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# Megestrol Acetate (Megace ES)
## Overview
Megestrol acetate is a synthetic progestin. It is available in oral suspension and tablet formulations.
## Primary Indications
* Treatment of anorexia, cachexia, or unexplained weight loss in patients with acquired immunodeficiency syndrome (AIDS).
* Palliative treatment of advanced breast cancer and endometrial carcinoma.
## Adult Dosing
* **Anorexia/Cachexia/Weight Loss (AIDS):**
* Oral Suspension: 625 mg (5 mL) once daily.
* Tablets: 800 mg once daily.
* Higher doses up to 1250 mg/day (suspension) have been used in some studies, but the optimal dose is not definitively established.
* **Breast Cancer:** 160 mg once daily.
* **Endometrial Carcinoma:** 40 mg four times daily (40 mg QID) or 40-80 mg twice daily (40-80 mg BID).
## Pediatric Dosing
* Dosing has not been established in pediatric patients for anorexia/cachexia/weight loss.
* Dosing for other indications is not established in pediatrics.
## Dose Adjustments
* No specific dose adjustments are routinely recommended for renal or hepatic impairment, but caution is advised.
## Contraindications
* Known or suspected pregnancy.
* Known hypersensitivity to megestrol acetate or any component of the formulation.
## Adverse Effects
* **Common:** Weight gain, increased appetite, hypertension, hot flashes, rash, diarrhea, nausea, headache, dyspnea.
* **Serious:** Adrenal insufficiency, thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism), hyperglycemia, Cushing's syndrome, tumor flare.
## Key Drug Interactions
* **CYP3A4 inhibitors/inducers:** May alter megestrol acetate plasma concentrations.
* **Aminoglutethimide:** May decrease megestrol acetate levels.
* **Antidiabetic agents:** May affect glycemic control.
## Monitoring
* **For all indications:** Monitor for signs and symptoms of adrenal insufficiency, thromboembolic events, and hyperglycemia.
* **For anorexia/cachexia:** Monitor weight and nutritional status.
* **For cancer:** Monitor for disease progression or response.
## Clinical Pearls
* Megestrol acetate should be used with caution in patients with a history of thromboembolic disease.
* Long-term use may be associated with adrenal suppression.
* The oral suspension may offer more convenient dosing for higher quantities.
* The 625 mg/5 mL suspension provides approximately 125 mg/mL.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details before making clinical decisions.
