Anorexia Side Effect
Anorexia is a condition characterized by excessive weight loss, abnormal loss of appetite, and intense fear of weight gain.
Mechanisms of drug-induced anorexia
- Inhibition of dopamine and serotonin reuptake
- Increase of satiety-inducing hypothalamic neurotransmitters8
- Endogenous digoxin-like factor disruption
- Abnormal serum leptin levels
- Taste alternation
- Drug-induced nausea or vomiting
List of medications that may cause anorexia
Amphetamine-like drugs (amphetamine, dextroamphetamine, lisdexamfetamine) are potent appetite suppressants and can induce anorexia.
| Drug | Incidence |
|---|---|
| Abelcet | |
| Abilify | > 1% |
| Accuretic | |
| Aciphex | |
| Actimmune | 3% |
| Actiq | < 1% |
| Adriamycin | 12% |
| Advicor | |
| Aggrenox | 1.2% |
| Agrylin | 7.7% |
| Aldoclor | |
| Aldoril | |
| Alferon N | 1% to 68% |
| Alimta | 35% |
| Alinia | < 1% |
| Aloxi | < 1% |
| Altace | < 1% |
| Altoprev | Rare |
| AmBisome | 10 to 14% |
| Ambien | 1% |
| Amphetamine (Adderall®) | 2.9% to 22% |
| Ancef | |
| Ancobon | |
| Anzemet | Rare |
| Aralen | |
| Arava | 3% |
| Aredia | 1% to 20.8% |
| Aricept | 4% |
| Arimidex | 5% to 8% |
| Aromasin | 6% |
| Asacol | |
| Atacand HCT | |
| Avalide | |
| Avelox | 0.1% to 3% |
| Avinza | 5% to 10% |
| Axid | 1.2% |
| Balamine DM | |
| Bentyl | |
| Bextra | 0.1% to 1.9% |
| Biaxin | |
| Biltricide | |
| Brevibloc | < 1% |
| Buprenex Injectable | Rare |
| Busulfex | 21% to 85% |
| Caduet | 0.1% to 2% |
| Calcijex | |
| Calcium Disodium Versenate | |
| Campath | 20% |
| Campral | 2% to 5% |
| Camptosar | 5.9% to 54.9% |
| Cancidas | < 1.3% |
| Captopril | 0.5% to 2% |
| Carbatrol | |
| Cardizem | < 2% |
| Carnitor | 3% to 6% |
| Casodex | 5% |
| Catapres | 1% |
| Catapres-TTS | < 0.5% |
| Cedax | 0.1% to 1% |
| Ceftin | 0.1% to 1% |
| Celebrex | 0.1% to 1.9% |
| Celexa | 4% |
| CellCept | 3% to 25.3% |
| Clinoril | > 1% |
| Clorpres | 1% |
| Clozapine | 1% |
| Clozaril | 1% |
| Colazal | 2% |
| Combivir | 10% |
| Comvax | 0.8% to 3.9% |
| Concerta | 4% |
| Copaxone | 8% |
| Copegus | 24% |
| Corzide | 0.1% to 0.5% |
| Cosmegen | |
| Cosopt | |
| Cozaar | < 1% |
| Crixivan | 2.7% |
| Cuprimine | |
| Cylert | |
| Cymbalta | 3% to 5% |
| Cytovene | 15% |
| DTIC-Dome | 90% |
| Dalmane | Rare |
| Dantrium | Rare |
| Daptagel | 9% to 17.6% |
| Daranide | Common |
| Daraprim | |
| Depacon | 4% to 12% |
| Depakene | 11% to 12% |
| Depakote | 1% to 12% |
| Dexfenfluramine (Redux®)5 | |
| Dextroamphetamine (Dexedrine®, Dextrostat®) | |
| Digitek | 1% |
| Dilaudid | |
| Diovan | Less frequent |
| Dipentum | 1.3% |
| Diuril | |
| Dolobid | < 1% |
| Dostinex | 1% to 10% |
| Doxil | 1% to 11.9% |
| Duragesic | 3% to 10% |
| Dynacin | |
| E.E.S. | Frequent |
| Edecrin | |
