From the FDA Drug Label
Known liver impairment or disease. Hepatic Impairment and/or past history of cholestatic jaundice Estrogens plus progestins may be poorly metabolized in women with impaired liver function.
Provera (medroxyprogesterone) is contraindicated in patients with known liver impairment or disease. Additionally, caution should be exercised when using estrogens plus progestins, such as Provera, in women with a history of cholestatic jaundice associated with past estrogen use or with pregnancy 1 1. Medication should be discontinued if liver impairment or disease occurs.
From the Research
Medroxyprogesterone (Provera) should be used with caution in patients with liver impairment, and is generally contraindicated in severe liver disease. For patients with mild to moderate liver impairment, dose adjustments may be necessary, though specific dosing guidelines are not well established 2. Close monitoring of liver function tests is recommended before and during treatment. Medroxyprogesterone is primarily metabolized in the liver, and impaired hepatic function can lead to decreased drug clearance and potential drug accumulation, increasing the risk of adverse effects. Some key points to consider when using Provera in patients with liver impairment include:
- Patients with a history of or active liver disease, including viral hepatitis, cirrhosis, or hepatic tumors, are at higher risk for complications.
- Common adverse effects that should be monitored include jaundice, dark urine, right upper quadrant pain, unexplained nausea, and fatigue.
- Alternative contraceptive or hormone therapy options should be considered for patients with significant liver disease.
- The medication can also cause fluid retention, which may exacerbate ascites in patients with decompensated liver disease.
- Regular liver function monitoring is essential throughout treatment to detect any worsening of hepatic function 3. It's also important to note that the management of liver failure is demanding and often involves the combined efforts of many specialists 4, and that liver diseases are a significant global cause of morbidity and mortality 3. In terms of specific considerations for liver impairment, the extent of hepatic extraction of the drug is an important factor in determining the need for dose adjustment 2. However, the most recent and highest quality study 3 suggests that prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. Therefore, close monitoring and careful consideration of the potential risks and benefits are necessary when using Provera in patients with liver impairment.