Human studiesGhrelin-receptor agonist (natural hunger hormone)
Ghrelin
Lenomorelin (INN), acyl ghrelin, octanoyl ghrelin, human ghrelin, SUN11031 (synthetic ghrelin tested by Daiichi Sankyo)
Common dose
Trial doses only
Cycle
No set cycle
Form
In trials only
A 28-amino-acid hormone made mainly in the stomach that rises before meals and drives hunger. It is the body’s own key to the ghrelin receptor, the receptor GHRP-6, ipamorelin and MK-677 act on, and it sets off a strong pulse of growth hormone.
Evidence. The stomach’s hunger hormone, given to people in many small studies, mostly as short IV courses in hospital. Randomized trials found more eating and less weight loss after stomach surgery (21 patients) and during chemotherapy (42), but a 12-week trial in 227 people with COPD found no gain in walking distance, and a 160-patient trial after cardiac arrest narrowly missed its main goal (2024). Ghrelin itself is approved nowhere; anamorelin, a ghrelin-mimicking pill, is a separate drug approved in Japan.
What it’s used for
None of these uses is approved. Uses tested in people come first, then claims that rest on animal studies or user reports.
Appetite and weight loss in cancer
TrialMixed: one IV infusion raised food intake 31% in 7 patients, and 8 weeks of daily injections improved appetite in 31; a 21-patient crossover trial found no change in eating.
Weight loss after stomach surgery
TrialPositive in one small trial: after total stomach removal, 21 patients given IV ghrelin twice daily for 10 days ate more and lost 1.4% of weight vs 3.7% on placebo.
Appetite loss during chemotherapy
TrialPositive in one trial: in 42 people with esophageal cancer on cisplatin, a week of IV ghrelin raised food intake (18.2 vs 12.7 kcal/kg a day) and cut nausea and appetite-loss events.
Muscle wasting in COPD
TrialMixed: in 33 patients it improved symptoms and breathing-muscle strength but not walking distance; a 12-week trial in 227 added about 1 kg of lean mass with no walking gain.
Heart failure
TrialUnproven: in an uncontrolled 3-week study of 10 patients, the heart’s pumping fraction rose from 27% to 31% and exercise capacity improved. No randomized trial followed.
Brain recovery after cardiac arrest
TrialNot shown: in 160 comatose patients, a week of IV ghrelin gave better recovery scores that narrowly missed significance (p = 0.06). The authors call for a phase 3 trial.
Malnutrition on dialysis
TrialPositive short term: a week of daily injections under the skin raised appetite and food intake in 12 malnourished dialysis patients, in a randomized crossover trial.
Deeper sleep
TrialNot a treatment: in 7 healthy men, four IV doses at night increased deep (slow-wave) sleep and cut REM sleep. It hasn’t been tested for sleep problems.
Not approved as a drug in the US, the EU or anywhere else. Drugs that mimic it are separate products: macimorelin is approved in the US as a one-time test for adult growth hormone deficiency, and anamorelin in Japan for cancer cachexia.
US compounding
Not nominated for compounding: it isn’t on FDA’s 503A (May 2026) or 503B (March 2025) nomination lists or the safety-risk page, so it has no compounding category.
European Union
No marketing authorization. Anamorelin, a ghrelin-mimicking pill, isn’t approved in Europe either.
United Kingdom
No marketing authorization (MHRA).
Canada
No marketing authorization (Health Canada).
Australia
No product registered. Not named in the Poisons Standard (October 2026), but its group entry for growth hormone secretagogues (Schedule 4; possession without authority illegal) likely covers it.
Sport (WADA 2026)
Banned in sportS2.2.4 growth hormone releasing factors: growth hormone secretagogues and their mimetics, with lenomorelin (ghrelin) named. Banned at all times.
Category 2 is FDA’s list of bulk substances that may present significant safety risks in compounding. The 503A bulks list adds substances that pharmacies may compound with. Advisory committee votes are advice; FDA makes the final decision. Sport status follows the WADA Prohibited List in force since January 1, 2026; athletes should confirm with their anti-doping organization. Checked October 5, 2026. Status outside the US checked October 7, 2026 against EMA, MHRA, Health Canada and TGA records. By country: EU, UK, Canada, Australia. Status of every compound.