| Effexor | 5% to 20% |
| Eldepryl | |
| Ellence | < 2.9% |
| Elmiron | < 1% |
| Eloxatin | 20% to 29% |
| Elspar | |
| Emend | 10.1% |
| Enbrel for | |
| Engerix-B Vaccine | < 1% |
| Epivir | 10% |
| Erbitux | 25% |
| Ery-Tab | Frequent |
| EryPed | Frequent |
| Erythrocin | Frequent |
| Erythromycin | Frequent |
| Eskalith | |
| Evoxac | 1% to 3% |
| Exelon | 17% |
| Exenatide (Byetta®, Bydureon®)3 | |
| Factive | 0.1% to 1% |
| Famvir | 1.1% to 2.6% |
| Fareston | |
| Faslodex | 9% |
| FazaClo | 1% |
| Femara | 3% to 5% |
| Ferrlecit | |
| Flexeril | < 1% |
| Flolan | 25% to 66% |
| Fludara | 7% to 34% |
| Flumadine | 1.6% |
| Fluoxetine (Prozac®)5 | 3% to 11% |
| Focalin | 6% |
| Fortovase | < 2% |
| Furosemide | |
| Fuzeon | 2.6% |
| Gabitril | > 1% |
| Gemzar for | Common |
| Gengraf | 2% to 3% |
| Geodon | 2% |
| Gleevec | 7% to 17% |
| Glucotrol | < 1% |
| Guanidine | |
| HIVID | < 1% |
| Haldol Decanoate | |
| Havrix | 1% to 10% |
| Hectorol | 4.9% |
| Herceptin | 14% |
| Hexalen | 1% |
| Hibtiter | |
| Hycamtin | < 19% |
| HydroDIURIL | |
| Hyzaar | |
| Indapamide | < 5% |
| Indocin | < 1% |
| Infergen | 21% to 24% |
| Intron A | 1% to 69% |
| Invanz | > 0.1% |
| Inversine | |
| Invirase | < 2% |
| Iressa | 7% to 11% |
| Kadian | < 3% |
| Kaletra | < 1% |
| Keppra | 3% |
| Ketek | 0.2% to 2% |
| Klonopin | |
| Lamictal | 2% |
| Lamisil | |
| Lanoxicaps | Common |
| Lanoxin | |
| Lariam | Frequent |
| Lescol | |
| Leukine | 13% to 54% |
| Levaquin | 0.1% to 1% |
| Levlen | |
| Levlite | |
| Lexapro | |
| Lipitor | < 2% |
| Lisdexamfetamine (Vyvanse®)2 | |
| Lofibra | |
| Lotensin | 0.3% to 1% |
| Lupron Depot | < 5% |
| Lupron | > 5% |
| MS Contin | Less frequent |
| MSIR | Less frequent |
| Malarone | 5% |
| Marinol | < 1% |
| Matulane | |
| Maxair Autohaler | |
| Maxalt | Rare |
| Maxzide | |
| Mefloquine1 | |
| Mepron | 7% |
| Meridia | 13% |
| Merrem | 0.1% to 1% |
| Metadate | 9% |
| Methylphenidate (Ritalin®)7 | 3.1% |
| Mevacor | Rare |
| Miacalcin | < 1% |
| Midamor | 3% to 8% |
| Mintezol | |
| Mirapex | 1% to 4% |
| Moduretic | 3% to 8% |
| Monurol Sachet | < 1% |
| Motrin | |
| Mustargen | |
| Myleran | |
| Mylotarg | 22% to 27% |
| Nadolol | 0.1% to 0.5% |
| Namenda | > 2% |
| Navelbine | < 46% |
| Neoral | 2% to 3% |
| Neulasta | 15% to 72% |
| Neumega | > 10% |
| Neupogen | 9% |
| Nexium | < 1% |
| Nilandron | 11% |
| Nipent | 13% to 16% |
| Nizoral | |
| Noroxin | Less frequent |
| Norpramin | |
| Norvasc | 0.1% to 1% |
| Norvir | 1.7% to 7.8% |
| Omnicef | 0.3% |
| Oncaspar | 1% to 5% |
| Ontak Vials | 36% |
| Oramorph | 1% to 10% |
| Orap | |
| Ortho Tri-Cyclen | |
| Orthoclone | < 1% |
| OxyContin | 1% to 5% |
| PCE Dispertab | Frequent |
| PEG-Intron Powder | 20% |
| Pacerone | 4% to 9% |
| Parcopa | |
