General

Pronunciation
me-JESS-trole

Trade Name(s)

• Megace

Pregnancy Category
Category D (tablets)
Category X (suspension)

Ther. class.
antineoplastics
hormones

Pharm. class.
progestins

Indications

• Palliative treatment of endometrial and breast carcinoma, either alone or with surgery or radiation (tablets only)

• Treatment of anorexia, weight loss, and cachexia associated with AIDS (oral suspension only)

Action

Antineoplastic effect may result from inhibition of pituitary function

Therapeutic Effect(s):

• Regression of tumor

• Increased appetite and weight gain in patients with AIDS

Pharmacokinetics

Absorption: Well absorbed from the GI tract

Distribution: Unknown

Protein Binding: >=90%

Metabolism and Excretion: Completely metabolized by the liver

Half-life: 38 hr (range 13–104 hr)

TIME/ACTION PROFILE (antineoplastic activity)

ROUTE	ONSET	PEAK	DURATION
PO	wk–mos	2 mo	unknown

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• OB: Pregnancy, missed abortion, or lactation

• Undiagnosed vaginal bleeding

• Severe liver disease

• Suspension contains alcohol and should be avoided in patients with known intolerance

Use Cautiously in:

• Diabetes

• Mental depression

• Renal disease

• History of thrombophlebitis

• Cardiovascular disease

• Seizure disorders

Adverse Reactions/Side Effects

CV: THROMBOEMBOLISM, edema.

GI: GI irritation.

Derm: alopecia.

Endo: asymptomatic adrenal suppression (chronic therapy).

Hemat: thrombophlebitis.

MS: carpal tunnel syndrome.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug
None significant

Route/Dosage

• PO (Adults):
Breast carcinoma—160 mg/day single dose or divided doses;
endometrial/ovarian carcinoma—40–320 mg/day in divided doses;
anorexia associated with AIDS—800 mg day; may decrease to 400 mg/day after 1 mo (range 400–800 mg/day).

Availability

• Tablets: 20 mg, 40 mg

» Cost:
Generic: 20 mg $37.99/100, 40 mg $52.99/100.

• Oral suspension (lemon-lime flavor): 40 mg/ml in 10–ml, 20–ml, 240–ml, and 480-ml bottles, 125 mg/ml in 150-ml bottles (Megace ES)

» Cost:
Generic: 40 mg/ml $131.33/240 ml
Megace ES: 125 mg/ml $526.89/150 ml.

Assessment

• Assess patient for swelling, pain, or tenderness in legs. Report these signs of deep vein thrombophlebitis

Anorexia

• Monitor weight, appetite, and nutritional intake in patients with AIDS

Potential Nursing Diagnoses

• Imbalanced nutrition: less than body requirements (Indications)

Implementation

• Because of high dose, suspension is most convenient form for patients with AIDS

» Do not confuse Megace 800 mg/20 mL with Megace ES 625 mg/5 mL

• PO: May be administered with meals if GI irritation becomes a problem

Patient/Family Teaching

• Instruct patient to take medication exactly as directed; do not skip or double up on missed doses. Missed doses may be taken as long as it is not right before next dose. Gradually decrease dose prior to discontinuation

• Advise patient to report to health care professional any unusual vaginal bleeding or signs of deep vein thrombophlebitis

• Advise patient that this medication may have teratogenic effects. Contraception should be used during therapy and for at least 4 months after therapy is completed

• Discuss with patient the possibility of hair loss. Explore methods of coping

Evaluation/Desired Outcomes

• Slowing or arresting the spread of endometrial or breast malignancy. Therapeutic effects usually occur within 2 months of initiating therapy

• Increased appetite and weight gain in patients with AIDS

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