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# Megestrol Acetate
## Overview
Megestrol acetate is a synthetic progestin used for palliative treatment of certain cancers and to manage anorexia, cachexia, or unexplained significant weight loss.
## Primary Indications
* Palliative treatment of advanced breast cancer.
* Palliative treatment of endometrial cancer.
* Management of anorexia, cachexia, or unexplained significant weight loss in patients with acquired immunodeficiency syndrome (AIDS).
## Adult Dosing
* **Breast Cancer:** 160 mg (1 tab) once daily.
* **Endometrial Cancer:** 40 mg (1 tab) four times daily (160 mg/day total).
* **AIDS-related Anorexia/Cachexia:** 400-800 mg daily. Higher doses may be more effective for weight gain.
## Pediatric Dosing
There is no established pediatric dosing. Use in pediatric patients is not recommended.
## Dose Adjustments
No specific dose adjustments are generally required for hepatic or renal impairment, though caution is advised in severe impairment.
## Contraindications
* Known or suspected pregnancy.
* Known hypersensitivity to megestrol acetate or any of its components.
## Adverse Effects
Common adverse effects include weight gain, increased appetite, nausea, vomiting, diarrhea, abdominal pain, hot flashes, dyspnea, hypertension, rash, alopecia, and headache. More serious adverse effects can include thromboembolic events (deep vein thrombosis, pulmonary embolism), adrenal insufficiency, hyperglycemia, and bone mineral density decrease.
## Key Drug Interactions
* **Aminoglutethimide:** May decrease megestrol acetate levels.
* **CYP3A4 inhibitors/inducers:** May alter megestrol acetate concentrations.
## Monitoring
* Weight and appetite.
* Signs and symptoms of thromboembolic events.
* Blood glucose levels, especially in diabetic patients.
* Adrenal function, particularly with long-term use or withdrawal.
* Bone mineral density, especially with long-term use.
## Clinical Pearls
* Onset of action for appetite stimulation may take several weeks.
* Discontinuation can lead to loss of appetite and weight.
* May cause menstrual irregularities.
* Use with caution in patients with a history of cardiovascular disease or risk factors for thromboembolism.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant literature for complete details before making treatment decisions.