| Parnate | |
| Paser Granules | Less frequent |
| Pediarix | |
| Pediazole | Frequent |
| Pegasys | 17% |
| Pentasa | 1% to 1.1% |
| Pepcid | Infrequent |
| Periostat | |
| Permax | 4.8% |
| Phentermine | |
| PhosLo | |
| Photofrin | 4% to 8% |
| Plaquenil | |
| Pletal | < 2% |
| Potaba | Infrequent |
| Pravachol | Rare |
| Prevacid | < 1% |
| Prevpac | < 1% |
| Priftin | 2.2% |
| Prilosec | < 1% |
| Prinivil | > 1% |
| Prinzide | |
| Prograf | 3% to 34% |
| Proleukin | 20% |
| Prometrium | |
| Protonix | < 1% |
| Protopic | > 1% |
| Provigil | 4% |
| Pulmicort Respules | 1% to 3% |
| Purinethol | 1% to 10% |
| Rapamune | 3% to 20% |
| ReFacto Vials | |
| Rebetol | 21% to 51% |
| Rebetron | 21% to 27% |
| Relafen | < 1% |
| Relpax | Infrequent |
| Reminyl | 1% to 9% |
| Requip | 4% |
| Retrovir | 11% to 20.1% |
| Reyataz | < 3% |
| Ribavirin | 21% to 27% |
| Rifadin | Rare |
| Rifamate | Rare |
| Rifater | |
| Rilutek | 3.8% to 8.6% |
| Risperdal | 2% to 8% |
| Rituxan | < 5% |
| Rocaltrol | |
| Roferon-A | 14% to 48% |
| Rythmol | |
| Salagen | < 1% |
| Salbutamol (Ventolin®)6 | |
| Sandimmune | < 2% |
| Sandostatin LAR Depot | 5% to 15% |
| Sensipar | 6% |
| Septra | Common |
| Seroquel | Frequent |
| Sertraline (Zoloft®)5 | 3% to 11% |
| Sonata | 1% to 2% |
| Soriatane | 1% to 10% |
| Spectracef | 0.1% to 1% |
| Sporanox | |
| Stalevo | |
| Strattera | |
| Stromectol | 0.9% |
| Sular | < 1% |
| Surmontil | |
| Sustiva | 1% to 2% |
| Symmetrel | 1% to 5% |
| Tabloid | Less frequent |
| Tambocor | 1% to 3% |
| Targretin | 2.4% to 22.6% |
| Tasmar | 19% to 23% |
| Taxotere Concentrate | 5% to 42% |
| Tegretol | |
| Temodar | 9% |
| Tequin | < 0.1% |
| Teveten | < 1% |
| Thalomid | 2.8% to 9.4% |
| Thioridazine | |
| Thiothixene | |
| Tiazac | < 2% |
| Ticlid | 1.0% |
| Timolide | |
| Timolol GFS | |
| Timoptic | Less frequent |
| Tindamax | 1.5% to 2.5% |
| Tobi | 18.6% |
| Topiramate (Topamax®)4 | 4% to 24% |
| Toradol | < 1% |
| Trecator-SC | Frequent |
| Trental | Less than 1% |
| Tri-Levlen | |
| Tricor | |
| Trileptal | 3% to 5% |
| Trisenox | 23% |
| Trizivir | 15% |
| Truvada | |
| Twinrix Vaccine | < 1% |
| Ultracet | 3% |
| Ultram | 1% to 5% |
| Uniretic | < 1% |
| VFEND | < 1% |
| Vaniqa | 0.7% to 1% |
| Vantin | < 1% |
| Vaseretic | |
| Vasotec | 0.5% to 1.0% |
| Velcade | 43% |
| Vesanoid | 17% |
| Vicoprofen | < 3% |
| Videx EC | |
| Viracept | < 2% |
| Viread | 3% to 4% |
| Vivactil | |
| Vytorin | |
| Xanax | |
| Xeloda | 1% to 13% |
| Xifaxan | < 2% |
| Zaroxolyn | |
| Zavesca | 7% |
| Zegerid | < 1% |
| Zerit | 19% |
| Zevalin | 8% |
| Zinecard | 27% to 42% |
| Zocor | |
| Zoladex | 1% to 5% |
| Zometa for Intravenous Infusion | |
| Zomig | Rare |
| Zonegran | 13% |
| Zyban | 1% to 3% |
| Zyprexa | |
| Zyrtec | < 2% |
