                   AIDS INFORMATION NEWSLETTER
                   Michael Howe, MSLS, Editor
                     AIDS Information Center
                VA Medical Center, San Francisco
                     (415) 221-4810 ext 3305
                         August 11, 1995

                Opportunistic Infections (Part VI)
                Diarrhea, Malabsorption, Wasting

                   DIARRHEA and MALABSORPTION

[Oportunistic Infections and Related Disorders; From AmFAR's
AIDS/HIV Treatment Directory, Vol. 7, No. 4 (January 1995)]

     Malabsorption is impaired uptake of nutrients from the
intestines.  Nutrients are normally absorbed from food in the
intestines by cells that make up the finger-like villi lining the
intestinal wall. Certain disease processescan cause the villi to 
become atrophied and shortened. This cell malfunction results in 
impaired absorption of nutrients.
     Diarrhea occurs at some point in the clinical course of most
people with AIDS or HIV infection. It may occur early on or in
end-stage infection, and may be sporadic or continuous. Diarrhea
is a major source of mortality in HIV-infected children in Africa
(Thea et al.); HIV-infected Zairian infants have an 11-fold
increased risk of dying from diarrhea compared with uninfected
infants. 
     The GI symptoms of AIDS were originally attributed to
opportunistic enteric pathogens or to malignancy. Smith et al.
report that specific pathogens can be isolated in the majority of
patients. Grohmann et al. detected viruses in 35% of fecal
specimens from 65 HIV-positive patient with diarrhea compared to
only 12% of specimens taken at the same time from 65 HIV-positive
patients without diarrhea. Patients with diarrhea were more likely
to have astrovirus, picobirnavirus, caliciviruses and adenoviruses.
However, Ullrich et al. suggest that abnormalities of the
intestinal lining can also result from HIV infection itself. 
     The gastrointestinal tract can be affected by many types of
infectious agents:

     Parasitic diseases:
     Cryptosporidiosis
     Isosporiasis
     Microsporidiosis
     Entameba histolytica and Giardia lamblia (both respond to
     conventional treatment).
 
     Viral infections:

     Cytomegalovirus. Colitis is the most commonly recognized GI
     manifestation of CMV disease in AIDS.

     Bacterial infections:

     Mycobacterium avium complex (MAC)
     Salmonellosis
     Campylobacter and chronic Shigella dysentery present with
     symptoms similar to those of salmonellosis. Standard
     treatments are effective.
     High rates of Clostridium difficile-associated diarrhea
     resulting from antibiotic therapy have been reported as well. 

     TREATMENT RESULTS:  Tierney et al. treated 9 HIV+ patients
with chronic diarrhea and no enteric pathogens with 5-ASA
(Mesalamine) 6 g/day PO. Diarrheal symptoms improved in 7/9
patients, and rectal p24 content was significantly reduced over 2
months. No side effects were reported.
     Cello et al. enrolled 51 patients with HIV-related wasting in
an open-label dose-escalating study of octreotide acetate
(Sandostatin) (50, 100, 250, 500 mcg SC three times daily). 21/51
patients (41.2%) had a complete response (reduction in daily stool
volume by 50% or reduction to <250mL/d). 14/21 responders (67%) had
no identifiable pathogens at initial screening compared to 9/30
(30%) nonresponders (P < 0.01). Reduction in stool volume from
baseline was associated with doses higher than 50 mcg. Side effects
included burning at injection site, nausea and vomiting. Octreotide
acetate may inhibit pancreatic secretion, but this side effect is
manageable with pancreatic enzyme replacement therapy.
     A phase I trial of the non-pathogenic yeast Saccharomyces
boulardii is under way for the treatment of chronic diarrhea in
HIV-infected people.

REFERENCES:

     Cello et al. Effect of octreotide on refractory
AIDS-associated diarrhea. Ann Int Med 115: 705-10, 1991.

     Grohmann G et al. Enteric viruses and diarrhea in HIV-infected
patients. NEJM 329(1): 14-20, 1993.

     Smith PD, moderator. Gastrointestinal infections in AIDS. Ann
Int Med 116: 63-77, 1992.

