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## Megestrol Acetate (Megace ES)
### Overview
Megestrol acetate is a synthetic progestin.
### Primary Indications
* Treatment of anorexia, cachexia, or unexplained significant weight loss in the palliative care of patients with acquired immunodeficiency syndrome (AIDS) or cancer.
* Treatment of advanced or metastatic breast cancer (hormone-responsive).
* Endometrial cancer (less common).
### Adult Dosing
* **Cachexia/Anorexia (AIDS/Cancer):** 625 mg orally once daily. Higher doses may be used in some cases but evidence for significant benefit beyond 625 mg daily is limited.
* **Breast Cancer:** 160 mg orally once daily.
* **Endometrial Cancer:** 40 mg orally 4 times daily (160 mg daily) or 160 mg orally once daily.
### Pediatric Dosing
The safety and efficacy of megestrol acetate have not been established in pediatric patients.
### Dose Adjustments
* **Renal Impairment:** No specific dose adjustments are recommended.
* **Hepatic Impairment:** No specific dose adjustments are recommended.
### Contraindications
* Known or suspected pregnancy.
* Known hypersensitivity to megestrol acetate or any component of the formulation.
### Adverse Effects
* **Common:** Weight gain (fluid retention, increased appetite), hypertension, hot flashes, dyspnea, nausea, diarrhea, abdominal pain, rash, edema, fatigue, sexual dysfunction.
* **Serious:** Adrenal insufficiency, thromboembolic events (deep vein thrombosis, pulmonary embolism), hyperglycemia, Stevens-Johnson syndrome.
### Key Drug Interactions
* **Aminoglutethimide:** May decrease megestrol acetate levels.
* **CYP3A4 inhibitors/inducers:** May alter megestrol acetate concentrations, though clinical significance is often unclear.
### Monitoring
* Weight and appetite changes.
* Blood pressure.
* Signs and symptoms of thromboembolic events.
* Blood glucose levels, especially in patients with diabetes or at risk.
* Adrenal function if long-term use is considered or during periods of stress (e.g., illness, surgery).
### Clinical Pearls
* Oral suspension formulations are available and may be preferred for ease of administration.
* Onset of action for weight gain may take several weeks.
* Use in pediatric patients should be approached with extreme caution due to lack of established safety and efficacy.
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***Disclaimer:*** *This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information with the most recent product labeling and institutional protocols.*
