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# Megestrol Acetate (Megace) ## Overview Megestrol acetate is a synthetic progestin with anti-androgenic and glucocorticoid properties. It is available in oral tablet and suspension formulations. ## Primary Indications * **Cachexia, anorexia, or unexplained weight loss:** Primarily associated with advanced malignancy (e.g., AIDS-related wasting). * **Palliative treatment of advanced breast cancer.** * **Palliative treatment of advanced prostate cancer.** ## Adult Dosing * **Cachexia/Anorexia/Weight Loss:** * Oral suspension: 625 mg (25 mL) once daily. May be decreased to 400 mg (16 mL) daily. * Tablets: 625 mg once daily. May be decreased to 400 mg daily. * **Advanced Breast Cancer:** 160 mg once daily. * **Advanced Prostate Cancer:** 40 mg four times daily (160 mg/day). ## Pediatric Dosing There is no established pediatric dosing. Use in pediatric populations is not recommended. ## Dose Adjustments * **Renal Impairment:** No specific dosage adjustments are recommended. * **Hepatic Impairment:** No specific dosage adjustments are recommended, but caution is advised. ## Contraindications * Known hypersensitivity to megestrol acetate or any component of the formulation. * Known or suspected pregnancy. * Use for initial management of neoplastic disease without other agents. ## Adverse Effects * **Common:** Weight gain, increased appetite, edema, hypertension, hot flashes, dyspnea, nausea, vaginal bleeding, rash, carpal tunnel syndrome. * **Serious:** Thrombotic and thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism, stroke), adrenal insufficiency (especially upon withdrawal after prolonged use), hyperglycemia, new onset diabetes, exacerbation of existing diabetes, hair loss, depression. ## Key Drug Interactions * **Aminoglutethimide:** May decrease megestrol acetate levels. * **CYP3A4 Inhibitors (e.g., ketoconazole, ritonavir):** May increase megestrol acetate levels; monitor for adverse effects. * **Antidiabetic agents:** Megestrol acetate may cause hyperglycemia, potentially reducing the efficacy of these agents. ## Monitoring * Weight and appetite. * Signs and symptoms of thromboembolic events. * Blood pressure. * Blood glucose levels (especially in patients with diabetes or at risk). * Signs of adrenal insufficiency (e.g., fatigue, weakness, nausea, vomiting, hypotension) particularly if abruptly discontinued after chronic use. ## Clinical Pearls * The oral suspension may be preferred for patients experiencing difficulty swallowing or for easier dose titration. * Gradual tapering of the dose is recommended if discontinuing after prolonged therapy to avoid potential adrenal insufficiency. * Patients should be counseled on the potential for weight gain and fluid retention. * Paradoxical tumor flare may occur in patients with hormone-sensitive tumors. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines before initiating or modifying therapy. Dosing and recommendations may vary based on individual patient factors and local protocols.