megestrol (Megace)
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Introduction
Tradename: Megace. Pregnancy risk category: X
Indications
- appetite stimulation ( AIDS anorexia)
- palliative therapy for advanced breast cancer, ovarian cancer[7] & endometrial carcinoma*
* does not improve quality of life or mortality in cance patients[4]
Contraindications
Caution:
- risk to fetus in 1st 4 months of pregnancy
- photosensitivity: wear protective clothing or use sunscreen
Dosage
Tablets: 20 mg, 40 mg
Suspension: 40 mg/mL in alcohol 0.06% (240 mL)
Adverse effects
- common (> 10%)
- less common (1-10%)
- depression, fever, melasma, chloasma, allergic rash withor without pruritus, cholestatic jaundice, changes in cervical secretions, weight gain or loss, insomnia, breast tenderness, deep vein thrombophlebitis, carpal tunnel syndrome, alopecia, hyperpnea
- other
- adverse effects of abrupt discontinuation:[5]
- adrenal insufficiency may occur after long-term use[4][6]
- features of adrenal insufficiency & Cushing's syndrome may be present[9]
- thromboembolism
- breakthrough vaginal bleeding
- peripheral edema
- hyperglycemia
- hypertension
- alopecia
- adrenal insufficiency may occur after long-term use[4][6]
Test interactions
altered thyroid & liver function tests
Laboratory
Mechanism of action
- progestin
- may directly or indirectly stimulate appetite
- may alter metabolic pathways that increase weight gain
- does NOT increase lean tissue mass
- weight gain is due to increase in fatty tissue only
- may suppress hypothalamic-pituitary-adrenal axis
- activates glucocorticoid receptors
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Jump up to: 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18, 19 American College of Physicians, Philadelphia 1998, 2012, 2018, 2022
- ↑ Jump up to: 5.0 5.1 Bruera & Neumann Canadian Medical Assoc. J (CAMJ):158:1717, 1998
- ↑ Jump up to: 6.0 6.1 Leinung MC, Liporace R, Miller CH. Induction of adrenal suppression by megestrol acetate in patients with AIDS. Ann Intern Med. 1995 Jun 1;122(11):843-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/7741369
- ↑ Jump up to: 7.0 7.1 Deprecated Reference
- ↑ Ruiz Garcia V, Lapez-Briz E, Carbonell Sanchis R et al Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD004310. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23543530
- ↑ Jump up to: 9.0 9.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019