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# Megestrol Acetate (Megace)
## Overview
Megestrol acetate is a synthetic progestin. It is available in oral tablet and suspension forms.
## Primary Indications
* **Cachexia, anorexia, or unexplained weight loss:** In patients with acquired immunodeficiency syndrome (AIDS).
* **Palliative treatment of advanced breast cancer** in postmenopausal women or men with hormone-responsive tumors.
* **Endometrial hyperplasia and carcinoma** (less common use).
## Adult Dosing
* **Weight Loss/Cachexia:**
* Suspension: 625 mg orally once daily.
* Tablets: 200 mg orally four times daily (800 mg/day total). Alternatively, 400 mg to 800 mg orally once daily.
* **Breast Cancer:** 160 mg orally once daily.
* **Endometrial Carcinoma:** 40 mg orally four times daily (160 mg/day total). Higher doses (e.g., 320 mg/day to 480 mg/day) may be used.
## Pediatric Dosing
* Dosing for pediatric patients is not well-established and should be determined by a specialist.
## Dose Adjustments
* **Hepatic Impairment:** No specific dose adjustments are routinely recommended, but caution is advised as the drug is metabolized in the liver.
## Contraindications
* Known or suspected pregnancy.
* Known hypersensitivity to megestrol acetate or any component of the formulation.
## Adverse Effects
* **Common:** Weight gain, increased appetite, hypertension, hot flashes, nausea, diarrhea, dyspnea, rash, carpal tunnel syndrome.
* **Serious:** Thrombophlebitis, pulmonary embolism, amenorrhea, vaginal bleeding, adrenal insufficiency, hyperglycemia, new-onset diabetes, exacerbation of pre-existing diabetes, depression, alopecia, visual disturbances.
## Key Drug Interactions
* **CYP3A4 Inhibitors/Inducers:** May alter megestrol acetate concentrations. Monitor for efficacy and toxicity.
* **Antidiabetic Agents:** Megestrol acetate can cause hyperglycemia; concurrent use may require increased doses of antidiabetic agents.
## Monitoring
* Weight and appetite (for cachexia indication).
* Blood pressure.
* Blood glucose levels, especially in diabetic patients.
* Signs of thromboembolic events (e.g., leg swelling, chest pain, shortness of breath).
* Adrenal function if long-term use is discontinued abruptly.
## Clinical Pearls
* The suspension formulation has a higher concentration and is often preferred for the weight loss indication.
* Onset of action can be slow; significant weight gain or tumor response may take several weeks to months.
* Use with caution in patients with a history of thrombophlebitis or thromboembolic disorders.
* Discontinue if signs of serious adverse events occur.
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*This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.*