     Thea DM et al. A prospective study of diarrhea and HIV-1
infection among 429 Zairian infants. NEJM 329:1696-702, 1993.

     Tierney AR et al. Treatment of HIV-associated inflammatory
bowel disease with oral 5-ASA. Abstract PoB 3725, VIII Intl Conf
AIDS, Amsterdam, 1992.

     Ullrich R et al. Small intestinal structure and function in
patients infected with human immunodeficiency virus (HIV): evidence
of HIV-induced enteropathy. Ann Int Med 111: 15-21, 1989.

OTHER REPORTS:

     Chlebowski R et al. Nutritional status, gastrointestinal
dysfunction, and survival in patients with AIDS. J Gastro 84:
1288-93, 1989.

     Connolly G et al. Non-cryptosporidial diarrhoea in human
immunodeficiency virus (HIV) infected patients. Gut 2: 195-200,
1989.

     Copyright (c) 1993 - American Foundation for AIDS Research
(AmFAR) - All Rights Reserved. Permission to reproduce for
non-profit use granted with the condition that the source and date
of the information be given, and that AmFAR be notified. Eric
Fretz, Treatment Information Services, AmFAR. DISTRIBUTED BY
GENA/aegis (714.248.2836 * 8N1/Full Duplex * v.34); taking you to
the edge of the electronic AIDS-information frontier and beyond. 


                        WASTING SYNDROME

[Oportunistic Infections and Related Disorders; From AmFAR's
AIDS/HIV  Treatment Directory, Vol. 7, No. 4 (January 1995]

     Involuntary weight loss, or wasting, is one of the most common
manifestations of HIV infection. It can occur at any stage of
infection and is indicative of disease progression. It may be
significant and progressive. In addition, chronic unintended weight
loss is associated with malnutrition, which may contribute to
increased immune suppression including reduction of T-lymphocyte
helper and suppressor cells, altered phagocytic functions, and  
decreased killer-cell activity. Weight loss can result from reduced
food intake, altered metabolism, or malabsorption and associated
diarrhea.
     Neuropsychological disorders associated with HIV infection can
result in loss of appetite (anorexia). Oral ulcerations and
lesions, and the side effects of some drugs may also result in
reduced food intake and subsequent weight loss.

     TREATMENT RESULTS: Dronabinol has been approved as an appetite
stimulant in AIDS patients with wasting. Side effects associated
with dronabinol include dizziness, thinking abnormalities, asthenia
and euphoria. Olson et al. enrolled 139 AIDS patients in a
double-blind placebo-controlled trial. All patients were at least
2.3 kg below their ideal body weights and were free from
intercurrent illness. Patients were randomized to receive
dronabinol 2.5 mg bid or placebo for six weeks, at which time all
patients received dronabinol in an open-label extension of the
study. After the randomized study, 50/72 dronabinol recipients and
38/67 placebo recipients were evaluable. Appetite (measured on a
visual analog scale) was significantly improved in the dronabinol
group (P = 0.02). Mean weight change was 0.1 kg in the dronabinol
group and -0.4 kg in the placebo group (P = NS). At the end of the
first month of the open-label extension study, 7/18 patients who
had originally received dronabinol had gained 2 kg, compared to
2/17 patients who had originally received placebo (P = 0.07).
Although CNS side effects were common in the dronabinol group,
adverse reactions requiring discontinuation of therapy were equally
frequent in the two groups (5 on dronabinol and 4 on placebo).
     Megestrol acetate (Megace) oral suspension has been approved
by the FDA for the treatment of anorexia, cachexia, or unexplained 
significant weight loss in patients with AIDS. The recommended dose
is 800 mg/day. This approval was based on data from two twelve-week
placebo-controlled studies conducted in patients with AIDS-related
wasting. Two-hundred and eighty three patients received megestrol
acetate 400 to 800 mg/day, and 86 patients received placebo. A 
five- to seven-pound weight gain was observed in the megestrol
acetate group, and a two-pound weight loss was observed in the
placebo group. While there was a trend towards increased mortality
in the megestrol acetate group (20/283 (7%) patients on megestrol
acetate and 2/86 (2%) on placebo died), this difference was not
statistically significant.
     Megestrol acetate is currently being investigated in liquid
formulation (800 mg/d).  Results from a twelve week, randomized,
placebo-controlled study of 100 patients with AIDS-related weight
loss of 10% or more of ideal body weight were reported by Oster et
al. 52 patients received megestrol acetate and 48 received placebo.

