Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: medroxyprogesterone acetate
BRAND NAME: Provera, Depo-Provera, Depo-Sub Q Provera 104
DRUG CLASS AND MECHANISM: Progestins and estrogens are the two major
classes of female hormones. Medroxyprogesterone is a derivative of the naturally
occurring female progestin, progesterone. Progestins are responsible for changes
in the mucus and inner lining of the uterus (endometrium) during the second half
(secretory phase) of the
menstrual cycle. Progestins prepare the endometrium for
implantation of the embryo. Once an embryo implants in the endometrium, for
example,
pregnancy occurs, progestins help maintain the pregnancy. At high doses,
progestins can prevent ovulation (release of the egg from the ovary) and thereby
prevent pregnancy. Progestins were first isolated in 1933, and progesterone
itself was synthesized in the 1940s.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 2.5, 5, and 10 mg. Intramuscular injection:
150, 160, and 400 mg/ml.
STORAGE: Medroxyprogesterone should be stored at room temperature,
between 20-25 C (68-77 F).
PRESCRIBED FOR: Medroxyprogesterone tablets are used for treating
secondary amenorrhea (cessation of menstruation);
abnormal bleeding from the
uterus due to hormonal imbalance and not due to
fibroids, or
cancer; and to
prevent endometrial hyperplasia (overgrowth in the endometrial lining) in
postmenopausal women who have not undergone a hysterectomy and are receiving
conjugated estrogens. Medroxyprogesterone injection is used for contraception
and for treating endometrial or renal cancer.
DOSING: The usual dose of medroxyprogesterone tablets is 5 or 10 mg
daily. Secondary amenorrhea is treated for 5 to 10 days. Uterine bleeding is
treated for 5 to 10 days beginning on day 16 or 21 of the menstrual cycle.
Endometrial hyperplasia is treated for 12 to 14 consecutive days beginning on
day 1 or 16 of the menstrual cycle.
The dose for contraception is 150 mg every 3 months injected intramuscularly
or 104 mg injected subcutaneously every 3 months. The dose for endometrial or
renal cancer is 400-1000 mg weekly initially followed by monthly maintenance
doses.
DRUG INTERACTIONS: Aminoglutethimide
(Cytadren) may increase the elimination of
medroxyprogesterone by the liver leading to a decrease in the concentration of
medroxyprogesterone in blood and possibly a reduction in the effectiveness of
the medroxyprogesterone.
PREGNANCY: Medroxyprogesterone inhibits fertility at high doses. It
should not be given during pregnancy.
NURSING MOTHERS: Medroxyprogesterone is secreted in
breast milk. The
effect on the infant has not been determined.
SIDE EFFECTS: Breast tenderness and leakage of liquid from the nipple
occur rarely with medroxyprogesterone. Various skin reactions, including
hives,
acne, hair growth and hair loss, also have been reported occasionally.
Break-through bleeding (menstrual-like bleeding in the middle of the menstrual
cycle), vaginal spotting of blood, changes in menstrual flow, increased or
decreased weight, nausea, fever, insomnia, and jaundice have all been reported.
Blood clots are an occasional serious side effect of progestin therapy, and cigarette smokers are at a higher risk for clots. Therefore, patients requiring
progestin therapy are strongly encouraged to quit smoking.
Diabetic patients may experience difficulty controlling blood glucose when
taking medroxyprogesterone for unclear reasons. Therefore, increased monitoring
of blood sugar and adjustment of medications for diabetes is recommended.
The Women's Health Initiative (WHI) study found an increased risk of
heart
attacks, stroke, breast cancer, blood clots, and
pulmonary emboli (blood clots
that lodge in the lungs) in postmenopausal women (50-79 years old) who took
medroxyprogesterone in combination with estrogens for 5 years, as well as an
increased risk of dementia in the women over age 65. Therefore,
medroxyprogesterone should not be used for the prevention of heart disease or
dementia. Although medroxyprogesterone alone has not been demonstrated to
promote breast cancer, since breast cancer has progesterone receptors,
physicians usually avoid using progestins in women who have had breast cancer.
Last Editorial Review: 12/10/2008
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Hormonal Methods of Birth Control - Read about hormonal birth control methods, such as oral contraceptives, the patch, birth control injection, and vaginal ring. The hormones used in hormonal birth control are estrogen and/or progesterone.
- Endometriosis - Lern about endometriosis symptoms like pelvic pain, infertility, diarrhea, constipation, lower back pain, abdominal pain, irregular or heavy menstrual bleeding, and even blood in the urine.
- Uterine Cancer - Learn uterine cancer (cancer of the uterus, endometrial cancer) causes, diagnosis, symptoms, signs, stages, statistics and treatment: surgery, radiation, chemotherapy.
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