From the Guidelines
Megace (megestrol acetate) is contraindicated in patients with a history of thromboembolism, known hypersensitivity to megestrol acetate, pregnancy, and severe liver disease, due to its association with increased clotting risk, potential for fetal harm, and risk of drug accumulation. When considering its use as an appetite stimulant, caution is also warranted in patients with diabetes, adrenal insufficiency, heart failure, hypertension, and prostate cancer, as it may worsen glycemic control, suppress adrenal function, and increase the risk of fluid retention, hypertension, and hyperglycemia 1. The medication's risks, including thromboembolic phenomena, oedema, and deaths, as highlighted in a Cochrane review analyzing 35 trials comprising 3963 patients, further emphasize the need for careful patient selection and monitoring 1. Key considerations for the use of Megace include:
- History of thromboembolism, including deep vein thrombosis or pulmonary embolism
- Known hypersensitivity to megestrol acetate or any components of the formulation
- Pregnancy, due to potential fetal harm
- Severe liver disease, due to potential drug accumulation
- Diabetes, as it can worsen glycemic control
- Adrenal insufficiency, as it may suppress adrenal function
- Heart failure, hypertension, or prostate cancer, requiring careful monitoring due to the risks of fluid retention, hypertension, and hyperglycemia.
From the FDA Drug Label
History of hypersensitivity to megestrol acetate or any component of the formulation. The contraindication for megace appetite stimulation is a history of hypersensitivity to megestrol acetate or any component of the formulation 2.
From the Research
Contraindications for Megace Appetite Stimulation
- The use of megestrol acetate (Megace) for appetite stimulation may be contraindicated in certain patients due to the risk of thrombosis 3, 4, 5.
- Studies have shown that megestrol acetate can increase the risk of deep vein thrombosis (DVT) in patients, particularly in those with advanced cancer or those who are nursing home residents 3, 4, 5.
- The risk of DVT may be higher in patients who are ambulatory and have no other known risk factors for thrombosis 4.
- The use of megestrol acetate in geriatric patients, especially those with impaired mobility, should be done with caution due to the risk of thromboembolic events 5.
- Pancreatic cancer may also be a risk factor for thrombosis, rather than the use of megestrol acetate itself 3.
- There is no evidence to suggest that megestrol acetate is contraindicated in patients with early endometrial adenocarcinoma, and it may be used as a treatment option for these patients 6.