Body weight in the megestrol acetate group increased by 3.86 kg
from baseline to week 8 (P=<.001), while body weight decreased in
the placebo group 0.46 kg. Body water, lean mass, and patient
survival were not statistically different between the two groups.
     Krentz et al. randomized ten patients with symptomatic HIV
infection and weight loss to receive recombinant human growth
hormone (rHGH) 2.5 or 5.0 mg SC tiw for three months. Three
patients were discontinued from the study after developing
opportunistic infections. In four patients who completed the
high-dose treatment, significant increases in lean body mass (3.8
+1.9 kg, P <0.05) and body weight (3.2 +2.4 kg, P <0.05) and a
significant decrease in fat mass (1.3 +0.8 kg, P <0.05) were
observed. Muscle strength and endurance were also enhanced. These
improvements were not sustained after stopping treatment.
Significant improvements were not observed in the low-dose group.
     Preliminary data from a twelve-week, phase III, multicenter;
placebo-controlled trial of rHGH (average dose of 6 mg daily) in
178 patients with AIDS-associated weight loss was recently
presented by Schambelan et al. Patients enrolled in the trial had
lost an verage of 14% of their normal body weight.  There were five
deaths among the participants; three were receiving the hormone and
two were on placebo. Without unblinding, preliminary data from 78
subjects were reported.  Weight change ranged from -12.3 to +9.1
kg; in the 41 subjects who gained 1 kg or more (mean +3.7 0.3 kg),
increased body mass was 90% fat-free mass.  Weight change in the
remaining 37 subjects averged -2.5 0.4 kg. Therapy with
rHGH/placebo was well tolerated with common side effects.
     Mulligan et al. treated six men with HIV-related weight loss
(mean loss of 19%) with a constant metabolic diet and rHGH 0.1
mg/kg/day for seven days. The men were hospitalized, as were six
HIV-negative volunteers who served as controls. A mean body weight
increase of 2.0 +0.3 kg was observed in the HIV-positive men
(compared with 1.6 +0.2 kg increase in the control group).
Increases in protein anabolism and lipid oxidation were observed.
     Landman et al. treated five patients with AIDS-related wasting
with pentoxifylline 400 mg three times daily. The rationale for the
treatment was based on pentoxifylline's anti-TNF- activity; TNF-
may a role in the pathogenesis of AIDS wasting. 3/5 patients had
elevated serum TNF- levels. No significant weight gain was
observed in any of the patients. In the two patients without
elevetaed TNF-, continued to lose weight and also developed
bacterial pneumonia within 3 weeks of starting therapy.
     Thalidomide is being investigated as a possible treatment for
AIDS-related wasting, due to its anti-TNF-activity. In a study
presented by Reyes-Teran et al., 23 patients receiving
antiretroviral therapy, without active opportunistic infection,
andwith 10% or greater weight loss in the previous six months were
included into a randomized, double-blind, placebo-controlled
efficacy trial. 18 patients have finished the treatment protocol.
Stabilization or weight gain occured in 8/9 patients from
thalidomide group and in 2/9 from the placebo group (P=0.008). Mild
and transient somnolence and erythematous macular lesions were only
observed in the thalidomide group.
     Couderc et al. reported their experience treating three AIDS
patients with wasting with open-label thalidomide 100 mg daily. The
three patients all gained weight (mean gain of 5 kg within three
weeks) and had reduced constitutional symptoms. No changes in CD4
counts or serum TNF- levels were observed. No adverse reactions
were noted.
     Some anecdotal reports have suggested that anabolic steroids
may have a role in the treatment of AIDS-related weight loss (Jekot
and Purdy). However, no data from controlled clinical trials in
AIDS patients have been reported.