How it works
Ghrelin is a 28-amino-acid hormone made mainly in the stomach; it works only after an enzyme attaches an 8-carbon fatty acid to it. It binds the ghrelin receptor (GHS-R1a) in the hypothalamus, the brain’s appetite and hormone center, and on the pituitary, raising hunger and releasing a large pulse of growth hormone. Blood levels rise before meals and fall after eating. In people, IV doses also raised cortisol, prolactin and blood sugar, and lowered insulin and blood pressure.
TrialMainly from studies in people.
Not known
Most ghrelin in blood is the desacyl form, which doesn’t activate this receptor; its own role and receptor are unclear. Whether raising ghrelin for months helps or harms, including in cancer, hasn’t been tested.
Protocol
Trial
Adachi 2010
3 mcg/kg into a vein twice daily for 10 days after total removal of the stomach; patients ate more and lost 1.4% of body weight vs 3.7% on placebo.
Trial
Nutma 2024
600 mcg into a vein twice daily for 7 days, started within 12 hours of a cardiac arrest, in 160 comatose patients; the main outcome narrowly missed significance.
Trial
Lundholm 2010
13 mcg/kg under the skin once daily for 8 weeks in weight-losing cancer patients, compared with a low 0.7 mcg/kg dose; appetite improved on the higher dose.
Frequency
Twice daily (IV) or once or twice daily (under the skin) in trials
Route
IV infusion in most trials; injection under the skin in some (trials only)
Cycle
No established cycle. Trials gave single doses or courses of 7 days to 12 weeks.
Week 15913172125
No set cycle, shown over 26 weeks
Common protocols
The ways Ghrelin is most often run, each tagged with where it comes from.
After stomach surgery
Trial
Dose
3 mcg/kg
How often
IV twice daily
How long
10 days
21 patients after total gastrectomy, randomized against saline (Adachi 2010). They ate more and lost 1.4% vs 3.7% of body weight. One stopped because of heavy sweating.
Cancer cachexia
Trial
Dose
13 mcg/kg (vs 0.7 mcg/kg)
How often
Once daily under the skin
How long
8 weeks
31 weight-losing patients with gut cancers (Lundholm 2010). Appetite improved and less body fat was lost on the higher dose; tumor markers didn’t rise.
Heart failure and COPD
Trial
Dose
2 mcg/kg
How often
IV twice daily
How long
3 weeks
10 heart-failure patients without randomization (Nagaya 2004) and 33 people with COPD wasting in a randomized trial (Miki 2012), all in hospital.
Coma after cardiac arrest
Trial
Dose
600 mcg
How often
IV twice daily
How long
7 days
160 patients, randomized and double-blind (GRECO, Nutma 2024). Better recovery scores narrowly missed significance; serious side effects matched placebo.
Dosing by body weight
Trial
0.7–40 mcg/kg. IV trials used 1–3 mcg/kg twice daily, and up to 10 mcg/kg as single doses; trials under the skin used 0.7–13 mcg/kg once daily and 20–40 mcg/kg twice daily (SUN11031). Hospital and trial use only.
Taking it
Where it goes
Most trials gave it into a vein as a short infusion, in hospital. The cancer, dialysis and COPD trials injected it under the skin once or twice daily. No product is sold for self-injection.
If you miss a dose
No published guidance, and no established schedule outside trials.
Growth hormone peaks: 43, 82 and 107 ng/mL after 0.2, 1 and 5 mcg/kg in 4 healthy men, with ACTH, cortisol and prolactin also rising.
Trial
During an IV infusion
People ate 28% more at a buffet (9 healthy volunteers) and 31% more (7 people with cancer and poor appetite) than during saline.
Trial
Over 1 to 10 days
More food eaten during chemotherapy (18.2 vs 12.7 kcal/kg a day over a week) and less weight lost after stomach surgery (1.4% vs 3.7% over 10 days).
Trial
Over 12 weeks
In 227 people with COPD, weight rose 1.75–2.44 kg vs 0.90 kg on placebo, with no gain in 6-minute walking distance (registry results).
Trial
Side effects and what to do
Heavy sweating or a warm feeling
Made 1 of 11 and 1 of 21 patients stop in two Japanese trials; excess sweating in 6 of 151 vs none on placebo over 12 weeks.
Lower blood pressure (12 mmHg after 10 mcg/kg IV in healthy men)
Heart rate didn’t rise. It matters more with low blood pressure or a tendency to faint.
