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# Megestrol Acetate (Megestrol)
## Overview
Megestrol acetate is a synthetic progestogen used primarily for its appetite-stimulating and anti-neoplastic effects.
## Primary Indications
* **Cancer Therapy:** Treatment of advanced breast cancer and endometrial cancer.
* **Cachexia/Anorexia:** Management of anorexia, cachexia, or unexplained weight loss in patients with acquired immunodeficiency syndrome (AIDS) or cancer.
## Adult Dosing
* **Breast Cancer:** 160 mg (400 mg/day) orally once daily.
* **Endometrial Cancer:** 40 mg (40 mg/day) orally four times daily. Alternatively, 40 mg (160 mg/day) orally once daily.
* **Anorexia/Cachexia/Weight Loss (AIDS/Cancer):** 400-800 mg orally once daily. Doses up to 800 mg daily have been used.
## Pediatric Dosing
There is no established pediatric dosing for megestrol acetate.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustments are recommended, but caution may be warranted due to potential accumulation.
* **Hepatic Impairment:** No specific dose adjustments are recommended, but caution may be warranted due to potential accumulation.
## Contraindications
* Known hypersensitivity to megestrol acetate or any component of the formulation.
* Pregnancy.
## Adverse Effects
* **Common:** Weight gain, increased appetite, hypertension, hot flashes, rash, diarrhea, nausea, dyspnea, fatigue, edema, amenorrhea, vaginal bleeding.
* **Serious:** Thrombophlebitis, pulmonary embolism, corticosteroid-like effects (adrenal suppression, Cushingoid symptoms), hyperglycemia, depression, alopecia.
## Key Drug Interactions
* **CYP3A4 Inhibitors/Inducers:** May alter megestrol concentrations.
* **Corticosteroids:** Increased risk of corticosteroid-like effects.
## Monitoring
* Weight and appetite.
* Blood pressure.
* Signs and symptoms of thromboembolic events.
* Adrenal function if used long-term or in conjunction with corticosteroids.
* Blood glucose, especially in diabetic patients.
## Clinical Pearls
* Megestrol acetate is effective in stimulating appetite and promoting weight gain, particularly in patients with cancer-related anorexia or AIDS wasting syndrome.
* Long-term use can lead to significant weight gain and potential corticosteroid-like side effects.
* Ensure patients are counselled regarding potential adverse effects, including thromboembolic events.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant guidelines for complete and up-to-date details.*
