megestrol acetate: clinical use

Prescribing considerations

• Use under specialist supervision with regular surveillance.
• Not recommended for children because safety and effectiveness have not been established.
• Use cautiously in older adults, considering renal, hepatic and cardiac function, comorbidities and concurrent treatment.
• Avoid abrupt, unsupervised withdrawal after prolonged treatment because adrenal insufficiency has occurred after discontinuation.

Contraindications and cautions

• Hypersensitivity to megestrol acetate or any excipient.
• The lactose-containing tablet should not be used in specified rare hereditary disorders of galactose or glucose-galactose handling.
• Exercise caution with previous thrombophlebitis or severe hepatic impairment.

Monitoring

• Clinical response and tumour flare
• Symptoms of venous thromboembolism or pulmonary embolism
• Blood glucose, particularly with diabetes or suggestive symptoms
• Features of Cushing's syndrome or adrenal suppression, including during withdrawal
• Renal function where impairment is likely, particularly in older adults
• Blood pressure, fluid retention and cardiac symptoms

Clinical pharmacology

A potent synthetic progestogen with anti-oestrogenic, antigonadotropic and slight glucocorticoid activity. It is absorbed orally and eliminated mainly through the urine, with metabolites including glucuronide conjugates.

Formulation and product differences

• The selected product is an oral lactose-containing tablet.
• Its break line facilitates swallowing and is not intended to divide the tablet into equal portions.

Tablet

Route: Oral

Strengths: 160 mg