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Medroxyprogesterone

  • Medical and Pharmacy Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Brand Name: DepoProvera, Depo-SubQ Provera 104, MPA, Provera

Generic Name: Medroxyprogesterone

Drug Class: Antineoplastics, Hormones; Progestins

What Is Medroxyprogesterone and How Does It Work?

Medroxyprogesterone is a prescription drug indicated for the treatment of secondary amenorrhea and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as fibroids or uterine cancer. Medroxyprogesterone is also indicated for use in the prevention of endometrial hyperplasia in nonhysterectomized postmenopausal women who are receiving daily oral conjugated estrogens 0.625 mg tablets.

Medroxyprogesterone is available under the following different brand names: DepoProvera, Depo-SubQ Provera 104, MPA, and Provera.

Dosages of Medroxyprogesterone:

Tablet

  • 2.5 mg
  • 5 mg
  • 10 mg

Injectable suspension

  • 150 mg/ml
  • 400 mg/ml

Prefilled syringe suspension

  • 104 mg/0.65 ml

Dosage Considerations – Should be Given as Follows:

Adult dosing only. Safety and efficacy not established for pediatric dosages.

Amenorrhea, Uterine Bleeding

  • Uterine bleeding: 5-10 mg/day orally for 5-10 days; beginning day 16 or 21 of the menstrual cycle; withdrawal bleeding may be expected within 3 to 7 days after discontinuing medroxyprogesterone
  • Amenorrhea, secondary: 5-10 mg/day orally for 5-10 days; may be started at any time; withdrawal bleeding may be expected within 3-7 days after discontinuing medroxyprogesterone

Contraception

Endometriosis

  • 150 mg deep intramuscular or 104 mg subcutaneously every 3 months
    • Dosing considerations
      • Give initial injection during first 5 days of menstrual cycle to avoid inadvertent administration to pregnant woman
      • If patient is nursing, give initial injection no earlier than 6 weeks post-partum

Paraphilla

  • 100-600 mg intramuscular weekly; alternatively, 100-500 mg orally daily; maintenance 100 mg intramuscularly every 1-4 weeks

SLIDESHOW

Choosing Your Birth Control Method See Slideshow

What Are Side Effects Associated with Using Medroxyprogesterone?

Common side effects of medroxyprogesterone include:

Postmarkeing reports of medroxyprogresterone:

  • Rash (allergic) with and without itching, change in weight (increase or decrease), fever, swelling/fluid retention, fatigue, decreased glucose tolerance
  • Increase or decrease in weight; reduced carbohydrate tolerance; aggravation of porphyria (abdominal pain, chest pain, vomiting, confusion, constipation, fever and seizures); swelling; joint pain; leg cramps; changes in sex drive (libido); hives, rapid swelling, acute allergic reaction (anaphylactoid/anaphylactic reactions); low blood calcium levels; exacerbation of asthma; increased triglycerides
  • Injection site reaction, injection site pain/tenderness, injection site persistent atrophy/indentation/dimpling, abnormal adipose tissue (lipodystrophy) acquired, injection site nodules/lumps

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Medroxyprogesterone?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Medroxyprogesterone has no known severe interactions with any other drugs.

Serious interactions of medroxyprogesterone include:

  • acitretin
  • brigatinib
  • darunavir
  • idelalisib
  • ivacaftor
  • lesinurad
  • nelfinavir
  • ritonavir
  • saquinavir
  • sugammadex sodium
  • telithromycin
  • voriconazole

Medroxyprogesterone has moderate interactions with at least 57 different drugs.

Mild interactions of medroxyprogesterone include:

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

QUESTION

Which of the following are methods for contraception? See Answer

What Are Warnings and Precautions for Medroxyprogesterone?

Warnings

Bone mineral density loss (injection)

  • Medroxyprogesterone contraceptive injection may cause significant loss of bone mineral density.
  • Bone loss is greater with increasing duration of use and may not be completely reversible.
  • Unknown whether use during critical period of bone accretion (adolescence or early adulthood) will reduce peak bone mass and increase osteoporotic fracture risk in later life.
  • Use for long-term (over 2 years) birth control only if other contraceptive methods are inadequate or poorly tolerated.

This medication contains medroxyprogesterone. Do not take DepoProvera, Depo-SubQ Provera 104, MPA, or Provera if you are allergic to medroxyprogesterone or any ingredients contained in this drug.

Cardiovascular risks (oral)

Dementia risks (oral)

  • Estrogens with progestins should not be used to prevent dementia.
  • Women's Health Initiative Memory Study (WHIMS), a substudy of WHI, reported increased risk of probable dementia in postmenopausal women aged 65 years or older undergoing 4 years of treatment with CE 0.625 mg/day plus MPA 2.5 mg/day versus placebo.
  • Unknown whether this finding applies to younger postmenopausal women.

