Lack of appetite

Start by determining if lack of appetite is reversible: check for constipation, nausea, poor oral hygiene, thrush.

If due to cachexia from disease see the talk tips at the bottom of the page. no survival benefit from parenteral nutrition but complications and infections. No evidence for supplements in increasing appetite or weight.


Appetite stimulants

  • usually not effective in patients with advanced disease
  • dronabinol and megesterol have equally low evidence for effect
  • don’t use megesterol if history of DVT


  • dexamethasone 4mg po/sc in a.m. may help temporarily


  • 15-30mg daily – weight gain, improved gastric emptying,


  • 1.25mg-5mg p.o. once daily at bedtime

Treat early satiety with metoclopramide or domperidone

Other therapies

  • treat reversible causes
  • eating is for pleasure only in advanced illness
  • suggest eating small amounts of favourite foods that are tolerated

Talk tip: if the patient has cachexia, emphasize to patient/family that patient is declining because of disease, not because they are not eating. Focus on hunger and thirst needs, not hydration and nutrition. If appropriate, review natural process of dying and that it’s natural to not want to eat and drink.