Higher blood sugar and lower insulin after an IV dose
Seen in 11 healthy volunteers for about 3 hours. Relevant with diabetes.
Higher cortisol, ACTH and prolactin after IV doses
Short-lived rises in healthy men; injections under the skin barely changed them.
Hunger
The intended effect in appetite trials, and an unwanted one for anyone trying to lose weight.
Stop and get medical help
In trials, infusions were stopped for heavy sweating. Fainting, chest pain, or swelling of the face or throat with trouble breathing needs emergency care.
Can it cause …?
The side effects people ask about most, answered one by one. Each answer says where it comes from.
Tiredness
Not reportedNot among the side effects listed for a 12-week trial in 227 people. Given by IV at night, ghrelin deepened sleep in 7 healthy men.
Headache
TrialNo more common than on placebo over 12 weeks in people with COPD: 9 of 151 on ghrelin vs 5 of 73 on placebo.
Nausea or vomiting
TrialSimilar to placebo over 12 weeks (6 of 151 vs 3 of 73), and during chemotherapy it reduced nausea-related events.
Diarrhea or constipation
TrialOver 12 weeks, diarrhea was less common than on placebo (3 of 151 vs 7 of 73) and upper belly pain more common (7 of 151 vs 0 of 73).
Dizziness
TrialPossible: an IV dose lowered blood pressure 12 mmHg in healthy men, and 1 of 5 frail older adults felt dizzy after an injection.
Trouble sleeping
TrialTrouble sleeping in 4 of 76 on the higher dose vs 1 of 73 on placebo over 12 weeks. IV doses at night deepened sleep in 7 healthy men.
Acne, rash or skin changes
TrialHeavy sweating: 6 of 151 on ghrelin vs none on placebo over 12 weeks, and it made 2 patients stop in Japanese trials. Rashes weren’t reported.
Joint or muscle pain
TrialBack pain was more common than on placebo over 12 weeks (7 of 151 vs 1 of 73); joint pain wasn’t among the common side effects listed.
Anxiety, low mood or irritability
TrialRegistry results of a 12-week trial list one suicide and one case of suicidal thoughts on the higher dose, none on placebo; causes weren’t reported.
Low or high blood sugar
TrialRaises blood sugar: an IV dose raised glucose and lowered insulin for about 3 hours in 11 healthy volunteers.
Fast heartbeat or blood pressure changes
TrialLowers blood pressure: an IV dose cut it 12 mmHg in 6 healthy men without speeding the heart; daily injections lowered it for up to 2 hours on dialysis.
More hunger
TrialYes, it’s the main effect: a single IV infusion raised buffet eating 28% in 9 healthy volunteers and 31% in 7 people with cancer.
Liver strain
Not reportedLiver problems weren’t reported in the published trials of up to 8 weeks or in the 12-week registry results.
Kidney problems
TrialNo sign of kidney strain: an infusion didn’t change urine output or creatinine clearance in 12 people with heart failure.
Cancer risk
TrialUnknown long term. Tumor markers didn’t rise over 8 weeks of daily injections in cancer patients, and a 2016 review found no treatment study linking it to tumor growth.
Hair lossWater retention or swelling
Not reportedNot reported in trials of up to 12 weeks, including 151 people on twice-daily injections.
Trial: reported in human studies. Not reported: studied in people and not reported. A side effect that hasn’t been reported can still happen, especially with long or high-dose use. Any of these across every compound: the side-effect finder.
Who should avoid it
No product label covers ghrelin, so these come from human studies and from precautions based on how it works. Most important first.
Diabetes or high blood sugar
TrialAn IV dose raised blood sugar and lowered insulin for about 3 hours in 11 healthy volunteers.
Low blood pressure or fainting
TrialIV doses lowered mean arterial pressure by 12 mmHg in healthy men and 9 mmHg in heart failure; daily injections lowered it for up to 2 hours on dialysis.
Alcohol use disorder
TrialAn IV dose increased alcohol craving in a 45-person laboratory study of alcohol-dependent heavy drinkers.
Pituitary or adrenal conditions
TrialIV doses raised ACTH, cortisol and prolactin in healthy men; these changes matter more when those glands already work abnormally.
Anyone with active or past cancer
PrecautionIt raises growth hormone, a growth signal. Trials in cancer patients saw no tumor growth over up to 8 weeks, but none was designed to test cancer risk.
