How effective is capromorelin for stimulating appetite in cats with CKD?

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Capromorelin (Elura, 2 mg/kg PO q24h) produces a +5.2% mean body weight gain in cats with CKD-associated weight loss by Day 55, compared to −1.6% in vehicle-treated controls — a difference of +6.8%. 3 Weight gain begins early and is sustained throughout treatment. By Day 15, capromorelin-treated cats had gained +3.3% body weight versus 0.0% in controls; by Day 27, +3.8% versus −0.9%.3 The labeled dose is 2 mg/kg PO once daily for 56 days in cats with ≥5% unintended weight loss and a history of chronic kidney disease (CKD).3 Capromorelin is the only ghrelin receptor agonist (GRA) authorized for weight loss management in cats, and its orexigenic and anabolic activity is not expected to be limited to CKD — comorbidities including hyperthyroidism, congestive heart failure, cancer, and arthritis were represented in the clinical population.1 The 2026 AAHA Oncology Guidelines also endorse capromorelin alongside mirtazapine as a first-line appetite stimulant in cats with cancer-related hyporexia.5 The safety profile at the labeled dose is acceptable. In safety evaluations using doses of 6–60 mg/kg/day in healthy cats, adverse observations were limited to emesis, hypersalivation, lethargy/depression, head shaking, and lip smacking, all occurring more frequently in capromorelin-treated groups than placebo; no clinically relevant clinical pathology differences were identified.4 Transient reductions in blood pressure and heart rate have been reported after administration, though the clinical significance of this in CKD patients has not been fully characterized.1 Capromorelin is the preferred first-line appetite stimulant for weight gain in feline CKD — mirtazapine (1.88 mg PO q48h) is an established alternative with demonstrated weight gain and reduced vomiting in CKD cats6, while maropitant reduces vomiting but does not improve appetite scores or body weight8, and omeprazole produces only a 2.7% increase in food consumption with no significant effect on appetite score or body