From the Guidelines
For an 89-year-old female, a suitable starting dose of Megace (megestrol acetate) is typically 160-200 mg daily, given her advanced age and potential for increased sensitivity to medication effects. This dose can be taken with food to enhance absorption, and adjustments can be made based on the patient's response and tolerance 1. The primary goal of using Megace in this patient population is to stimulate appetite and promote weight gain in cases of cachexia or anorexia, which can significantly impact quality of life.
Key considerations when initiating Megace in elderly patients include:
- Monitoring for common side effects such as increased risk of thromboembolism, fluid retention, hyperglycemia, and adrenal suppression 1
- Regular assessment of weight, blood glucose, and symptoms of fluid retention
- Individualized treatment duration based on clinical response, as the medication typically takes 1-3 weeks to show effects on appetite
Given the potential for significant benefits in appetite stimulation and weight gain, as well as the importance of minimizing risks in elderly patients, starting with a lower dose of Megace and closely monitoring the patient's response is a prudent approach 1. This strategy allows for the optimization of therapeutic benefits while minimizing the risk of adverse effects.
From the FDA Drug Label
The recommended adult initial dosage of megestrol acetate oral suspension, USP is 800 mg/day (20 mL/day). In clinical trials evaluating different dose schedules, daily doses of 400 and 800 mg/day were found to be clinically effective.
The suitable starting dose of Megace (megestrol acetate) for an 89-year-old female is 400 mg/day or 800 mg/day, however considering the patient's age, a more conservative approach would be to start with the lower dose of 400 mg/day 2.
From the Research
Suitable Starting Dose of Megace for an 89-year-old Female
The suitable starting dose of Megace (megestrol acetate) for an 89-year-old female is not explicitly stated in the provided studies. However, the following information can be considered:
- A study published in 2005 3 found that megestrol acetate at doses of 400 mg and 800 mg increases prealbumin in recently hospitalized older persons, but cortisol suppression is common at higher doses and may be persistent.
- Another study published in 2013 4 reported that patients developed symptomatic adrenal insufficiency while receiving 160-320 mg MA daily, highlighting the need for clinicians to be aware of the endocrine complications secondary to MA treatment.
- The studies suggest that lower doses of megestrol acetate, such as 160-320 mg daily, may be associated with a lower risk of adrenal insufficiency, but the optimal starting dose for an 89-year-old female is not clearly established.
Key Considerations
- The risk of adrenal insufficiency associated with megestrol acetate use, particularly at higher doses 5, 6, 3, 4.
- The importance of monitoring patients for signs of adrenal insufficiency, such as hypotension and fatigue 5, 4.
- The need for clinicians to be aware of the endocrine complications secondary to MA treatment and to adjust the dose accordingly 4.