Dose and duration (oral)

  • In the absence of comparable data, cardiovascular and dementia risks should be assumed to be similar for other doses of CE and MPA and for other combinations and dosage forms of estrogens and progestins
  • Accordingly, estrogens, with or without progestins, should be prescribed at lowest effective dosage and for shortest duration consistent with treatment goals and individual risks.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

  • Known or suspected pregnancy or as a diagnostic test for pregnancy
  • Active thrombophlebitis, or current or past history of thromboembolic disorders, or cerebral vascular disease
  • Known or suspected malignancy of breast
  • Malignancy of breast or genital organs
  • Missed abortion
  • Undiagnosed vaginal bleeding
  • Known or suspected estrogen-or progesterone-dependent neoplasia
  • Known anaphylactic reaction or rapid swelling
  • Known liver impairment or disease
  • Documented hypersensitivity

Effects of Drug Abuse

  • None

Short-Term Effects

  • See "What Are Side Effects Associated with Using Medroxyprogesterone?"

Long-Term Effects

  • See "What Are Side Effects Associated with Using Medroxyprogesterone?"

Cautions

  • Use caution in patients with asthma, diabetes mellitus, history of depression, epilepsy, migraine, porphyria, systemic lupus erythematosus, and hepatic hemangiomas.
  • Not recommended as primary therapy for renal or endometrial cancer.
  • If used with conjugated estrogens, may increase risk of heart attack (myocardial infarction), stroke, pulmonary emboli, deep vein thrombosis (DVT), breast cancer; discontinue therapy in patients who develop thrombosis.
  • Depo-Provera: Prolonged use may result in significant loss of bone density.
  • Monitor women with a strong family history of breast cancer.
  • Consider ectopic pregnancy if a woman receiving therapy becomes pregnant or complains of severe abdominal pain.
  • Provide emergency medical treatment if severe allergic reaction occurs.
  • Discontinue if yellowing eyes and skin (jaundice) or disturbances of liver function develop.
  • Use may mask onset of menopause in women treated for endometrial cancer.
  • Not for use in children prior to menarche.
  • Adding a progestin to estrogen therapy has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer.
  • In some epidemiologic studies, use of estrogen plus progestin and estrogen-only products, in particular for 5 or more years, has been associated with increased risk of ovarian cancer; however, duration of exposure associated with increased risk is not consistent across all epidemiologic studies and some report no association.
  • Discontinue if the following develop: hepatic impairment/cholestatic jaundice, visual problems, 4-6 week before major surgery, any symptoms of VTE, massive blood pressure increase, unusually severe migraines or first-time migraines, depression.
  • Studies of addition of progestin for 10 or more days of cycle of estrogen administration, or daily with estrogen in a continuous regimen, have reported lowered incidence of endometrial hyperplasia than would be induced by estrogen treatment alone; possible risks associated with the use of progestins with estrogens compared to estrogen-alone regimens include an increased risk of breast cancer.
  • In cases of unexpected abnormal vaginal bleeding, adequate diagnostic measures are indicated.
  • Blood pressure should be monitored at regular intervals with estrogen plus progestin therapy.
  • In women with preexisting hypertriglyceridemia, estrogen therapy may be associated with elevations of plasma triglycerides leading to pancreatitis; consider discontinuation of treatment if pancreatitis occurs.
  • Progestins may cause some degree of fluid retention; women with condition influenced by fluid retention including epilepsy, migraine, asthma, cardiac or kidney dysfunction, require careful observation.
  • Estrogen therapy should be used with caution in women with hypoparathyroidism as estrogen-induced hypocalcemia may occur.
  • Therapy should be discontinued pending examination if there is a sudden partial or complete loss of vision, or if there is a sudden onset of proptosis; double vision or migraine; if examination reveals papilledema or retinal vascular lesions, medication should be withdrawn.
  • Patients may exhibit suppressed adrenal function; medroxyprogesterone acetate may have cortisol-like glucocorticoid activity and provide negative feedback to hypothalamus or pituitary; this may result in decreased plasma cortisol levels, decreased cortisol secretion, and low plasma ACTH levels; use of sterile aqueous suspension may, due to its cortisol-like glucocorticoid activity, also produce Cushingoid symptoms such as weight gain, swelling, and facial swelling.
  • Medroxyprogesterone acetate reduces serum estrogen levels when given as 150 mg intramuscularly every 3 months and is associated with loss of bone mineral density (BMD); this loss of BMD is of particular concern during adolescence and early adulthood, a critical period of bone accretion; unknown if use by younger women will reduce peak bone mass and increase risk for osteoporotic fracture in later life; an evaluation of BMD may be appropriate in some patients who use higher doses of medroxyprogesterone acetate for long-term treatment of endometrial or renal carcinoma.
  • Monitor patients for hepatic dysfunction periodically and temporarily interrupt therapy if patient develops hepatic dysfunction; do not resume use until markers of liver function return to normal.
  • Any multi-dose use of vials may lead to contamination unless strict aseptic technique is observed.
  • Treatment with progestin may mask the onset of the climacteric.
  • Persistent injection site reactions may occur after administration due to inadvertent subcutaneous administration or release of drug into subcutaneous space while removing the needle.

Pregnancy and Lactation

  • There is no available information for use of medroxyprogresterone during pregnancy. Consult your physician.
  • Medroxyprogesterone is safe for use while breastfeeding
References
Medscape. Medroxyprogesterone.
https://reference.medscape.com/drug/depo-provera-depo-subq-provera-104-medroxyprogesterone-342782#0
RxList. Provera Side Effect Center.
https://www.rxlist.com/provera-drug/side-effects-interactions.htm
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