Drug reference

Medroxyprogesterone acetate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 878, 879

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Dysfunctional uterine bleeding ▶BY MOUTH ▶Adult: 2.5–10 mg daily for 5–10 days, repeated for 2 cycles, begin treatment on day 16–21 of cycle Secondary amenorrhoea ▶BY MOUTH ▶Adult: 2.5–10 mg daily for 5–10 days, repeated for 3 cycles, begin treatment on day 16–21 of cycle Genito-urinary system Mild to moderate endometriosis ▶BY MOUTH ▶Adult: 10 mg 3 times a day for 90 consecutive days, begin treatment on day 1 of cycle Progestogenic opposition of oestrogen HRT ▶BY MOUTH ▶Adult: 10 mg daily for the last 14 days of each 28-day oestrogen HRT cycle Endometrial cancer | Renal cell cancer ▶BY MOUTH ▶Adult: 200–600 mg daily Breast cancer ▶BY MOUTH ▶Adult: 0.4–1.5 g daily Contraception ▶BY DEEP INTRAMUSCULAR INJECTION ▶Females of childbearing potential: 150 mg, to be administered within the ﬁrst 5 days of cycle or within ﬁrst 5 days after parturition (delay until 6 weeks after parturition if breast-feeding) ▶BY SUBCUTANEOUS INJECTION ▶Females of childbearing potential: 104 mg, to be administered within ﬁrst 5 days of cycle or within 5 days postpartum (delay until 6 weeks postpartum if breast-feeding), injected into anterior thigh or abdomen, dose only suitable if no hormonal contraceptive use in previous month Long-term contraception ▶BY DEEP INTRAMUSCULAR INJECTION ▶Females of childbearing potential: 150 mg every 12 weeks, ﬁrst dose to be administered within the ﬁrst 5 days of cycle or within ﬁrst 5 days after parturition (delay until 6 weeks after parturition if breast-feeding) ▶BY SUBCUTANEOUS INJECTION ▶Females of childbearing potential: 104 mg every 13 weeks, ﬁrst dose to be administered within ﬁrst 5 days of cycle or within 5 days postpartum (delay until 6 weeks postpartum if breast-feeding), injected into anterior thigh or abdomen, dose only suitable if no hormonal contraceptive use in previous month Contraception (when patient changing from other hormonal contraceptive) ▶BY SUBCUTANEOUS INJECTION ▶Females of childbearing potential: (consult product literature) Hot flushes caused by long-term androgen suppression in men with prostate cancer ▶BY MOUTH ▶Adult: 20 mg once daily initially for 10 weeks, evaluate effect at the end of the treatment period l UNLICENSED USE g Medroxyprogesterone acetate is used for the treatment of hot ﬂushes caused by long-term androgen suppression in men, h but it is not licensed for this indication.

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Contra Indications

GENERAL CONTRA-INDICATIONS Acute porphyrias p. 1120. severe arterial disease. undiagnosed vaginal bleeding SPECIFIC CONTRA-INDICATIONS ▶With intramuscular use or subcutaneous use History of breast cancer but can be used after 5 years if no evidence of disease and non-hormonal contraceptive methods unacceptable ▶With oral use Breast cancer (unless progestogens are being used in the management of this condition). genital cancer (unless progestogens are being used in the management of this condition). history of liver tumours

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Cautions

GENERAL CAUTIONS Possible risk of breast cancer SPECIFIC CAUTIONS ▶With intramuscular use or subcutaneous use History during pregnancy in disturbances of lipid metabolism. history during pregnancy of deterioration of otosclerosis. history during pregnancy of pruritus ▶With oral use Asthma. cardiac dysfunction. conditions that may worsen with ﬂuid retention. diabetes (progestogens can decrease glucose tolerance—monitor patient closely). epilepsy. history of depression. hypertension. migraine. susceptibility to thromboembolism (particular caution with high dose)

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Safety

Interactions

→Appendix 1: medroxyprogesterone

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Side Effects

GENERAL SIDE-EFFECTS ▶Common or very common Alopecia. breast abnormalities. depression. dizziness. ﬂuid retention. insomnia. menstrual cycle irregularities. nausea. sexual dysfunction . skin reactions. weight changes ▶Uncommon Drowsiness. embolism and thrombosis. fever. galactorrhoea. hirsutism. muscle spasms. tachycardia SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With oral use Appetite increased. cervical abnormalities. constipation. fatigue. headache. hyperhidrosis. hypersensitivity. nervousness. oedema. tremor. vomiting ▶With parenteral use Anxiety. asthenia. gastrointestinal discomfort. headaches. mood altered. pain. vulvovaginal infection ▶Uncommon ▶With oral use Congestive heart failure. corticoid-like effects . diabetes mellitus exacerbated. diarrhoea. dry mouth. euphoric mood. hypercalcaemia ▶With parenteral use Appetite abnormal. arthralgia. hot ﬂush. hypertension. ovarian cyst. painful sexual intercourse. uterine haemorrhage. varicose veins. vertigo . vulvovaginal disorders ▶Rare or very rare ▶With oral use Cerebral infarction. jaundice. malaise. myocardial infarction ▶With parenteral use Breast cancer. lipodystrophy ▶Frequency not known ▶With oral use Adrenergic-like effects. cataract diabetic. concentration impaired. confusion. glycosuria. palpitations. visual impairment (discontinue if papilloedema or retinal vascular lesions) ▶With parenteral use Hepatic disorders. osteoporosis. osteoporotic fractures. seizure SIDE-EFFECTS, FURTHER INFORMATION With oral use In general, side effects may be more common with high doses such as those used in malignant disease. With parenteral use Reduction in bone mineral density is greater with increasing duration of use.The loss is mostly recovered on discontinuation.

