From the Guidelines
Megace (megestrol acetate) is contraindicated in patients with a history of hypersensitivity to the medication, those with known or suspected pregnancy, and individuals with undiagnosed vaginal bleeding, as well as those with severe liver disease, active thrombophlebitis, or a history of thromboembolic disorders. The use of Megace should be approached with caution due to its potential to increase the risk of thromboembolic phenomena, with 1 in 6 patients developing such conditions 1. Additionally, the medication may worsen glycemic control in patients with diabetes mellitus, and its use in patients with adrenal insufficiency requires careful consideration and adequate replacement with corticosteroids.
Key Considerations
- History of hypersensitivity to Megace
- Known or suspected pregnancy
- Undiagnosed vaginal bleeding
- Severe liver disease
- Active thrombophlebitis
- History of thromboembolic disorders
- Diabetes mellitus
- Adrenal insufficiency
- Hormone-sensitive cancers It is essential to weigh the potential benefits of Megace, particularly its appetite-stimulating effects in conditions like cancer-related cachexia, against its risks, as highlighted in a recent systematic review and meta-analysis 1. The decision to use Megace should be made on a case-by-case basis, taking into account the individual patient's medical history, current health status, and potential for adverse effects.
From the FDA Drug Label
History of hypersensitivity to megestrol acetate or any component of the formulation. The contraindication to Megace (megestrol acetate) is a history of hypersensitivity to megestrol acetate or any component of the formulation 2.
From the Research
Contraindications to Megace (Megestrol Acetate)
There are no direct contraindications to Megace (megestrol acetate) mentioned in the provided studies. However, some studies suggest potential risks and complications associated with megestrol acetate therapy:
- Deep vein thrombosis (DVT) has been reported as a complication of megestrol acetate therapy, particularly among nursing home residents 3.
- The use of megestrol acetate may be limited in patients with a high risk of DVT, and its efficacy in nursing home residents with weight loss is unproven 3.
- Thromboembolic events have been reported in patients receiving megestrol acetate, including grade 4 events 4.
- Other potential toxicities associated with megestrol acetate include gastrointestinal, neurologic, and genitourinary events 4.
Potential Precautions
Some studies suggest that megestrol acetate may not be effective in certain patient populations, such as:
- Patients with ovarian cancer who have undergone previous treatment 5.
- Patients with advanced endometrial carcinoma who have received prior cytotoxic or hormonal treatment 4.
Key Points
- Megestrol acetate may increase the risk of DVT, particularly in nursing home residents 3.
- The use of megestrol acetate should be carefully considered in patients with a high risk of DVT 3.
- Patients receiving megestrol acetate should be monitored for potential toxicities, including thromboembolic events 4.