medroxyprogesterone actetate; acetoxymethylprogesterone (Provera, Cycrin, Amen)
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Introduction
Tradenames: Provera, Depo-Provera, Cycrin, Amen.
Indications
- Contraceptive (Depo-Provera)
- hormone replacement therapy
- relief of uterine vasomotor symptoms
- amenorrhea
- abnormal uterine bleeding
- endometriosis[7]
- hormonal imbalance
- precocious puberty[7]
- palliative therapy for advanced breast carcinoma & endometrial carcinoma (by similarity to megestrol)
- endometrial dysplasia
- polycystic ovary disease[7]
- progesterone challenge test[7]
Contraindications
Dosage
- hormone replacement therapy: 2.5-5 mg PO QD
- abnormal uterine bleeding: 5-10 mg PO X 5-10 days
- relief of uterine vasomotor symptoms: 20 mg/day
- amenorrhea: 5-10 mg/day for 5-10 days
- contraception: 150 mg IM every 3 months
Tabs: 2.5, 5, 10 mg. Injection (suspension): 150 mg/mL (1 mL); 400 mg/mL (2.5 & 10 mL).
Pharmacokinetics
- withdrawal bleeding in estrogen-primed individuals occurs within 3-7 days of last dose
- onset of relief from hot flashes occurs within 4-7 days
- maximum effect on hot flashes after 1 month
elimination via liver
Adverse effects
- common (> 10%)
- less common (1-10%)
- depression, fever, melasma, chloasma, allergic rash with or without pruritus, cholestatic jaundice, changes in cervical secretions, weight gain or loss, insomnia, breast tenderness, thrombophlebitis, thromboembolism
- other
Adverse effects of abrupt discontinuation:[5]
- adrenal insufficiency may occur after long-term use
- thromboembolism
- breakthrough vaginal bleeding
- peripheral edema
- hyperglycemia
- hypertension
- Cushing's syndrome
- osteoporosis[4]
- alopecia
Drug interactions
- aminoglutethimide may decrease effects
- drug interaction(s) of beta-adrenergic receptor antagonists with oral contraceptives
- drug interaction(s) of NSAIDs with oral contraceptive
Test interactions
- altered thyroid & liver function tests
Mechanism of action
- progestin (progestational agent)
- 17-alpha-acetoxyprogestational agent with more potent progestational effects & better bioavailability than progesterone
Notes
- Deprecated Reference lists as antineoplastic agent
More general terms
Component of
- estrogen/medroxyprogesterone
- flavocoxid (Limbrel)
- Lunelle
- conjugated estrogens/medroxyprogesterone (Prempro, Premphase)
- Depo-Provera
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. American College of Physicians, Philadelphia 1998, 2012
- ↑ Jump up to: 5.0 5.1 Bruera & Neumann Canadian Medical Assoc. J (CAMJ):158:1717, 1998
- ↑ Jump up to: 6.0 6.1 Stringer EM et al HIV disease progression by hormonal contraceptive method: Secondary analysis of a randomized trial. AIDS 2009 Jul 17; 23:1377. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19448528
- ↑ Jump up to: 7.0 7.1 7.2 7.3 7.4 Deprecated Reference
- ↑ Jump up to: 8.0 8.1 Bonny AE et al. A pilot study of depot medroxyprogesterone acetate pharmacokinetics and weight gain in adolescent females. Contraception 2014 May; 89:357. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24582292
Beasley A et al. Randomized clinical trial of self versus clinical administration of subcutaneous depot medroxyprogesterone acetate. Contraception 2014 May; 89:352. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24656555
Burke HM et al. Observational study of the acceptability of Sayana® Press among intramuscular DMPA users in Uganda and Senegal. Contraception 2014 May; 89:361. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24631328
Burke HM et al. Provider acceptability of Sayana® Press: Results from community health workers and clinic-based providers in Uganda and Senegal. Contraception 2014 May; 89:368. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24576792