Medroxyprogesterone

# Medroxyprogesterone ## Overview - **Classification**: Progestin (synthetic progesterone derivative) - **Mechanism**: Suppresses ovulation by inhibiting GnRH release, thins the endometrial lining, and thickens cervical mucus. ## Primary Indications 1. **Contraception** - Prevents pregnancy (injectable or oral forms). 2. **Secondary Amenorrhea** - Treatment of absent menstrual periods due to hormonal imbalance. 3. **Abnormal Uterine Bleeding (AUB)** - Management of dysfunctional uterine bleeding. 4. **Endometrial Protection** - Used with estrogen replacement therapy to reduce endometrial hyperplasia/cancer risk. 5. **Endometriosis** - Management of endometriosis-related pain. 6. **Adjunctive Cancer Therapy** - For advanced, recurrent endometrial or renal carcinoma. ## Adult Dosing ### Standard Dosing **Contraception (IM/SQ Injection)** - **Dose**: **150 mg** (IM) or **104 mg** (SQ) - **Frequency**: Every **3 months (13 weeks)** - **Route**: Intramuscular (IM) or Subcutaneous (SQ) - **Special Consideration**: Initiate within 5 days of menses, or immediately postpartum/post-abortion. **Secondary Amenorrhea (Oral)** - **Dose**: **5-10 mg** - **Frequency**: Once daily for **5-10 days** - **Route**: Oral - **Duration**: Therapy can be repeated as needed. **Abnormal Uterine Bleeding (AUB, Oral)** - **Dose**: **5-10 mg** - **Frequency**: Once daily for **5-10 days** - **Route**: Oral - **Duration**: Can be repeated for several cycles. **Endometrial Protection (Oral, with estrogen)** - **Dose**: **5-10 mg** - **Frequency**: Daily for **12-14 consecutive days** per month or **2.5 mg** daily continuously. - **Route**: Oral **Endometriosis (Oral)** - **Dose**: **10 mg** - **Frequency**: Three times daily (total **30 mg/day**) - **Route**: Oral - **Duration**: For **90 consecutive days**. **Advanced Endometrial/Renal Carcinoma (Oral)** - **Dose**: **400-1000 mg** - **Frequency**: Weekly - **Route**: Oral - **Special Consideration**: High doses; often used as palliative therapy. ### Dose Adjustments - **Renal Impairment**: No specific dose adjustment recommended; primarily hepatic metabolism. - **Hepatic Impairment**: Use with caution. Not recommended in severe hepatic dysfunction or active liver disease. - **Elderly Patients**: Use lowest effective dose. Consider increased risk of VTE and other adverse effects. ## Pediatric Dosing ### Neonates (0-28 days) - Not typically indicated for routine use in this age group. - **Special Notes**: Off-label uses for specific conditions (e.g., precocious puberty) are highly specialized and individualized. ### Infants (1-12 months) - Not typically indicated for routine use in this age group. - **Special Notes**: Off-label uses for specific conditions (e.g., precocious puberty) are highly specialized and individualized. ### Children (1-12 years) - Not typically indicated for routine use in this age group. - **Special Notes**: Off-label uses (e.g., precocious puberty, specific oncologic uses) are under specialist guidance. Dosing is highly individualized. Potential impact on bone health should be considered. ### Adolescents (13-18 years) - **Contraception (IM/SQ)**: Same as adult dosing; **150 mg IM** or **104 mg SQ** every **3 months**. - **Secondary Amenorrhea/AUB (Oral)**: Same as adult oral dosing; **5-10 mg** daily for **5-10 days**. - **Maximum**: Adult doses apply. - **Special Notes**: Injectable medroxyprogesterone (DMPA) can cause bone mineral density (BMD) loss. Counsel on adequate calcium/Vit D intake and exercise. Generally, use for >2 years is not recommended unless other methods are unsuitable. ## Safety Information ### Contraindications - **Absolute**: Known or suspected pregnancy - **Absolute**: Undiagnosed abnormal genital bleeding - **Absolute**: Known or suspected breast cancer or other hormone-sensitive malignancy - **Absolute**: Active thromboembolic disease or history of VTE/PE - **Absolute**: Severe liver disease or dysfunction - **Absolute**: Hypersensitivity to medroxyprogesterone acetate ### Common Adverse Effects - **Very Common (>10%)**: Menstrual irregularities (irregular bleeding, spotting, amenorrhea), weight gain, headache, abdominal pain. - **Common (1-10%)**: Dizziness, mood changes, decreased libido, nausea, breast tenderness, injection site reactions (for IM/SQ). - **Serious but Rare**: Thromboembolic events (DVT, PE), stroke, myocardial infarction, significant bone mineral density loss (with DMPA), severe depression, anaphylaxis. ### Key Drug Interactions - **CYP3A4 Inducers (e.g., carbamazepine, rifampin, phenytoin, St. John's Wort)**: May decrease medroxyprogesterone plasma levels, reducing efficacy. - **Aminoglutethimide**: May significantly decrease medroxyprogesterone levels. Consider alternative contraception/therapy. - **Corticosteroids**: Medroxyprogesterone may decrease corticosteroid clearance; monitor for increased steroid effects and adjust dose if needed. ## Monitoring & Follow-up - **Before Treatment**: Exclude pregnancy. Baseline blood pressure, weight. - **During Treatment**: Annual physical exam, blood pressure, weight. Assess bleeding patterns regularly. - **Clinical Signs**: Monitor for signs of VTE (leg pain/swelling, chest pain, shortness of breath), severe headache, vision changes, signs of depression. ## Clinical Pearls - 💡 **Bone Health**: Injectable medroxyprogesterone (DMPA) can cause reversible bone mineral density loss. Counsel on calcium/Vit D and exercise. Reassess use after 2 years. - 💡 **Return to Fertility**: Return to fertility after discontinuing DMPA can be delayed (average 6-12 months). - 💡 **Weight Gain**: A common side effect, particularly with DMPA. Counsel patients on lifestyle modifications. - 💡 **Bleeding Patterns**: Irregular bleeding, spotting, or amenorrhea are common and expected with progestin-only contraception. - 💡 **Injection Technique**: Ensure proper IM or SQ injection. For SQ, do not massage the injection site to ensure proper absorption. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.