibros 2003; 2: 177-182. [PubMed]
Darmaun D, Hayes V, Schaeffer D, et al. Effects of glutamine and recombinant growth hormone on protein metabolism in prepubertal children with cystic fibrosis. J Clin Endocrinol Metab 2004; 89: 1146-1152. [PubMed]
Eubanks V, Koppersmith N, Woolridge N, et al. Effects of megestrol acetate on weight gain, body composition and pulmonary function in patients with cystic fibrosis. J Pediatr 2002; 140: 439-444. [PubMed]
Hardin DS, Rice J, Ahn C, et al. Growth hormone treatment enhances nutrition and growth in children with cystic fibrosis receiving enteral nutrition. J Pediatr 2005; 146: 324-328. [PubMed]
Homnick DN, Marks JH, Hare KL, et al. Long-term trial of cyproheptadine as an appetite stimulant in cystic fibrosis. Pediatr Pulmonol 2005; 40: 251-256. [PubMed]