What is the recommended dose of Megace (megestrol acetate) for appetite stimulation?

Megestrol Acetate Dosing for Appetite Stimulation

The recommended dose of megestrol acetate for appetite stimulation is 800 mg/day (20 mL/day) of the oral suspension. 1

Dosing Guidelines

• Standard dosing: 800 mg/day (20 mL/day) of oral suspension
• Alternative effective dose: 400 mg/day has also shown clinical efficacy 1
• Administration: Shake container well before using
• Concentrated formulation: A newer nanocrystal dispersion (NCD) formulation (Megace ES) allows for once-daily 5 mL dosing (625 mg/5 mL) with improved bioavailability 2

Evidence Supporting Dosing

Clinical trials have demonstrated that:

• Both 400 mg/day and 800 mg/day doses are clinically effective for appetite stimulation 1
• The 800 mg/day dose showed the highest efficacy with:
  • 64% of patients gaining ≥5 pounds (vs. 57% at 400 mg/day and 24% with placebo) 1
  • Mean weight increase of 7.8 pounds over 12 weeks (vs. 4.2 pounds at 400 mg/day) 1
  • Statistically significant improvements in appetite, caloric intake, and overall well-being 1

Lower Dose Considerations

For certain patient populations, lower doses may be considered:

• For maintenance dialysis patients, 400 mg/day has shown efficacy in improving nutritional status and reducing inflammation without major side effects 3
• For non-hormonally dependent cancer patients, 80 mg twice daily (160 mg/day) has been reported as an appropriate starting dose, with the option to escalate if needed 4

Clinical Monitoring

When initiating megestrol acetate therapy:

• Monitor weight changes regularly
• Assess appetite improvement at follow-up visits
• Watch for potential side effects including:
  • Edema (reported in clinical trials) 1
  • Thromboembolic events (relative risk 1.84) 5
  • Increased mortality risk (relative risk 1.42) 5

Special Considerations

• The medication primarily increases body fat rather than lean body mass 6
• For optimal results in patients with significant weight loss, consider combining with:
  • Exercise program (where appropriate)
  • Nutritional counseling
  • High-calorie, nutrient-dense foods 5

Practical Approach

1. Start with standard dose of 800 mg/day (20 mL/day)
2. If not tolerated, consider reducing to 400 mg/day
3. Assess response after 4 weeks
4. Continue effective dose for maintenance therapy as needed
5. For patients who prefer less volume, consider the concentrated NCD formulation