medroxyprogesterone acetate

(me drox' ee proe jess' te rone)

Oral:
Alti-MPA (CAN), Amen, Curretab, Cycrin, Gen-Medroxy (CAN), Novo-
Medrone (CAN), Provera
Parenteral, antineoplastic:
Depo-Provera

Pregnancy Category X

Drug classes
Hormone
Progestin
Antineoplastic

Therapeutic actions
Progesterone derivative; endogenous progesterone transforms proliferative endometrium
into secretory endometrium; inhibits the secretion of pituitary gonadotropins, which
prevents follicular maturation and ovulation; inhibits spontaneous uterine contraction.

Indications
• Reduction of endometrial hyperplasia in postmenopausal women
• Oral: Treatment of secondary amenorrhea
• Oral: Abnormal uterine bleeding due to hormonal imbalance in the absence of
organic pathology
• Parenteral: Adjunctive therapy and palliation of inoperable, recurrent, and
metastatic endometrial carcinoma or renal carcinoma
• Unlabeled use for depot form: Long-acting contraceptive, treatment of breast
cancer

Contraindications and cautions

• Contraindicated with allergy to progestins; thrombophlebitis, thromboembolic
disorders, cerebral hemorrhage or history of these conditions; hepatic disease,
carcinoma of the breast, ovaries, or endometrium, undiagnosed vaginal bleeding,
missed abortion; pregnancy (fetal abnormalities, including masculinization of the
female fetus have been reported); lactation.
• Use cautiously with epilepsy, migraine, asthma, cardiac or renal dysfunction.

Available forms
Tablets—2.5, 5, 10 mg; with estradiol—25 mg medroxyprogesterone and 5 mg estradiol
cypionate per 0.5 mL; injection—150, 400 mg/mL

Dosages
ADULTS
• Contraception monotherapy: 150 mg IM q 3 mo.
 • Secondary amenorrhea: 5–10 mg/day PO for 5–10 days. A dose for inducing an
optimum secretory transformation of an endometrium that has been primed with
exogenous or endogenous estrogen is 10 mg/day for 10 days. Start therapy at any
time; withdrawal bleeding usually occurs 3–7 days after therapy ends.
• Abnormal uterine bleeding: 5–10 mg/day PO for 5–10 days, beginning on the
16th or 21st day of the menstrual cycle. To produce an optimum secretory
transformation of an endometrium that has been primed with estrogen, give 10
mg/day PO for 10 days, beginning on the 16th day of the cycle. Withdrawal
bleeding usually occurs 3–7 days after discontinuing therapy. If bleeding is
controlled, administer two subsequent cycles.
• Endometrial or renal carcinoma: 400–1,000 mg/wk IM. If improvement occurs
within a few weeks or months and the disease appears stabilized, it may be
possible to maintain improvement with as little as 400 mg/mo IM.
• Reduction of endometrial hyperplasia: 5–10 mg/day PO for 12–14 days/mo.

Pharmacokinetics
Route Onset Peak
Oral Slow Unknown
IM Weeks Months

Metabolism: Hepatic; T1/2: Unknown

Distribution: Crosses placenta; enters breast milk
Excretion: Unknown

Adverse effects
• CNS: Sudden, partial, or complete loss of vision; proptosis, diplopia, migraine,
precipitation of acute intermittent porphyria, mental depression, pyrexia,
insomnia, somnolence, nervousness, fatigue
• CV: Thrombophlebitis, cerebrovascular disorders, retinal thrombosis, pulmonary
embolism, thromboembolic and thrombotic disease, increased BP
• Dermatologic: Rash with or without pruritus, acne, melasma or chloasma,
alopecia, hirsutism, photosensitivity, pruritus, urticaria
• GI: Cholestatic jaundice, nausea
• GU: Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea,
changes in cervical erosion and cervical secretions, breast tenderness and
secretion
• Other: Fluid retention, edema, increase or decrease in weight, decreased glucose
tolerance

Interactions
Drug-lab test
• Inaccurate tests of hepatic and endocrine function

Nursing considerations
Assessment
 • History: Allergy to progestins; thrombophlebitis; thromboembolic disorders;
cerebral hemorrhage; hepatic disease; carcinoma of the breast, ovaries, or
endometrium; undiagnosed vaginal bleeding; missed abortion; epilepsy; migraine;
asthma; cardiac or renal dysfunction; pregnancy; lactation
• Physical: Skin color, lesions, turgor; hair; breasts; pelvic exam; orientation,
affect; ophthalmologic exam; P, auscultation, peripheral perfusion, edema; R,
adventitious sounds; liver evaluation; liver and renal function tests, glucose
tolerance, Pap smear

Interventions
• Arrange for pretreatment and periodic (at least annual) history and physical,
which should include BP, breasts, abdomen, pelvic organs, and a Pap smear.
• Before therapy begins, caution patient to prevent pregnancy and to have frequent
medical follow-up visits.
• Discontinue medication and consult physician if sudden, partial, or complete loss
of vision occurs; if papilledema or retinal vascular lesions are present, discontinue
drug.
• Discontinue medication and consult physician at the first sign of thromboembolic
disease (leg pain, swelling, peripheral perfusion changes, shortness of breath).

Teaching points
• If you are taking the oral form of this drug, mark days you should take the
medication on a calendar.
• This drug should not be taken during pregnancy due to risk of serious fetal
abnormalities; using barrier contraceptives is suggested.
• These side effects may occur: Sensitivity to light (avoid exposure to the sun; use
sunscreen and protective clothing); dizziness, sleeplessness, depression (use
caution driving or performing tasks that require alertness); skin rash, color
changes, loss of hair; fever; nausea.
• Report pain or swelling and warmth in the calves, acute chest pain or shortness of
breath, sudden severe headache or vomiting, dizziness or fainting, visual
disturbances, numbness or tingling in the arm or leg.

Adverse effects in Italic are most common; those in Bold are life-threatening.