MEDROXYPROGESTERONE ACETATE (me-drox'ee-proe-jess'te-rone) Cycrin, Depo-Provera, Depo-subQ Provera 104, Provera Classifications: hormones and synthetic substitutes; progestin Prototype: Progesterone Pregnancy Category: X
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2.5 mg, 5 mg, 10 mg tablets; 104 mg/0.65 mL, 150 mg/mL, 400 mg/mL injection
Synthetic derivative of progesterone with prolonged, variable duration of action and androgenic and antiestrogenic activity.
No deleterious effects on lipid metabolism.
Induces and maintains endometrium, preventing uterine bleeding; inhibits production of pituitary gonadotropin, preventing
ovulation; and produces thick cervical mucus resistant to passage of sperm.
Dysfunctional uterine bleeding; secondary amenorrhea; parenteral form (Depo-Provera) used in adjunctive, palliative treatment
of inoperable, recurrent, and metastatic endometrial or renal carcinoma; contraception; endometriosis-associated pain.
Obstructive sleep apnea.
History of thromboembolic disorders; pregnancy (category X), lactation.
Asthma, seizure disorders, migraine, cardiac or kidney dysfunction, liver disease.
Secondary Amenorrhea Adult: PO 510 mg/d for 510 d beginning any time if endometrium is adequately estrogen primed (withdrawal bleeding occurs
in 37 d after discontinuing therapy)
Abnormal Bleeding due to Hormonal Imbalance Adult: PO 510 mg/d for 510 d beginning on the assumed or calculated 16th or 21st day of menstrual cycle; if bleeding is
controlled, administer 2 subsequent cycles
Carcinoma Adult: IM 4001000 mg/wk; continue at 400 mg/mo if improvement occurs and disease stabilizes
Contraceptive Adult: IM 100 mg q3mo
Sleep Apnea Adult: PO 20 mg t.i.d.
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Oral
- Oral drug may be given with food to minimize GI distress.
Intramuscular
- Administer IM deep into a large muscle.
- Store both formulations at 15°30° C (59°86° F); protect from freezing.
CNS:
Cerebral thrombosis or hemorrhage, depression. CV: Hypertension, pulmonary embolism, edema. GI: Vomiting, nausea, cholestatic jaundice, abdominal cramps. Urogenital:
Breakthrough bleeding, changes in menstrual flow, dysmenorrhea, vaginal candidiasis. Skin: Angioneurotic edema. Body as a Whole: Weight changes; breast tenderness, enlargement or secretion. Musculoskeletal: Loss of bone mineral density.
Drug:
Aminoglutethimide decreases serum concentrations of medroxyprogesterone; barbiturates, carbamazepine,
oxcarbazepine,
phenytoin,
primidone,
rifampin,
modafinil,
rifabutin,
topiramate can increase metabolism and decrease serum levels of medroxyprogesterone. Herbal: intermenstrual bleeding and loss of contraceptive efficacy may occur with St. John's wort.
Peak: 24 h PO, 3 wk IM. Distribution: >90% protein bound. Metabolism: Metabolized in liver. Elimination: Excreted primarily in feces. Half-Life: 30 d PO, 50 d IM.
Assessment & Drug Effects
- See progesterone for numerous additional nursing implications.
- Be aware that IM injection may be painful. Monitor sites for evidence of sterile abscess. A residual lump and discoloration
of tissue may develop.
- Monitor for S&S of thrombophlebitis (see Appendix F).
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Note: Planned menstrual cycling with medroxyprogesterone may benefit the patient with a history of recurrent episodes of abnormal
uterine bleeding.
Patient & Family Education
- Be aware that after repeated IM injections, infertility and amenorrhea may persist as long as 18 mo.
- Learn breast self-examination.
- Review package insert to ensure complete understanding of progestin therapy.
- Do not breast feed while using this drug.