Side Effects and Preferred Schedule of High Dose MPA

High-dose progestins are well tolerated (Table 1); very rarely, the treatment must be interrupted because of the appearance of severe side-effects. Thromboembolic phenomena have been observed employing the intramuscular route only. MPA

NITROGEN INTAKE URIN. NITROGEN BALANCE (=I-U)

PROTEIN INTAKE (g/day) ETAftêr ■ Before CALORIES INTAKE (Kcal/day) □ After □ Before

PROTEIN INTAKE (g/day) ETAftêr ■ Before CALORIES INTAKE (Kcal/day) □ After □ Before

Fig. 2. High-dose (> 500 mg/day) medroxyprogesterone acetate as an anabolic agent: nitrogen balance (fop), protein and caloric intake (boffom). (Modified from [5]). I - U, intake - urinary

Table 1. Side-effects of high-dose MPA (296 patients). (Modified from [3])

Side-effect

Percentage

Sweating

16%

Fine tremors

12.5%

Vaginal spotting

10%

Cushing face

8%

Cramps

7%

Gluteal abscess

7%a

Gastric intolerance

4%b

Insomnia

2%

Constipation

2%

Itching

1%

Thrombophlebitis

0.5%a

aBy IM route, bPO

aBy IM route, bPO

should generally be avoided only in cases of severe liver damage, previous ipercoagulability status or severe hypertension [3, 6]. One possible advantage of MPA over megestrol acetate (MA) is that it can be given in an intramuscular depot formulation in order to simplify the administration for non-compliant patients and to maintain good drug plasma levels [3]. Nevertheless, in patients with a life expectancy of at least 4 weeks, the dose level of 1000 mg daily orally should be considered a 'golden standard', considering that following oral administration MPA is rapidly, even if not completely, absorbed, depending on the particle size of the oral formulation, according to our experience [3].

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