The lack or loss of appetite for food, which may occur in patients with cancer, AIDS, and other chronic diseases. Anorexia may lead to cachexia, a complex syndrome characterized by progressive tissue nutritional depletion and profound weight loss.

Scope
- Reduced food and fluid intake is normal at the end of life.
- Treatment of anorexia and weight loss may not be appropriate if these symptoms are not having a direct impact on quality of life.
- Management of anorexia and weight loss includes identification and, if appropriate, treatment of possible underlying cause(s) and should include the use of pharmacological and nonpharmacological treatment approaches.
- This application considers only the pharmacological management of fatigue.
- If treatment of the underlying cause is not possible or is not effective, pharmacological management of anorexia and weight loss may be appropriate.

Corticosteroids in the management of anorexia and weight loss in palliative care
Recommendations:
- Systematic reviews of a small number of studies suggest oral or parenteral corticosteroids may be of use in the short-term management of anorexia in palliative care.
- Dexamethasone is included in the IAHPC List of Essential Medicines for the treatment of anorexia, nausea, neuropathic pain, and vomiting.
- Optimal dose and duration of therapy with corticosteroids has not been established. Dexamethasone usually is initiated with a higher dosage (12-24 mg per day) and then tapered off during the next 2-3 weeks until a maintenance dosage of 2-8 mg per day is reached. The use of 4 mg tablets is recommended to facilitate initial titration and maintenance treatment.

Where this alone is insufficient: evidence for management of this symptom
- Anorexia may be linked with low cortisol levels that may be improved with corticosteroid therapy.

Additional supporting information for this drug
Corticosteroids have a number of potential roles in palliative care in the treatment of:
- Fatigue
- Pain relief
- Nerve compression, dyspnea, raised intracranial pressure
- Anticancer hormone therapy

Dexamethasone presentation
Injection: 4 mg/mL in 1‐mL ampoule (as disodium phosphate salt)
Oral liquid: 2 mg/5 mL
Tablet: 4 mg

Adapted from Radbruch L et al. Essential medicines in palliative care — An application for the 19th WHO Expert committee on the selection and use of essential medicines. Kindle Ed., 135 pp. Published June 5, 2013 by IAHPC Press. Available at https://www.amazon.com/Essential-Medicines-Palliative-Care-Application-ebook/dp/B00D7S2D0C