     ONGOING TRIALS: A phase I/II study comparing the combination
of dronabinol and megestrol acetate with either drug alone in
patients with HIV-wasting syndrome is under way through the
Division of AIDS Treatment Research Initiative (DATRI 004).  
     Several trials are ongoing to investigate the anabolic steroid
oxandrolone as a treatment for muscle wasting and weight loss in
AIDS patients. No data are yet available.

REFERENCES

     Couderc LJ et al. Thalidomide in wasting syndrome in AIDS.
Abstract P321, Fourth European Conference on Clinical Aspects and
Treatment of HIV Infection. Milan, 1994.

     Jekot WF and Purdy DW. Treating HIV/AIDS patients with
anabolic steroids. A retrospective study. AIDS Pat Care, 68-74,
April, 1993.

     Krentz AJ et al. Anthropometric, metabolic, and immunological
effects of recombinant human growth hormone in AIDS and
AIDS-related complex. J AIDS 6:245-51, 1993.

     Landman D et al. Use of pentoxifylline therapy for patients
with AIDS-related wasting: pilot study. Clin Inf Disease 18:97-9,
1994.

     Mulligan CK et al. Anabolic effects of recombinant human
growth hormone in patients with wasting associated with human
immunodeficiency virus infection. J Clin Endocrin Metab 77:956-62,
1993.

     Olson R et al. Dronabinol for treatment of anorexia and weight
loss in AIDS patients. Oral presentation, VIII Intl Conf AIDS,
Amsterdam, 1992.

     Oster et al. Megestrol acetate in patients with AIDS and
cachexia. Ann Int Med 121:400-408, 1994.

     Reyes-Teran G et al. Effects of thalidomide on wasting
syndrome in patients with AIDS, A randomized double-blind, placebo-
controlled clinical trial. Abstract #536B, X Intl Conf AIDS,
Yokohama, 1994.

     Schambelan M et al. Growth Hormone therapy of AIDS wasting.
Abstract #432B, X Int Conf AIDS, Yokohama, 1994.

     Von Roenn JH et al. Megastrol acetate in patients with AIDS-
related cachexia. Ann Intern Med 121:393,300, 1994.

OTHER REPORTS:

     Flynn N et al. Megestrol acetate 800 mg/day vs placebo for
treatment of weight loss and anorexia in AIDS patients. Abstract
PoB 3687, VIII Intl Conf AIDS, Amsterdam, 1992.

     Graham KK et al. Steady-state pharmacokinetic and
pharmacodynamic evaluation of megestrol acetate oral suspension in
cachectic AIDS patients. 31st ICAAC, abstract 550, 1991.

     Grunfeld C et al. Metabolic disturbances and wasting in the
acquired immunodeficiency syndrome. NEJM 327: 329-37, 1992.

     Hickey M et al. Nutritional management of patients with ARC
or AIDS. Gastro Cl N Amer 17: 546-61, 1988.

     Kotler D et al. Malnutrition in HIV infection and AIDS. AIDS
3(supp.1): 175-80, 1989.

     Koster F et al. A randomized, double blind, place-contrlled
Phase II trial of growth hormone and insulin-like growth factor-
I for AIDS wasting. Abstract #110, ICAAC, Orlando, 1994.

     Krentz A et al. Treatment of AIDS patients with growth
hormone. American College of Physicians meeting, Albuquerque, 1990.

     Plasse T et al. Dronabinol stimulates appetite and causes
weight gain in HIV patients. Abstract PuB 7442, VIII Intl Conf
AIDS, Amsterdam, 1992.

     Von Roenn et al. Controlled trial of megestrol acetate for the
treatment of AIDS related anorexia and cachexia. VII Intl Conf
AIDS, Florence. Vol 2: 280(W.B.2392), 1991.

     Winick M et al. Guidelines for nutrition support in AIDS.
Nutrition 5(1): 39-46, 1989.

