| Exclusion Criteria: | 1) Have dementia or delirium (as determined by the palliative care specialist) at study entry.
2) Are pregnant
3) Severe sinus bradycardia with a heart rate of < 45 beat/min,atrial fibrillation with an uncontrolled ventricular response,a high degree Atrioventricular block,a history of congestive heart failure;a history of myocardial infarction or stroke within the past 3 months, a history of hypertrophic cardiomyopathy; a history of moderate to severe stenotic valvular heart disease.
4) Have been taking corticosteroids for longer than 48 hours.
5) Have pulmonary edema, ascites or pitting edema on clinical examination.
6) Are unable to walk.
7) Hypersensitivity to ibuprofen or a history of asthma, urticaria or allergic-type reactions after taking aspirin or other NSAID's
8) Have a history of serious adverse gastrointestinal events (i.e., bleeding or perforation),history of a coagulopathy or current anti-coagulant use.
9) Have symptoms of dyspepsia or a history of uncomplicated peptic ulcer disease and are unable to add a proton pump inhibitor to their medication.
10) Are older than 65 years, have a hemoglobin level <9 g/dl, platelet count less than 50 000/mm3, calculated creatinine clearance level of less than 60 cc/min, or ALT/AST>3x upper limit of normal.
11) Have a history of hypersensitivity or allergy to beta-blockers,or a history of uncontrolled bronchial asthma or severe chronic obstructive pulmonary disease.
12) Patients on methotrexate.
13) Patients taking melatonin receptor agonists (such as RozeremŽ [ramelteon]).
14) Patients that, after discussion between the primary oncologist and the palliative care specialist, the oncologist is of the opinion that anti-neoplastic therapy is more likely to improve the cachexia and its associated quality of life. |