From the FDA Drug Label
The recommended adult initial dosage of megestrol acetate oral suspension, USP is 800 mg/day (20 mL/day). The suitable starting dose of Megace (megestrol acetate) for an elderly patient is 800 mg/day.
- This dose is based on the recommended adult initial dosage.
- No specific dose adjustment is mentioned in the label for elderly patients, so the standard adult dose is applied. 1
From the Research
The recommended starting dose of Megace (megestrol acetate) for an elderly patient is 200 mg daily, which can be titrated upward as needed and tolerated, due to the potential for adverse effects such as adrenal suppression, thromboembolic events, and hyperglycemia, as reported in studies such as 2. When initiating Megace in elderly patients, it's crucial to monitor for potential side effects, which may include fluid retention, hyperglycemia, adrenal suppression, and increased risk of thromboembolic events.
- Elderly patients often have altered pharmacokinetics and may be more sensitive to medications, so starting at a lower dose allows for assessment of tolerability.
- The medication should be taken consistently, preferably with food, and patients should be evaluated regularly for effectiveness and adverse effects.
- Megace works by stimulating appetite through multiple mechanisms, including antagonism of pro-inflammatory cytokines and direct effects on the hypothalamic feeding center, which explains its effectiveness in treating anorexia in the elderly population, as noted in studies like 2 and 3. Key considerations in the management of elderly patients on Megace include:
- Regular monitoring of blood glucose levels due to the risk of hyperglycemia, as indicated in 4.
- Assessment for signs of adrenal insufficiency, such as hypotension and fatigue, as reported in cases like those in 3 and 5.
- Evaluation for thromboembolic events, given the increased risk associated with Megace therapy, as highlighted in 6.