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# Megestrol Acetate (Megace) ## Overview Megestrol acetate is a synthetic progestin with anti-androgenic and glucocorticoid activities. It is available as an oral suspension and tablet. ## Primary Indications * **Cachexia, anorexia, or unexplained significant weight loss** associated with acquired immunodeficiency syndrome (AIDS). * Palliative treatment of advanced **breast cancer**. * Endometrial carcinoma. ## Adult Dosing * **AIDS-associated cachexia/anorexia:** 625 mg (25 mL of suspension) once daily. Dose may be increased to 1250 mg (50 mL of suspension) daily if tolerated and beneficial. * **Breast cancer:** 160 mg (66 mL of suspension or 4 x 40 mg tablets) once daily. Higher doses (e.g., 400-800 mg daily) have also been used. * **Endometrial carcinoma:** 40 mg (10 mL of suspension or 1 tablet) four times daily. Higher doses (e.g., 320 mg daily) have also been used. ## Pediatric Dosing * No established pediatric dosing for approved indications. ## Dose Adjustments * **Hepatic Impairment:** No specific guidelines, but caution is advised due to potential for altered metabolism. * **Renal Impairment:** No specific guidelines. ## Contraindications * Known or suspected pregnancy. * Undiagnosed abnormal vaginal bleeding. * Known hypersensitivity to megestrol acetate or any component of the formulation. ## Adverse Effects * **Common:** Weight gain, increased appetite, hypertension, hot flashes, rash, dyspnea, nausea, diarrhea, fatigue, edema. * **Serious:** Adrenal insufficiency (especially with abrupt withdrawal after long-term use), thromboembolic events (e.g., pulmonary embolism, deep vein thrombosis), hyperglycemia, Cushingoid symptoms, Stevens-Johnson syndrome, toxic epidermal necrolysis. ## Key Drug Interactions * **CYP3A4 Inhibitors/Inducers:** May alter megestrol acetate concentrations, though clinical significance is unclear. * **Antidiabetic Agents:** Hyperglycemia may occur, requiring adjustment of antidiabetic medications. ## Monitoring * Weight and appetite. * Blood pressure. * Electrolytes, glucose, and adrenal function (especially with prolonged use or abrupt discontinuation). * Signs and symptoms of thromboembolic events. * Lactation status in women of childbearing potential. ## Clinical Pearls * Gradual tapering is recommended for patients receiving high doses for prolonged periods to avoid adrenal insufficiency. * Weight gain may be due to fluid retention as well as increased fat and lean body mass. * Use in women of childbearing potential requires effective contraception. * The oral suspension contains sugar and should be used cautiously in diabetic patients. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions. Dosing and recommendations may vary based on patient-specific factors and local protocols.*