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# Megestrol Acetate
## Overview
Megestrol acetate is a synthetic progestational drug with anti-androgenic and anti-estrogenic properties.
## Primary Indications
* Treatment of cachexia, anorexia, or unexplained significant weight loss in patients with acquired immunodeficiency syndrome (AIDS).
* Palliative treatment of advanced breast cancer in postmenopausal women or men.
* Palliative treatment of endometrial carcinoma.
## Adult Dosing
* **AIDS-related cachexia/anorexia:** 800 mg (20 mL) orally once daily.
* **Breast cancer:** 40 mg (10 mL) orally four times daily (160 mg/day total).
* **Endometrial carcinoma:** 40 mg (10 mL) orally four times daily (160 mg/day total). Treatment should be continued until disease progression.
## Pediatric Dosing
Data on pediatric use is limited. Use is generally not recommended due to lack of established safety and efficacy.
## Dose Adjustments
* **Renal impairment:** No specific dose adjustments are established.
* **Hepatic impairment:** No specific dose adjustments are established.
## Contraindications
* Known or suspected pregnancy.
* Undiagnosed abnormal vaginal bleeding.
* Known hypersensitivity to megestrol acetate or any of its components.
## Adverse Effects
* **Common:** Weight gain, increased appetite, hot flashes, hypertension, nausea, edema, dyspnea, carpal tunnel syndrome, headache, abdominal pain, rash, hair loss, bleeding, diarrhea, flatulence, vomiting, fatigue.
* **Serious:** Adrenal insufficiency, thromboembolic events (deep vein thrombosis, pulmonary embolism), hyperglycemia, Stevens-Johnson syndrome, toxic epidermal necrolysis,QT prolongation, new onset diabetes, tumor flare.
## Key Drug Interactions
* **CYP3A4 inhibitors/inducers:** May alter megestrol acetate plasma concentrations. Avoid concurrent use or monitor closely.
* **Aminoglutethimide:** May decrease plasma concentrations of megestrol acetate.
## Monitoring
* Weight and appetite.
* Signs and symptoms of thromboembolic events.
* Blood glucose levels, especially in diabetic patients.
* Adrenal function if therapy is to be discontinued.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Can cause significant weight gain due to increased appetite; this is often the desired therapeutic effect in cachexia.
* Discontinuation of therapy should be gradual to avoid adrenal insufficiency, especially with long-term use.
* Counsel patients on potential adverse effects, including thromboembolic events and fluid retention.
* The oral suspension contains sucrose and should be used with caution in patients with diabetes.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. Local protocols may dictate specific dosing or management strategies.
