What is the recommended dose of Megace (megestrol) for treating hot flashes in men on Androgen Deprivation Therapy (ADT)?

Recommended Dosage of Megestrol for Hot Flashes in Men on ADT

The recommended dosage of megestrol acetate for treating hot flashes in men on androgen deprivation therapy (ADT) is 20 mg twice daily (40 mg/day total). 1

Pharmacological Management of Hot Flashes in Men on ADT

Megestrol Acetate

• Megestrol acetate at a dose of 20 mg twice daily has been shown to reduce hot flashes by up to 85% in men with prostate cancer on ADT 1
• This low-dose regimen is well-tolerated and substantially more effective than placebo for controlling vasomotor symptoms 1
• Long-term studies show that many patients continue to use megestrol acetate for up to 3 years or longer with continued control of hot flashes, with most using ≤20 mg daily 2
• While the FDA-approved dosing for other indications is higher (800 mg/day), the evidence specifically for hot flash management supports the lower dose of 40 mg/day 3, 1

Alternative Pharmacological Options

• Other hormonal options for treating hot flashes in men on ADT include estrogen and cyproterone acetate 4
• Non-hormonal pharmacological alternatives include:
  • SSRIs/SNRIs such as venlafaxine (37.5 mg/day) or paroxetine (10 mg/day) 4, 5
  • Gabapentin (300-900 mg/day), which has shown moderate efficacy in randomized controlled trials 4, 6

Clinical Considerations and Potential Side Effects

Monitoring for Side Effects of Megestrol

• Potential side effects of megestrol acetate include:
  • Appetite stimulation and weight gain 2, 7
  • Chills 2
  • Carpal tunnel syndrome symptoms 2
• Regular monitoring for these side effects is recommended, particularly when used long-term

Important Caveats

• Androgens (testosterone) are contraindicated in men with advanced prostate cancer on ADT 4
• The use of megestrol should be considered in the context of other potential ADT-related side effects that may require management, including gynecomastia, sexual dysfunction, and bone mineral density loss 7
• Vitamin E supplements should be used with caution as there are concerns they may increase prostate cancer risk 4

Non-Pharmacological Approaches

• Non-pharmacological treatments that can be tried concurrently include:
  • Acupuncture, which has shown effectiveness in small studies 4
  • Exercise/physical activity and yoga 4
  • Lifestyle modifications and weight loss if overweight 4
  • Cognitive behavioral therapy (CBT), which has been shown to reduce the perceived burden of hot flashes 4

For men experiencing significant hot flashes on ADT that impact quality of life, megestrol acetate at 20 mg twice daily represents an effective first-line pharmacological intervention with demonstrated efficacy and acceptable side effect profile for long-term use.