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Conception And Contraception

▶With intramuscular use If interval between dose is greater than 12 weeks and 5 days (in long-term contraception), rule out pregnancy before next injection and advise patient to use additional contraceptive measures (e.g. barrier) for 14 days after the injection. ▶With subcutaneous use If interval between dose is greater than 13 weeks and 7 days (in long-term contraception), rule out pregnancy before next injection.

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Pregnancy

▶With oral use Avoid—genital malformations and cardiac defects reported. ▶With intramuscular use or subcutaneous use Not known to be harmful.

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Breast Feeding

Present in milk—no adverse effects reported. Progestogen-only contraceptives do not affect lactation. ▶With intramuscular use or subcutaneous use The manufacturers advise that in women who are breast- feeding, the ﬁrst dose should be delayed until 6 weeks after birth; however, evidence suggests no harmful effect to infant if given earlier. The beneﬁts of using medroxyprogesterone acetate in breast-feeding women outweigh any risks.

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Hepatic Impairment

▶With oral use Manufacturer advises caution; avoid in acute or active disease. ▶With intramuscular use or subcutaneous use Manufacturer advises caution; avoid in severe or active disease.

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Renal Impairment

▶When used for Mild to moderate endometriosis or Progestogenic opposition of oestrogen HRT or Dysfunctional uterine bleeding or Secondary amenorrhoea Use with caution.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet ▶Climanor (ReSource Medical UK Ltd) Medroxyprogesterone acetate 5 mg Climanor 5mg tablets | 28 tablet P £3.27 ▶Provera (Pfizer Ltd) Medroxyprogesterone acetate 2.5 mg Provera 2.5mg tablets | 30 tablet P £1.84 DT = £1.84 Medroxyprogesterone acetate 5 mg Provera 5mg tablets | 10 tablet P £1.23 DT = £1.23 | 100 tablet P £12.32 Medroxyprogesterone acetate 10 mg Provera 10mg tablets | 10 tablet P £2.47 | 90 tablet P £22.16 DT = £22.16 | 100 tablet P £24.73 Medroxyprogesterone acetate 100 mg Provera 100mg tablets | 60 tablet P £29.98 | 100 tablet P £49.94 DT = £49.94 Medroxyprogesterone acetate 200 mg Provera 200mg tablets | 30 tablet P £29.65 DT = £29.65 Medroxyprogesterone acetate 400 mg Provera 400mg tablets | 30 tablet P £58.67 DT = £58.67 Suspension for injection ▶Depo-Provera (Pfizer Ltd) Medroxyprogesterone acetate 150 mg per 1 ml Depo-Provera 150mg/1ml suspension for injection pre-filled syringes | 1 pre-filled disposable injection P £6.01 DT = £6.01 ▶Sayana Press (Pfizer Ltd) Medroxyprogesterone acetate 160 mg per 1 ml Sayana Press 104mg/0.65 ml suspension for injection pre-filled disposable devices | 1 pre-filled disposable injection P £6.90 DT = £6.90 3.6 Contraception, spermicidal SPERMICIDALS

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Clinical care

Patient And Carer Advice

▶With intramuscular use or subcutaneous use Full counselling backed by patient information leaﬂet required before administration—likelihood of menstrual disturbance and the potential for a delay in return to full fertility. Delayed return of fertility and irregular cycles may occur after discontinuation of treatment but there is no evidence of permanent infertility.

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Dose text by age group

Adult

2.5–10 mg daily for 5–10 days, repeated for

First-line fragment. Read the complete Indications and Dose section above.

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Adult

2.5–10 mg daily for 5–10 days, repeated for

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10 mg 3 times a day for 90 consecutive days,

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10 mg daily for the last 14 days of each 28-day

First-line fragment. Read the complete Indications and Dose section above.

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Adult

200–600 mg daily

First-line fragment. Read the complete Indications and Dose section above.

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Adult

0.4–1.5 g daily

First-line fragment. Read the complete Indications and Dose section above.

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Adult

20 mg once daily initially for 10 weeks, evaluate

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Medroxyprogesterone acetate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 878, 879

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 878

Contra Indications

PDF page 878

Cautions

PDF page 878

Safety

Interactions

→Appendix 1: medroxyprogesterone

PDF page 878

Side Effects

PDF page 878

Conception And Contraception

PDF pages 878, 879

Pregnancy

▶With oral use Avoid—genital malformations and cardiac defects reported. ▶With intramuscular use or subcutaneous use Not known to be harmful.

PDF page 879

Breast Feeding

PDF page 879

Hepatic Impairment

▶With oral use Manufacturer advises caution; avoid in acute or active disease. ▶With intramuscular use or subcutaneous use Manufacturer advises caution; avoid in severe or active disease.

PDF page 879

Renal Impairment

▶When used for Mild to moderate endometriosis or Progestogenic opposition of oestrogen HRT or Dysfunctional uterine bleeding or Secondary amenorrhoea Use with caution.

PDF page 879

Dose and formulations

Medicinal Forms

PDF page 879

Clinical care

Patient And Carer Advice

PDF page 879

Dose text by age group

Adult

2.5–10 mg daily for 5–10 days, repeated for

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Adult

2.5–10 mg daily for 5–10 days, repeated for

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Adult

10 mg 3 times a day for 90 consecutive days,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Adult

10 mg daily for the last 14 days of each 28-day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Adult

200–600 mg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Adult

0.4–1.5 g daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Adult

20 mg once daily initially for 10 weeks, evaluate

First-line fragment. Read the complete Indications and Dose section above.

PDF page 878

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.