Names and pronunciation
(me-jess′trole) Megace
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Drug reference
(me-jess′trole) Megace
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Func. class.: Antineoplastic hormone
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Chem. class.: Progestin
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ACTION: Affects endometrium with antiluteinizing effect; thought to bring about cell death, stimulates appetite by unknown action
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USES: Breast, endometrial cancer; cachexia, anorexia, weight loss with AIDS Unlabeled uses: Hot flashes, endometriosis
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CONTRAINDICATIONS: Preg- nancy, hypersensitivity, breastfeeding Precautions: Diabetes, thrombosis, adrenal insufficiency
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SIDE EFFECTS CNS: Mood swings, insomnia, fever, leth- argy, depression CV: Thrombophlebitis, thromboembolism, hypertension ENDO: Adrenal insufficiency GI: Nausea, vomiting, diarrhea, abdomi- nal cramps, weight gain, flatus, indigestion GU: Gynecomastia, fluid retention, vagi- nal bleeding, discharge, impotence, decreased libido, menstruation disorders INTEG: Alopecia, rash, pruritus MISC: Tumor flare, leukopenia
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INTERACTIONS • Increase: serious arrhythmias—dofet- ilide; avoid using concurrently • Decrease: megestrol effect—antidia- betics; may need to increase megestrol dose • Decrease: effect of indinavir; may need to increase indinavir dose Drug/Lab Test Increase: glucose
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DOSAGE AND ROUTES Endometrial carcinoma (palliative) • Adult: PO 40-320 mg/day in divided doses Anorexia, cachexia, severe weight loss in AIDS • Adult: PO (oral suspension) 400-800 mg daily; 625 mg (5-mL concentrated oral suspension) daily Breast carcinoma (palliative) • Adult: PO 40 mg qid or 160 mg/day (tablets) Hot flashes (unlabeled) M • Adult: PO 20 mg daily
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Available forms: Tabs 20, 40, 160 mg; oral susp 40, 125 mg/mL
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Administer: • Oral susp for AIDS patients; shake well • Without regard to food • Store in tight container at room tem- perature
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Assess: • PSA levels in men (prostate cancer); blood glucose, LFTs, serum calcium, weight • Psychosocial: effects of alopecia on body image; feelings about body changes • Frequency of stools, characteristics: cramping, acidosis, signs of dehydration (poor skin turgor, decreased urine out- put, dry skin, restlessness, weakness), rapid respirations • Anorexia, nausea, vomiting, constipa- tion, weakness, loss of muscle tone • Thrombophlebitis: unilateral in- crease in leg girth; edema; warm, red skin; pain in extremity; notify prescriber immediately • HPA axis suppression: in chronic us- ers, do not discontinue abruptly; wear medical ID; monitor for hypotension during stress, trauma, acute illness • Beers: avoid in older adults as an appetite stimulant; minimal effect on weight; increased risk of thrombotic events • Pregnancy/breastfeeding: do not use in pregnancy or breastfeeding
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Evaluate: • Therapeutic response: decreased tu- mor size, spread of malignancy; weight gain in AIDS patients; resolved dysfunc- tional uterine bleeding
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report vaginal bleeding • That gynecomastia, alopecia can oc- cur; reversible after discontinuing treat- ment • To recognize signs of fluid retention, thromboemboli; to report these immediately • To monitor blood glucose if diabetic • That products may be taken without food • Pregnancy/breastfeeding: that non- hormonal contraception should be used during and for 4 mo after treatment
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PHARMACOKINETICS PO: Half-life 13-105 hr; metabolized in liver; excreted in feces, urine, breast milk; food increases bioavailability of oral sol
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• Adult: PO 40-320 mg/day in divided doses Anorexia, cachexia, severe weight loss in AIDS
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• Adult: PO (oral suspension) 400-800 mg daily; 625 mg (5-mL concentrated oral suspension) daily Breast carcinoma (palliative)
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• Adult: PO 40 mg qid or 160 mg/day (tablets) Hot flashes (unlabeled) M
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• Adult: PO 20 mg daily
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