Dofetilide-induced anorexia in an older adult

An 84-year-old woman presented to her primary care physician with an unexplained 4-month history of weight and appetite loss after initiation of dofetilide 125 mcg orally twice daily for atrial fibrillation. She was noted to have lost 2.5 kg, which was a 3.6% decrease from her initial body weight of 69.4 kg. After excluding other etiologies for her anorexia, such as medication changes or changes in other diseases or conditions, her primary care physician and cardiologists elected to continue dofetilide but monitor the patient's appetite and body weight. After 7 months of dofetilide use with persistent appetite loss, the cardiology team discontinued dofetilide. Continued weight loss was observed until approximately 1 month after stopping dofetilide, with a maximum weight loss of 2.9 kg or a 4.2% decrease. Improvements in appetite were reported 2 months after discontinuing dofetilide, with minor increases in weight that eventually stabilized. In this case, while taking dofetilide, the patient experienced anorexia leading to weight loss that subsided after discontinuation of the drug. Based on the temporal association between the patient's changes in appetite and body weight and treatment with dofetilide, the drug was most likely the cause of the patient's anorexia. We are unaware of other reports of anorexia associated with dofetilide, but clinicians may want to consider the drug as a potential cause for otherwise unexplained changes in appetite or body weight.