     Copyright (c) 1995. American Foundation for AIDS Research
(AmFAR). All rights reserved. Permission to reproduce for
non-profit use granted with the condition that the source and date
of the information be given, and that AmFAR be notified. Eric
Fretz, Treatment Information Services, AmFAR. DISTRIBUTED BY
GENA/aegis (714.248.2836 * 8N1/Full Duplex * v.34); taking you to
the edge of the electronic AIDS-information frontier and beyond. 


                 DRONABINOL FOR ANOREXIA IN AIDS

[For more information about the study described below, see:
Beal JE et al. Dronabinol as a treatment for anorexia associated
with weight loss in patients with AIDS. J Pain Symptom Manage 1995
Feb;10:89-97.]

     Dronabinol (Marinol), a medicinal form of tetrahydro-
cannabinol, has been used to treat nausea and vomiting in
chemothrapy patients.  This six-week randomized, placebo-
controlled trial tested dronabinol (2.5 mg twice daily) as a
treatment for anorexia and poor appetite in 139 AIDS patients at
18 U.S. centers.
     All patients had lost at least 2.3 kg from normal body weight
but were physically able to eat a normal diet.  The efficacy
analysis focused on 88 patients who took at least 75% of planned
doses and did not violate protocol by using marijuana, megestrol
acetate, or corticosteroids.
     At last follow-up, the dronabinol group had significantly
greater improvements than the placebo group in self-reported
appetite (38% vs 8%) and nausea (a 20% vs 7% decline).  They also
showed a trend toward greater weight stabilization.  Side effects
were common (43%), consisting mainly of mild-to-moderate euphoria,
dizziness, thinking abnormalities, and sleepiness.
     Other evidence, though sparse, suggests a benefit from
dronabinol in AIDS patients, and the drug deserves further
evaluation.  In this study, differneces in weight loss were not
statistically significant, but follow-up averaged only 35 to 36
days, perhaps too short to allow gains in appetite to take effect.


       DRONABINOL (MARINOL) - DESCRIPTION - FROM AIDSDRUGS

PHARMACOLOGY  - Forms numerous metabolites, including 11-hydroxy-
tetrahydrocannabinol, which is psychoactive and is the principal
active metabolite. Maximum plasma concentration of dronabinol and
several metabolites occurs approximately 2-3 hours after oral
dosing. Biliary excretion is the major route of elimination. The
elimination phase exhibits biphasic kinetics with an alpha
half-life of about 4 hours and a terminal half-life of 25-36 hours.
The terminal plasma half-life for the principal active metabolite
is approximately 15-18 hours. [PDR 1993]

DISEASES STUDIED - FDA approved 12/23/92 for appetite stimulation
and the prevention of weight loss in HIV-infected patients [AmFAR
Tx Dir 1993;6(4)]

CLASSIFICATION CODE -  Appetite stimulant [AmFAR Tx Dir 1993;6(4)];
Antiemetic [USAN 1993]

OTHER MAJOR USES - Nausea and vomiting associated with cancer
hemotherapy [PDR 1993]

SUBSTANCE INTERACTIONS - May interact with barbiturates and
hypnotics and sedatives. May delay absorption of alcohol. [Drug
Interactions and Side Effects Index 1992]

ADVERSE EFFECTS - The most frequently reported adverse reaction
involved the central nervous system. In decreasing order of
frequency these events were drowsiness, dizziness, muddled thinking
and brief impairment of coordination, sensory and perceptual
functions. Easy laughing, elation and heightened awareness, often
termed a high, was observed in 24% of  patients. [PDR 1993]

CONTRAINDICATIONS - Contraindicated in pregnant and nursing women,
in patients whose nausea and vomiting arise from any cause other
than cancer chemotherapy, and in patients with known
hypersensitivity to either dronabinol or sesame oil. Should be used
with caution in patients with hypertension or heart disease; in
manic, depressive, or schizophrenic patients; and in patients
receiving other psychoactive drugs. [PDR 1993]

CHEMICAL/PHYSICAL DATA - DRUG DESCRIPTION: Synthetically
manufactured version of the active substance in marijuana,
delta-9-tetrahydrocannabinol [AmFAR Tx Dir 1993;6(4)]

SUBSTANCE DELIVERY DATA - DOSAGE FORM: 2.5, 5, and 10 mg soft
gelatin capsules. [PDR 1993]. MODE OF DELIVERY: Oral. [PDR 1993].
STORAGE: Store between 8 and 15 C (46 and 59 F). Protect from
freezing. [USP DI 1989]

MANUFACTURER - Roxane Laboratories, Incorporated

REFERENCES

     Cat LK, Coleman RL. Treatment for HIV wasting syndrom. Ann
Pharmacother. 1994 May;28(5):595-597.

