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# Megestrol Acetate
## Overview
Megestrol acetate is a synthetic progestogen used primarily for palliative treatment of advanced breast cancer and for management of anorexia, cachexia, or unexplained significant weight loss in patients with acquired immunodeficiency syndrome (AIDS).
## Primary Indications
* Treatment of advanced, metastatic breast cancer in postmenopausal women.
* Management of anorexia, cachexia, or unexplained significant weight loss in patients with AIDS.
## Adult Dosing
* **Breast Cancer:** 160 mg orally once daily. Higher doses (e.g., 400-800 mg daily) have also been used.
* **AIDS-Associated Weight Loss:** 400-800 mg orally once daily. Some studies have used doses as low as 100-200 mg orally daily.
## Pediatric Dosing
No established pediatric dosing. Use is generally not recommended in children due to lack of safety and efficacy data.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustments are established. Use with caution.
* **Hepatic Impairment:** No specific dose adjustments are established. Use with caution.
## Contraindications
* Known or suspected pregnancy.
* Known hypersensitivity to megestrol acetate or any component of the formulation.
## Adverse Effects
* **Common:** Weight gain, increased appetite, hot flashes, nausea, vomiting, diarrhea, hypertension, dyspnea, edema, rash, vaginal bleeding, abdominal pain, headache, lethargy.
* **Serious:** Adrenal insufficiency (especially with abrupt discontinuation after prolonged use), thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism), hyperglycemia, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **CYP3A4 Inhibitors/Inducers:** May alter megestrol acetate levels. Monitor for efficacy and adverse effects.
* **Corticosteroids:** Concomitant use may increase the risk of adrenal suppression.
## Monitoring
* **Tumor Response:** For breast cancer indication.
* **Weight and Appetite:** For AIDS-associated weight loss.
* **Electrolytes:** Particularly sodium and potassium.
* **Blood Glucose:** Especially in patients with diabetes or at risk.
* **Signs of Thromboembolism:** Such as leg pain, swelling, chest pain, shortness of breath.
* **Signs of Adrenal Insufficiency:** Fatigue, weakness, nausea, vomiting, hypotension, especially upon discontinuation.
## Clinical Pearls
* Dosing for AIDS-associated anorexia/cachexia can vary widely; titrate based on patient response and tolerability.
* Abrupt discontinuation after prolonged use, particularly at higher doses, can lead to adrenal insufficiency. Taper dose if discontinuing.
* Use caution in patients with a history of thromboembolic disorders.
* The oral suspension contains sucrose; use with caution in diabetic patients.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the current prescribing information and relevant literature for complete details and to confirm drug information before making clinical decisions.*