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Risk factors
Factors that increase the likelihood of anorexia9:
- Perfectionism (one of the strongest risk factors)
- Negative self-evaluation
- Female sex
- Sociocultural idealization of thinness
- Body dissatisfaction
- Genetic predisposition
- History of depression or dementia
Complications
Health problems of associated with anorexia:
- Impaired gastrointestinal motility
- Gastric dilatation10
- Osteoporosis10
- Liver dysfunction10
- Electrolyte imbalances: hyponatremia (sodium depletion), hypovolemia, hypophosphatemia, hypomagnesemia10
- Cardiovascular complications: bradycardia, hypotension, significant prolongation of QT interval, arrhythmias, congestive heart failure11
- Loss of skin thickness
References
- 1. Albright TA, Binns HJ, Katz BZ. Side effects of and compliance with malaria prophylaxis in children. J Travel Med. 2002 Nov-Dec;9(6):289-92. PubMed
- 2. Soutullo C1, Banaschewski T, Lecendreux M, et al. A post hoc comparison of the effects of lisdexamfetamine dimesylate and osmotic-release oral system methylphenidate on symptoms of attention-deficit hyperactivity disorder in children and adolescents. CNS Drugs. 2013 Sep;27(9):743-51 PubMed
- 3. Kadowaki T1, Namba M, Yamamura A, et al. Exenatide exhibits dose-dependent effects on glycemic control over 12 weeks in Japanese patients with suboptimally controlled type 2 diabetes. Endocr J. 2009;56(3):415-24.
- 4. Storey JR, Calder CS, Hart DE, Potter DL. Topiramate in migraine prevention: a double-blind, placebo-controlled study. Headache. 2001 Nov-Dec;41(10):968-75.
- 5. Samanin R, Garattini S. Neurochemical mechanism of action of anorectic drugs. Pharmacol Toxicol. 1993 Aug;73(2):63-8. PubMed
- 6. Garattini S, Samanin R. d-Fenfluramine and salbutamol: two drugs causing anorexia through different neurochemical mechanisms. Int J Obes. 1984;8 Suppl 1:151-7. PubMed
- 7. Golinko BE. Side effects of extroamphetamine and methylphenidate in hyperactive children. Prog Neuropsychopharmacol Biol Psychiatry. 1984;8(1):1-8.
- 8. Leibowitz SF, Weiss GF, Shor-Posner G. Hypothalamic serotonin: pharmacological, biochemical, and behavioral analyses of its feeding-suppressive action. ClinNeuropharmacol. 1988;11(Suppl 1):S51–71
- 9. Fairburn CG, Cooper Z, Doll HA, Welch SL. Risk factors for anorexia nervosa. Arch Gen Psychiatry. 1999 May;56(5):468-76.
- 10. Mitchell JE, Crow S. Medical complications of anorexia nervosa and bulimia nervosa. CurrOpin Psychiatry. 2006 Jul;19(4):438-43.
- 11. Sachs KV, Harnke B, Mehler PS, Krantz MJ. Cardiovascular complications of anorexia nervosa. Int J Eat Disord. 2016 Mar;49(3):238-48
Published: May 28, 2008
Last updated: December 12, 2017
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