Pregnancy or breastfeeding
PrecautionNo human safety data exist. FDA notes that in mice, ghrelin harmed fertilization and embryo development.
Anyone using laboratory-grade ghrelin
PrecautionIt is sold only as a lab reagent, not made for injection, so sterility isn’t assured, and the fatty acid that makes it active comes off in solution.
Interactions
Only interactions stated on a product label or measured in a human study are listed.
GHRH (growth-hormone-releasing hormone, given IV)
TrialLow doses of ghrelin with GHRH released more growth hormone than the two separately added together in healthy men; ACTH and prolactin weren’t boosted.
Desacyl (unacylated) ghrelin
TrialGiven together in 6 volunteers, it cancelled ghrelin’s rise in blood sugar and fall in insulin, without changing its hormone effects.
Trial: seen in human studies, or a group those studies left out. Precaution: follows from how it works or from a related drug, and hasn’t been tested. This isn’t a complete list: a pharmacist or doctor can check a specific medicine or condition. Every documented interaction, by medicine: drug interactions.
Special situations
What’s known about pregnancy, breastfeeding, kidney and liver problems, age and surgery. Where nothing has been studied, the row says so.
Pregnancy
PrecautionNo human safety data. FDA notes that in mice, ghrelin harmed fertilization and early embryo development.
Breastfeeding
PrecautionNo data on giving ghrelin while breastfeeding.
Kidney problems
TrialTested short term: a week of daily injections raised appetite in 12 malnourished dialysis patients, with blood pressure dipping for up to 2 hours. Ghrelin levels run high in kidney failure.
Liver problems
PrecautionNot studied in liver disease.
Older adults
TrialIn 5 frail adults aged 70 or older, single injections raised food intake by up to 39%, with mild warmth or dizziness. The cardiac-arrest trial’s patients had a median age of 68.
Children and teens
PrecautionNot approved at any age; the treatment trials described here were in adults.
Surgery and anesthesia
TrialGiven after stomach and esophagus surgery in Japanese trials, where it reduced weight loss and inflammation. It lowers blood pressure; tell the surgical team about any injected compound.
Trial: from human studies. Precaution: not studied, so the caution follows from how it works or from a related drug. Ages are given as approved or studied; this site never gives doses for children. Across every compound: pregnancy, breastfeeding, kidney disease, liver disease, older adults and surgery.
Tracking and pairing
Worth tracking
Blood pressure
Blood sugar
Body weight and appetite
Often paired with
Usually run on its own.
Human studies
5 key published human studies, with how many people took part. Animal studies aren’t listed here.
2024160 people
Better neurological recovery scores narrowly missed significance (odds ratio 1.78, 95% CI 0.98–3.22, p = 0.06); deaths were 37% vs 51% (p = 0.08), and serious adverse events were similar.
Design
Randomized, double-blind, placebo-controlled phase 2 trial (GRECO) in 3 Dutch intensive care units
Dose
600 mcg IV twice daily, started within 12 hours of cardiac arrest
Length
7 days; followed 6 months
Nutma et al., JAMA Neurol 2024, PMID 38709502
2009227 people
6-minute walking distance rose 5.9 and 10.0 m vs 28.5 m on placebo; weight rose 1.75 and 2.44 kg vs 0.90 kg, and lean mass 1.36 and 1.44 kg vs 0.29 kg.
Design
Randomized, double-blind, placebo-controlled phase 2b trial in COPD with wasting; results posted to the registry, not published in a journal
Registered trials that are still running, or that finished without published results, most important first. Checked on ClinicalTrials.gov, October 7, 2026.
Not applicable (physiology study)NCT06576440
One injection of acyl ghrelin under the skin vs saline: effects on motivation and energy use in 24 adults (listed condition: major depression)
Completed December 2024; no results posted
Phase 2NCT04377126
Daily injections of unacylated (desacyl) ghrelin, the form that doesn’t act on the ghrelin receptor, for walking in 25 people with peripheral artery disease
Completed January 2025; registry results (June 2026) show walking distance fell 17 m vs rose 23 m on placebo; not yet published
Human data come from small studies, most giving IV ghrelin for a day to 3 weeks in hospital to people with cancer, recent stomach surgery, heart failure, COPD or kidney failure. The largest are a 160-patient cardiac-arrest trial that narrowly missed its goal and a 12-week, 227-person COPD trial with no walking benefit, published only as registry results. Effects beyond 12 weeks, cancer risk, and use outside a hospital or trial are untested.
