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# Megestrol Acetate (Megace ES)
## Overview
Megestrol acetate is a synthetic progestogen. It is available as an oral suspension and tablet.
## Primary Indications
* **Palliative treatment of advanced breast cancer** in women.
* **Palliative treatment of endometrial carcinoma**.
* **Management of anorexia, cachexia, or unexplained significant weight loss** in patients with acquired immunodeficiency syndrome (AIDS).
## Adult Dosing
* **Breast Cancer:** 160 mg (approximately 10 mL of the 40 mg/mL suspension or 4 tablets) once daily.
* **Endometrial Carcinoma:** 40 mg (approximately 2.5 mL of the 40 mg/mL suspension or 1 tablet) 4 times daily (total 160 mg daily). Alternatively, 40-80 mg once daily.
* **AIDS-related Anorexia/Cachexia:** 800 mg (20 mL of the 40 mg/mL suspension) once daily.
## Pediatric Dosing
The safety and efficacy of megestrol acetate in pediatric patients have not been established.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is recommended.
* **Hepatic Impairment:** No specific dose adjustment is recommended, but caution may be warranted.
## Contraindications
* Known hypersensitivity to megestrol acetate or any component of the formulation.
* Pregnancy.
## Adverse Effects
* **Common:** Weight gain, increased appetite, hot flashes, dyspnea, nausea, edema, hypertension, rash, pain, carpal tunnel syndrome, mood changes.
* **Serious:** Thrombotic and thromboembolic events (e.g., pulmonary embolism, deep vein thrombosis), adrenal insufficiency, hyperglycemia, new onset diabetes, exacerbation of existing diabetes, Cushing's syndrome, vaginal bleeding, loss of libido, gynecomastia.
## Key Drug Interactions
* **Aminoglutethimide:** May decrease the plasma concentrations of megestrol acetate.
* **CYP3A4 Inhibitors/Inducers:** While megestrol acetate is a substrate of CYP3A4, clinically significant interactions are not well-documented. However, concurrent use with strong CYP3A4 inducers or inhibitors may alter megestrol acetate concentrations.
## Monitoring
* **Weight and appetite:** Monitor for effectiveness and for signs of fluid retention.
* **Blood glucose:** Especially in patients with diabetes or at risk.
* **Adrenal function:** In patients with conditions predisposing to adrenal insufficiency, especially during or after discontinuation.
* **Signs of thromboembolic events.**
* **Vaginal bleeding** and menstrual irregularities.
## Clinical Pearls
* For appetite stimulation and weight gain in AIDS, the higher dose of 800 mg daily is typically used.
* Withdrawal of the drug may be necessary in cases of adrenal insufficiency.
* Caution is advised in patients with a history of thromboembolic events.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant guidelines for complete details. Dosing may vary based on specific patient factors and local protocols.*
