medroxyprogesterone acetate Nursing Considerations & Management

Drug Name

Generic Name : medroxyprogesterone acetate

Brand Name:

Classification: Hormone, Progestin, Antineoplastic, Contraceptive

Pregnancy Category X

Available forms : Tablets—2.5, 5, 10 mg; injection—150, 400 mg/mL; 104 mg/0.65 mL (Depo-subQ)

Contraception monotherapy: 150 mg IM q 3 mo. For Depo-subQ Provera: 104 mg subcutaneously into thigh or abdomen q 12 to 14 wk.
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. Start on 1st or 16th day of cycle.
Management of endometriosis-associated pain: 104 mg subcutaneously (Depo-subQ Provera) into anterior thigh or abdomen every 12–14 wk; do not use for longer than 2 yr.

Medroxyprogesterone is a synthetic progestogen which converts the proliferative phase of the endometrium into secretory phase. It has some androgenic and anabolic activities but no oestrogenic effects. Parenteral use leads to inhibition of pituitary gonadotropins, thus preventing follicular maturation and ovulation.

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
Subcutaneous depot: Long-acting contraceptive; management of endometriosis-associated pain
Unlabeled use for depot form: Treatment of breast cancer

Depression, fluid retention. Fatigue, insomnia, dizziness, headache, nausea; breast tenderness; wt gain/loss, anorexia; cholestatic jaundice; pain at Inj site.
Potentially Fatal: Thrombophlebitis and pulmonary embolism.

Thromboembolic disorders; cerebral apoplexy; severe hepatic dysfunction; undiagnosed vaginal bleeding, incomplete abortion, hormone-dependent carcinoma; pregnancy.

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 impairment; pregnancy; lactation
Physical: Skin color, lesions, turgor; hair; breasts; pelvic examination; orientation, affect; ophthalmologic examination; P, auscultation, peripheral perfusion, edema; R, adventitious sounds; liver evaluation; LFTs, renal function tests, glucose tolerance, Pap smear

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

If you are taking the oral form of this drug, mark days you should take the medication on a calendar.
If using the subcutaneous depot form of this drug, mark your calendar for days you should receive new injections.
This drug should not be taken during pregnancy due to risk of serious fetal abnormalities; using barrier contraceptives is suggested.
You may experience these side effects: 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.