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

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: