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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