How it’s supplied
Synthetic human ghrelin: 2–3 mcg/kg or 600 mcg IV twice daily, or 0.7–40 mcg/kg under the skin, in trials; not sold as a medicine. Infused into a vein by hospital staff in most trials; some trials injected it under the skin once or twice daily, for up to 12 weeks. It’s available only in clinical trials, so the calculator and dose log don’t apply.
No research vials are commonly sold. Ghrelin exists as a laboratory reagent in microgram-to-milligram amounts, and its active form loses the fatty-acid group that makes it work once it is in solution.
Datasheet
Half-life
about 9–13 minutesTrialElimination half-life of acylated (active) ghrelin after IV doses of 1 and 5 mcg/kg in healthy young men. Total ghrelin, including the inactive desacyl form it turns into, lasted 27–31 minutes.
Type
Peptide, 28 amino acids
Molecular weight
3,370.9 g/mol
Formula
C149H249N47O42
Sequence
GSSFLSPEHQRVQQRKESKKPPAKLQPRThe serine at position 3 carries an octanoyl group, an 8-carbon fatty acid needed for activity
Storage before use
No medicine exists. Laboratory ghrelin is stored frozen (−20 °C), dry and sealed.
After mixing or opening
Use soon after dissolving: the octanoyl group that makes it active comes off in solution and in blood, leaving inactive desacyl ghrelin.
Half-life: Akamizu et al., Eur J Endocrinol 2004, PMID 15080773
Molecule: PubChem CID 91668172 (ghrelin, human); FDA GSRS UNII UXG268Q86R (lenomorelin), with the same sequence and octanoyl serine
Storage:Community Common laboratory practice; no approved label exists. Hosoda et al., Clin Chem 2004, PMID 15161728 (rapid loss of the octanoyl group in blood samples)
No injectable product exists; laboratory ghrelin comes in microgram-to-milligram packs. Only the octanoylated form is active, and the fatty acid comes off in solution and blood. Rat and mouse ghrelin differ from human ghrelin at two positions.
Cautions
Approved nowhere and not sold as a medicine: every human dose so far was given inside a study, most of them in hospital.
IV doses lowered blood pressure (by 12 mmHg in 6 healthy men) and raised blood sugar while lowering insulin.
Heavy sweating made 2 patients stop in Japanese trials, and in a 12-week trial excess sweating affected 6 of 151 people on ghrelin vs none on placebo.
In 45 heavy drinkers, an IV dose increased alcohol craving.
Anamorelin, macimorelin and the GHRPs act on the same receptor but are different drugs; their results don’t transfer to ghrelin, or the reverse.
Questions
What is ghrelin?
A 28-amino-acid hormone made mainly in the stomach that rises before meals and drives hunger. It is the body’s own key to the ghrelin receptor, the receptor GHRP-6, ipamorelin and MK-677 act on, and it sets off a strong pulse of growth hormone.
How does ghrelin work?
Ghrelin is a 28-amino-acid hormone made mainly in the stomach; it works only after an enzyme attaches an 8-carbon fatty acid to it. It binds the ghrelin receptor (GHS-R1a) in the hypothalamus, the brain’s appetite and hormone center, and on the pituitary, raising hunger and releasing a large pulse of growth hormone. Blood levels rise before meals and fall after eating. In people, IV doses also raised cortisol, prolactin and blood sugar, and lowered insulin and blood pressure. Most ghrelin in blood is the desacyl form, which doesn’t activate this receptor; its own role and receptor are unclear. Whether raising ghrelin for months helps or harms, including in cancer, hasn’t been tested.
Is ghrelin FDA-approved?
Not approved as a drug in the US, the EU or anywhere else. Drugs that mimic it are separate products: macimorelin is approved in the US as a one-time test for adult growth hormone deficiency, and anamorelin in Japan for cancer cachexia. Not nominated for compounding: it isn’t on FDA’s 503A (May 2026) or 503B (March 2025) nomination lists or the safety-risk page, so it has no compounding category.
What is the usual ghrelin dose?
