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**Drug:** Megestrol Acetate
## Overview
Megestrol acetate is a synthetic derivative of progesterone. It is available in oral suspension and tablet formulations.
## Primary Indications
* **Cachexia, anorexia, or unexplained significant weight loss:** Associated with acquired immunodeficiency syndrome (AIDS) or in patients with cancer.
* **Endometrial carcinoma:** Palliative treatment of recurrent, advanced, or metastatic disease.
* **Breast cancer:** Palliative treatment of advanced or metastatic disease.
## Adult Dosing
* **Cachexia/Anorexia (AIDS):**
* **Oral Suspension:** 625 mg (5 mL) orally once daily. Can be increased to 1250 mg (10 mL) once daily.
* **Tablets:** 160 mg orally once daily. Can be increased to 320 mg to 800 mg once daily.
* **Endometrial Carcinoma:** 40 mg (10 mL suspension or 40 mg tablet) orally four times daily.
* **Breast Cancer:** 160 mg (10 mL suspension or 160 mg tablet) orally once daily.
## Pediatric Dosing
Dosing in pediatric patients has not been established and is not generally recommended due to lack of data and potential for adverse effects.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is recommended, as megestrol acetate is not significantly renally excreted.
* **Hepatic Impairment:** No specific dose adjustment is recommended, but caution is advised.
## Contraindications
* Known hypersensitivity to megestrol acetate or any component of the formulation.
* Pregnancy and breastfeeding.
* Undiagnosed abnormal vaginal bleeding.
## Adverse Effects
* **Common:** Weight gain, increased appetite, edema, hypertension, hot flashes, dyspnea, nausea, diarrhea, rash, thrombocytopenia, alopecia.
* **Serious:** Adrenal insufficiency (especially with abrupt discontinuation), thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism), hyperglycemia, new onset diabetes, exacerbation of existing diabetes, Cushing's syndrome.
## Key Drug Interactions
* **Aminoglutethimide:** May decrease megestrol acetate plasma concentrations.
* **CYP3A4 Inhibitors/Inducers:** May affect megestrol acetate levels, though clinical significance is often uncertain.
## Monitoring
* Weight and appetite.
* Blood pressure.
* Signs and symptoms of thromboembolic events.
* Blood glucose levels, especially in patients with diabetes or risk factors.
* Electrolytes.
* Adrenal function if prolonged use or abrupt discontinuation is suspected.
## Clinical Pearls
* Weight gain and increased appetite are common and often the desired effects in cachexia.
* Monitor for adrenal insufficiency, particularly with abrupt discontinuation after prolonged therapy. Consider a tapering regimen.
* Thromboembolic events are a significant risk; patients should be advised to report symptoms immediately.
* Use in patients with diabetes requires careful blood glucose monitoring.
**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always refer to the most current prescribing information and consult with a healthcare professional for any medication-related questions or decisions.
