Megestrol Acetate Abuse Potential
Megestrol acetate is not a drug of abuse and has no recognized potential for misuse, addiction, or recreational use. This medication is a synthetic progestational agent used exclusively for medical purposes in cancer-related anorexia/cachexia, with no psychoactive properties or euphoric effects that would make it attractive for non-medical use 1.
Why Megestrol Is Not Abusable
No psychoactive effects: Megestrol acetate works through downregulation of proinflammatory cytokines and influence on the hypothalamic appetite regulation center, with potential glucocorticoid-like effects at higher doses—none of these mechanisms produce euphoria, altered consciousness, or other effects sought by individuals misusing substances 2, 3.
Adverse effect profile discourages misuse: The drug carries significant risks including thromboembolic events (1 in 6 patients), increased mortality risk (relative risk 1.42), and edema—side effects that would actively deter any non-medical use 4, 2.
No evidence of overdose for intoxication: Studies involving doses as high as 1,600 mg/day and animal studies with 5 g/kg showed no toxic effects suggesting potential for abuse, and the medication has such low solubility that dialysis would be ineffective even in overdose scenarios 1.
Clinical Context
Megestrol acetate is prescribed specifically for patients with cancer-related anorexia/cachexia where increased appetite is an important quality of life goal, typically in doses of 400-800 mg/day 4.
The medication produces modest weight gain (primarily adipose tissue rather than muscle) in only 1 in 12 patients, with appetite improvement in 1 in 4 patients—outcomes that have no recreational or abuse value 4, 2.
Duration of therapy is intentionally limited due to cumulative risks of thromboembolic phenomena and mortality, with guidelines recommending short-term trials and regular reassessment rather than indefinite use 5, 4.
Monitoring Considerations
When prescribing megestrol acetate, the focus should be on monitoring for legitimate medical risks (thromboembolic events, adrenal suppression with long-term use, edema) rather than diversion or abuse 4, 3.
Adrenal function should be monitored in patients on long-term therapy, as the drug can cause suppression of the pituitary-adrenal axis due to glucocorticoid receptor affinity, potentially leading to adrenal insufficiency 4, 6.