Medroxyprogesterone
Synonym :
Medroxyprogesterone Acetate
Mechanism :
It is a synthetic progesterone used to regulate menstrual cycles and dysfunctional uterine bleeding. It is used in combination with estrogen as an oral contraceptive.
Indication :
- Dysfunctional Uterine Bleeding
- Contraception
- Delayed puberty in females
Contraindications :
Hepatic disease, Hypersensitivity, Undiagnosed vaginal bleeding, Breast CA, Progesterone-dependent CA, Venous thromboembolism, Arterial thromboembolism, Pregnancy, Missed abortion.
Dosing :
Contraception:
150 mg every 3 months as deep IM injection. Start within 5 days of menses onset.
Hormone replacement and Dysfunctional uterine bleeding:
2.5-10 mg daily for 5-10 days of cycle PO 24 hourly. Begin on the 16th day of the cycle and continue for 10 days or begin on the 21st day of the cycle and continue for 5 days. Withdrawal bleeding usually occurs within 3 to 7 days after the last dose.
Delayed puberty in female:
5-10 mg PO OD x 10-12 days every 4 weeks. Start after breakthrough bleeding on unopposed estrogen occurs or 2 years of estrogen treatment; give on last 10-12 days of menstrual cycle.
Adverse Effect :
Anaphylaxis, break through bleeding or spotting, nausea, vomiting, weight gain, dizziness, migraine, anaphylaxis, breast pain/tenderness, galactorrhea, weight changes, fluid retention, headache, insomnia, anorexia, weakness, pain at injection site, somnolence, dizziness, nervousness, depression, rash, pruritus, urticaria, acne, hirsutism, alopecia, abnormal glucose tolerance, increased clear or white vaginal discharge with or without odour, itching of the vagina or genital area.
Interaction :
Avoid/Use Alternative:
Dabrafenib, Tranexamic Acid, Griseofulvin, Isotretinoin, Amprenavir.
Monitor/Modify Treatment:
Cholestyramine, Colestipol, Tesamorelin.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function. Monitor carefully |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| HD | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unlikely to be dialysed. Dose as in normal renal function |
Hepatic Dose :
Elimination of medroxyprogesterone is reduced in patients with cirrhosis. The oral dose may be reduced in patients with moderate or severe hepatic impairment. No guidelines are available for the injectable formulations.