From human studies (Adachi 2010): 3 mcg/kg into a vein twice daily for 10 days after total removal of the stomach; patients ate more and lost 1.4% of body weight vs 3.7% on placebo. Nutma 2024: 600 mcg into a vein twice daily for 7 days, started within 12 hours of a cardiac arrest, in 160 comatose patients; the main outcome narrowly missed significance. These are the amounts sources reference, not recommendations.
How is ghrelin given?
Infused into a vein by hospital staff in most trials; some trials injected it under the skin once or twice daily, for up to 12 weeks. It isn’t sold: it’s available only in clinical trials.
Who should avoid ghrelin?
No product label covers ghrelin, so these come from human studies and from precautions based on how it works. Diabetes or high blood sugar: An IV dose raised blood sugar and lowered insulin for about 3 hours in 11 healthy volunteers. Low blood pressure or fainting: IV doses lowered mean arterial pressure by 12 mmHg in healthy men and 9 mmHg in heart failure; daily injections lowered it for up to 2 hours on dialysis. Alcohol use disorder: An IV dose increased alcohol craving in a 45-person laboratory study of alcohol-dependent heavy drinkers. The “Who should avoid it” section lists 4 more groups and 2 interactions.
What is the half-life of ghrelin?
About 9–13 minutes, measured in human studies. Elimination half-life of acylated (active) ghrelin after IV doses of 1 and 5 mcg/kg in healthy young men. Total ghrelin, including the inactive desacyl form it turns into, lasted 27–31 minutes.
How should ghrelin be stored?
Before mixing: No medicine exists. Laboratory ghrelin is stored frozen (−20 °C), dry and sealed. Use soon after dissolving: the octanoyl group that makes it active comes off in solution and in blood, leaving inactive desacyl ghrelin. This is common practice; no product label covers it.
Is ghrelin banned in sport?
Yes. S2.2.4 growth hormone releasing factors: growth hormone secretagogues and their mimetics, with lenomorelin (ghrelin) named. Banned at all times.
Has ghrelin been studied in people?
Yes. The human studies section lists 5 published studies. The largest, from 2009, included 227 people. 6-minute walking distance rose 5.9 and 10.0 m vs 28.5 m on placebo; weight rose 1.75 and 2.44 kg vs 0.90 kg, and lean mass 1.36 and 1.44 kg vs 0.29 kg.
How long has ghrelin been studied in people?
Trial 12 weeks of twice-daily injections under the skin in 151 people with COPD, in a 227-person trial reported only as registry results.
Does ghrelin come in other forms, like a pill or nasal spray?
Trial Given into a vein in most trials and under the skin in several, for up to 12 weeks. No nasal or oral form has been tested in people; ghrelin-mimicking pills are separate drugs.
Can you drink alcohol while taking ghrelin?
Trial In 45 alcohol-dependent heavy drinkers, IV ghrelin increased alcohol craving compared with placebo. No study has looked at drinking during ghrelin treatment.
Can ghrelin be taken with semaglutide or tirzepatide?
Precaution No study has combined them. They pull in opposite directions: GLP-1 drugs curb appetite, while ghrelin raised food intake by about 30% in infusion studies.
What happens if you take too much ghrelin?
Trial No overdose reports. The highest doses tried were 40 mcg/kg under the skin twice daily for 12 weeks; IV doses lowered blood pressure. Call Poison Help (1-800-222-1222), or emergency services for severe symptoms.
Sources
Kojima et al., ghrelin, a growth-hormone-releasing acylated peptide from stomach (Nature 1999) PMID 10604470
Wren et al., IV ghrelin increases food intake in healthy volunteers (J Clin Endocrinol Metab 2001) PMID 11739476
Adachi et al., ghrelin after total gastrectomy, randomized phase 2 trial (Gastroenterology 2010) PMID 20060830
Lundholm et al., 8 weeks of daily ghrelin in weight-losing cancer patients (Cancer 2010) PMID 20186829
Nutma et al., GRECO randomized trial of ghrelin in coma after cardiac arrest (JAMA Neurol 2024) PMID 38709502
SUN11031 (synthetic ghrelin) phase 2b trial in COPD with wasting, results posted on ClinicalTrials.gov (2021) NCT00698828
Wakabayashi et al., regulatory approval of anamorelin for cancer cachexia in Japan (J Cachexia Sarcopenia Muscle 2021) PMID 33382205