     Struwe M, Kaempfer SH, Geiger CJ, Pavia AT, Plasse TF, Shepard
KV, Ries K, Evans TG. Effect of dronabinol on nutritional status
in HIV infection. Ann Pharmacother. 1993 Jul-Aug;27(7-8):827-831.

     Beal J, Olson R, Shepard KV, Plasse T. Effect of dronabinol
on appetite and weight in AIDS: long-term follow-up. Int Conf AIDS
1993 Jun 6-11;9(1):527 (abstract no. PO-B36-2354).

     Struwe M, Kaempfer SH, Pavia AT, Geiger CJ, Shepard KV, Plasse
TF, Evans T. Randomized study of dronabinol in HIV related weight
loss. Int Conf AIDS. 1992 Jul 19-24;8(3):137 (abstract no. PuB
7531).

     Plasse T, Conant M, Gorter R, Shepard KV. Dronabinol
stimulates appetite and causes weight gain in HIV patients. Int
Conf AIDS. 1992 Jul 19-24;8(3):122 (abstract nol PuB 7442).

     Plasse TF, Gorter RW, Krasnow SH, Lane M, Shepard KV, Wadleigh
RG. Recent clinical experience with dronabinol. Pharmacol Biochem
Behav. 1991 Nov;40(3):695-700.

     Conant M, Roy D, Shepard KV, Plasse TF. DRONABINOL ENHANCES
APPETITE AND CONTROLS WEIGHT LOSS IN HIV PATIENTS (MEETING
ABSTRACT) Proc Annu Meet Am Soc Clin Oncol;10:A9 1991. 

     Beal JA. Appetite effect of dronabinol [letter;comment]. J
Clin Oncol. 1994 Jul;12(7):1524-1525.


    MEGESTROL ACETATE (MEGACE) - DESCRIPTION - FROM AIDSDRUGS

PHARMACOLOGY - While the precise mechanism by which megestrol
acetate produces its antineoplastic effects against endometrial
carcinoma is unknown at the present time, inhibition of pituitary
gonadotropin production and resultant decrease in estrogen
secretions may be factors. There is evidence to suggest a local
effect as a result of the marked changes brought about by the
direct instillation of progestational agents into the endometrial
cavity. Metabolites account for only 5-8% of the administered dose
and are considered negligible. The major route of drug elimination
in humans is the urine. Peak drug levels for the first 40 mg dose
ranged from 1.0 to 3.0 hours (mean 2.2 hours). Plasma elimination
half-life ranged from 13.0 to 104.9 hours (mean 34.2 hours). The
steady state plasma concentrations for a 40 mg qid regimen have not
been established. [PDR 1993]

DISEASES STUDIED - Indicated for the treatment of anorexia,
cachexia or an unexplained significant weight loss in people with
AIDS [Bristol-Myers Squibb News Release 09/15/93 Megace Approved]

CLASSIFICATION CODE - Antineoplastic agent [Merck Index 1989]; Oral
contraceptive [Merck Index 1989]; Appetite stimulant [USAN 1990]

OTHER MAJOR USES - Palliative treatment of advanced carcinoma of
the breast or endometrium; dysfunctional uterine bleeding [PDR
1993] [Drug Evaluations Annual 1992]

