Indications & Dose:
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
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, 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, 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 contraception)
▶ BY SUBCUTANEOUS INJECTION
▶ Females of childbearing potential: (consult product literature)
Contraindications:
GENERAL CONTRA-INDICATIONS
Acute porphyrias. 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
Side Effects:
GENERAL SIDE-EFFECTS
Breast discomfort . changes in libido . depression . dizziness . headache . indigestion . loss of vision during treatment (discontinue treatment if papilloedema or retinal vascular lesions) . menstrual irregularities . nausea . pruritus . vomiting . weight gain SPECIFIC SIDE-EFFECTS
▶ Rare
▶ With intramuscular use or subcutaneous use Osteoporosis .osteoporotic fractures
▶ Frequency not known
▶ With intramuscular use or subcutaneous use Disturbance of appetite . injection site-reactions . reduced bone mineral density . skin disorders
▶ With oral use Acne . adrenergic-like effects (when used for malignant disease) . alopecia . anaphylactoid reactions .
bloating . breast tenderness . cervical erosions (when used for malignant disease) . confusion (when used for malignant disease) . congestive heart failure (when used for malignant disease) . constipation (when used for malignant disease) . diarrhoea (when used for malignant disease) . drowsiness . dry mouth (when used for malignant disease) . euphoria (when used for malignant disease) .fluid retention . galactorrhoea (when used for malignant disease) . glucocorticoid effects may lead to a cushingoid syndrome (with high doses for malignant disease) .
hirsutism . hypercalcaemia (when used for malignant disease) . hyperpyrexia (when used for malignant disease) .
hypertension (when used for malignant disease) . insomnia. jaundice . loss of concentration (when used for malignant disease) . nervousness (when used for malignant disease) .
palpitation (when used for malignant disease) .premenstrual-like syndrome . raised platelet count (when used for malignant disease) . raised white blood cell count (when used for malignant disease) . rash . retinal thrombosis (when used formalignant disease) . skin reactions . tachycardia (when used for malignant disease) .
urticaria . vision disorders (when used formalignant disease)
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)
Precautions:
Interaction:
Warnings:
Adverse Effects:
Lactations:
PREGNANCY
▶ With oral use Avoid—genital malformations and cardiac
defects reported.
▶ With intramuscular use or subcutaneous use Not known to be
harmful.
l 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 breastfeeding, 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.
l HEPATIC IMPAIRMENT Avoid in liver tumour.
▶ With oral use Avoid in hepatic impairment.
▶ With intramuscular use or subcutaneous use Caution in severe liver disease and recurrent cholestatic jaundice.
l 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.
l 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.
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
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