medroxyprogesterone acetate
Amen, Curretab, Cycrin, Depo-Provera, Provera

Available forms
Available by prescription only
Injection: 150 mg/ml, 400 mg/ml
Tablets: 2.5 mg, 5 mg, 10 mg

Indications and dosages
 Abnormal uterine bleeding from hormonal imbalance. Adults: 5 to 10 mg P.O. daily for 5 to 10 days beginning on day 16 to 21 of menstrual cycle. If patient has received estrogen, then 10 mg P.O. daily for 10 days beginning on day 16 of cycle. If bleeding is controlled satisfactorily, give two subsequent cycles of combination therapy.
 Secondary amenorrhea. Adults: 5 to 10 mg P.O. daily for 5 to 10 days, preferably beginning on day 16 to 21 of menstrual cycle. If patient has received estrogen, then 10 mg P.O. daily for 10 days.
 Endometrial or renal carcinoma (adjunct). Adults: 400 to 1,000 mg I.M. weekly. If disease improves or stabilizes in a few weeks or months, 400 mg/month.
 Paraphilia in men ◇. Adults: Initially, 200 mg I.M. b.i.d. or t.i.d. or 500 mg I.M. weekly. Adjust dosage based on response.
 Contraception in women. Adults: 150 mg I.M. q 3 months; give first injection on first 5 days of menstrual cycle.

Pharmacodynamics
Progestational action: Parenteral medroxyprogesterone suppresses ovulation, causes thickening of cervical mucus, and induces sloughing of the endometrium.
Antineoplastic action: Drug may inhibit growth progression of progestin-sensitive endometrial or renal cancer tissue by an unknown mechanism.

Pharmacokinetics
Absorption: Absorption is slow after I.M. administration.
Distribution: Not well characterized.
Metabolism: Primarily hepatic; not well characterized.
Excretion: Primarily renal; not well characterized.

Contraindications and precautions
Contraindicated in pregnant women, patients hypersensitive to drug, and patients with active or previous thromboembolic disorders, cerebral vascular disease, apoplexy, breast cancer, undiagnosed abnormal vaginal bleeding, missed abortion, or hepatic dysfunction. Tablets are contraindicated in patients with liver dysfunction or known or suspected malignant disease of the genital organs.
  Use cautiously in patients with diabetes mellitus, seizures, migraines, cardiac or renal disease, asthma, or depression.

Interactions
Drug-drug. Aminoglutethimide: May increase hepatic metabolism of medroxyprogesterone, possibly decreasing its therapeutic effect. Avoid use together.

Adverse reactions
CNS: depression, CVA.
CV: thrombophlebitis, pulmonary embolism, edema, thromboembolism.
EENT: exophthalmos, diplopia.
GU: breakthrough bleeding, dysmenorrhea, amenorrhea, cervical erosion, abnormal secretions.
Hepatic: cholestatic jaundice.
Metabolic: changes in weight.
Skin: rash, pain, induration, sterile abscesses, acne, pruritus, melasma, alopecia, hirsutism.
Other: breast tenderness, enlargement, or secretion.

Effects on lab test results
• May increase liver function test values and cause abnormal thyroid function test results.

Overdose and treatment
No information available.

Special considerations
• Drug has been used to treat obstructive sleep apnea and to manage paraphilia.
• When used as a long-acting contraceptive, rule out pregnancy before starting therapy.
• Shake suspension vigorously just before use to ensure complete suspension of drug.
• Use parenteral form only for I.M. administration. Inject deep into large muscle mass, preferably the gluteal muscle. Monitor patient for development of sterile abscesses.
• Monitor serum glucose level in diabetic patient.
• Store drug between 59° and 86° F (15° and 30° C); avoid freezing.
Breast-feeding patients
• Drug has been detected in breast milk. Infants exposed to drug via breast milk have shown no adverse developmental or behavioral effects through puberty.

Patient education
• Tell patient not to take drug if she becomes pregnant.
• Advise patient to report chest pain, difficulty breathing, or leg pain.
• Warn patient about signs of CVA.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use