ADVERSE EFFECTS - The most common adverse events observed at a
dosage of 800 mg per day were diarrhea, rash, impotence, edema,
flatulence and weakness. The weight gain has been associated with
increased appetite and is not necessarily associated with fluid
retention. Thromboembolic phenomena including thrombophlebitis and
pulmonary embolism have been rarely reported. Also nausea and
vomiting, edema, breakthrough bleeding, dyspnea, tumor flare (with
or without hypercalcemia), hyperglycemia, alopecia, hypertension,
and carpal tunnel syndrome have been reported as adverse effects.
[Bristol-Myers Squibb News Release 09/15/93 Megace Approved] [PDR
1993]

CONTRAINDICATIONS - Contraindicated as a diagnostic test for
pregnancy. Should not be used during pregnancy. [PDR 1993]

CHEMICAL/PHYSICAL DATA - DRUG DESCRIPTION: A synthetic derivative
of the naturally occurring steroid hormone progesterone
[Bristol-Myers Squibb News Release 09/15/93 Megace Approved];
MOLECULAR FORMULA: C24H32O4 [Merck Index 1989]; MOLECULAR WEIGHT:
384.5 [Merck Index 1989]; MELTING POINT: 214-215 C [Merck Index
1989]; SOLUBILITY: (37 C) water, 2 mcg/ml; plasma, 24 mcg/ml [Merck
Index 1989]; PHYSICAL DESCRIPTION: White crystalline solid [PDR
1993]; ELEMENTAL COMPOSITION: C74.97%, H8.39%, O16.65% [Merck Index
1989]; DOSAGE FORM: Lemon-lime flavored suspension containing 40
mg megestrol acetate per ml. [Bristol-Myers Squibb News Release
09/15/93 Megace Approved]

SUBSTANCE DELIVERY DATA - MODE OF DELIVERY: Oral. [PDR 1993];
STORAGE: Store at room temperature. Protect from temperatures above
40 C. [PDR 1993]

MANUFACTURERS - Bristol-Myers; Mead Johnson; Schering Plough

REFERENCES

     Aronson NE, Amegin GP. Posterior subscapular cataracts
associated with megestrol acetate therapy. J Cataract Refract Surg.
1993 Jan;19(1):90-1. 

     Von Roenn JH, Roth EL, Craig R. HIV-related cachexia:
potential mechanisms and treatment. Oncology. 1992;49 Suppl 2:50-4.

     Orzechowski A, del Rio C, Tellez I. Weight gain with the use
of megace in patients with AIDS in Mexico. Int Conf AIDS. 1992 Jul
19-24;8(3):115 (abstract no. PuB 7397).

     Flynn N, Enders S, Oster M, Cone L, Hooten T. Megestrol
acetate 800 mg/day vs placebo for treatment of weight loss and
anorexia in AIDS patients. Int Conf AIDS. 1992 Jul 19-24;8(2):B205
(abstract no. PoB 3687).

     Henry K, Rathgaber S, Sullivan C, McCabe K. Diabetes mellitus
induced by megestrol acetate in a patient with AIDS and cachexia
[see comments]. Ann Intern Med. 1992 Jan 1;116(1):53-4.

     Mahayni H, Minor JR. Megestrol acetate in AIDS-related
cachexia. Am J Hosp Pharm. 1991 Nov;48(11):2479-80.

     Von Roenn J, Roth E, Murphy R, Weitzman S, Armstrong D.
Controlled trial of megestrol acetate for the treatment of anorexia
and cachexia. Int Conf AIDS. 1991 Jun 16-21;7(2):280 (abstract no.
W.B.2392).

     Tierney A, Cuff P, Kotler DP. The effect of megestrol acetate
(Megace) on appetite, nutritional repletion, and quality of life
in AIDS cachexia. Int Conf AIDS. 1991 Jun 16-21;7(1):247 (abstract
no. M.B.2263).

     Gold J, Oliver C. Evaluation of megestrol acetate treatment
in AIDS. Int Conf AIDS. 1989 Jun 4-9;5:336 (abstract no.
T.B.P.298).

     von Roenn JH, Murphy RL, Weber KM, Williams LM, Weitzman SA.
Megestrol acetate for treatment of cachexia associated with human
immunodeficiency virus (HIV) infection. Ann Intern Med. 1988 Nov
15;109(10):840-1.


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