What forms does Megestrol acetate (appetite stimulant) come in for a patient with difficulty swallowing?

Megestrol Acetate Formulations for Patients with Dysphagia

Megestrol acetate is available in both tablet and oral suspension formulations, with the liquid suspension being the preferred option for patients with swallowing difficulties. 1, 2, 3

Available Formulations

Oral Suspension (Preferred for Dysphagia)

• The liquid formulation is specifically advantageous for patients with advanced disease who have difficulty swallowing pills, as it eliminates the need to take multiple tablets and improves patient compliance 2

• Two oral suspension concentrations are available:

  • Standard suspension: 800 mg/20 mL (40 mg/mL) - requires a full dosage cup daily 3, 4
  • Concentrated suspension (Megace ES): 625 mg/5 mL (125 mg/mL) - requires only one teaspoon (5 mL) daily, representing a 75% volume reduction 3, 4

• The concentrated NanoCrystal Dispersion (NCD) formulation offers improved bioavailability, more rapid onset of action, and more convenient dosing compared to the standard suspension 3, 4

Tablet Formulations

• 20 mg tablets: white, round, scored, can be split 1
• 40 mg tablets: white, round, scored, can be split 1
• Tablets are supplied in bottles of 100-500 count 1

Dosing Considerations for Dysphagia Patients

Recommended Approach

• For appetite stimulation, the optimal dose range is 400-800 mg daily, which can be administered as a single daily dose of the oral suspension 5, 6
• The concentrated suspension (625 mg/5 mL) is particularly practical as it delivers a therapeutic dose in just one teaspoon, compared to 16-20 mL of the standard suspension 3, 4

Practical Administration

• The suspension formulation was specifically studied and found effective in patients with far advanced cancer suffering from anorexia, with doses of 480-840 mg daily showing appetite improvement in 95% of cases after 2 weeks 2
• The liquid form eliminates the burden of swallowing 10-20 tablets daily (at 40 mg per tablet for an 800 mg dose) 2

Important Safety Considerations

Monitoring Requirements

• 1 in 6 patients will develop thromboembolic events (deep vein thrombosis, pulmonary embolism) with a relative risk of 1.84 5, 6
• 1 in 23 patients are at risk of treatment-related mortality with a relative risk of 1.42 5, 6
• Regular assessment for signs of thromboembolism (leg swelling, chest pain, shortness of breath) is essential 5
• Adrenal suppression occurs commonly at doses ≥400 mg, with 70-78% of patients showing cortisol suppression at 400-800 mg doses 7

Storage

• Store at room temperature 15-30°C (59-86°F), protect from temperatures above 40°C 1

Clinical Context

• The liquid formulation is not only easier to swallow but also less expensive and more bioavailable than tablets, making it the clear first choice for patients with dysphagia 5
• The suspension was well tolerated in studies of patients with far advanced cancer, a population particularly likely to have swallowing difficulties 2