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# Megestrol Acetate (Megace) ## Overview Megestrol acetate is a synthetic progestin. ## Primary Indications * Treatment of cachexia, anorexia, or unexplained weight loss associated with acquired immunodeficiency syndrome (AIDS). * Palliative treatment of advanced breast cancer and endometrial cancer. ## Adult Dosing * **AIDS-related cachexia/anorexia:** * Oral suspension: 625 mg (25 mL) orally once daily. Higher doses of up to 1250 mg daily have been used. * Tablets: 800 mg orally once daily. * **Breast cancer:** 160 mg orally once daily. * **Endometrial cancer:** 40 mg orally 4 times daily (total 160 mg/day). ## Pediatric Dosing There is no established pediatric dosing for megestrol acetate. Its use in pediatric patients is generally not recommended due to limited data and potential risks. ## Dose Adjustments * **Renal Impairment:** No specific dose adjustment is typically recommended. * **Hepatic Impairment:** No specific dose adjustment is typically recommended, but caution is advised. ## Contraindications * Known or suspected pregnancy. * Known hypersensitivity to megestrol acetate or any of its components. ## Adverse Effects * **Common:** Weight gain, increased appetite, nausea, vomiting, diarrhea, headache, hot flashes, hypertension, rash, shortness of breath, carpal tunnel syndrome. * **Serious:** Adrenal insufficiency, thromboembolic events (deep vein thrombosis, pulmonary embolism, stroke), hyperglycemia, Cushing's syndrome, bone mineral density decrease. ## Key Drug Interactions * **CYP3A4 Inducers (e.g., rifampin, phenytoin, carbamazepine):** May decrease megestrol acetate plasma concentrations. * **CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole):** May increase megestrol acetate plasma concentrations. * **Antidiabetic agents:** Megestrol acetate can cause hyperglycemia, potentially requiring adjustment of antidiabetic medications. ## Monitoring * Weight and nutritional status. * Blood glucose levels, especially in patients with diabetes or at risk. * Signs and symptoms of thromboembolic events (e.g., leg swelling, chest pain, shortness of breath). * Adrenal function (particularly if prolonged use or abrupt discontinuation is considered). * Blood pressure. ## Clinical Pearls * The oral suspension contains approximately 7.5 calories per mL, which may contribute to weight gain. * Abrupt discontinuation may lead to adrenal insufficiency, especially after prolonged use. Tapering may be necessary. * May cause significant mood changes, including depression. * Use with caution in patients with a history of cardiovascular disease or thromboembolic disorders. *** **Disclaimer:** This information is intended for clinical use by healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information, guidelines, and institutional protocols before initiating or modifying therapy.