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Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
MPA is well absorbed orally, with blood levels peaking after 2–4 hours and a half-life of 12–17 hours. It can also be administered in a depot form (i.e., Depo-ProveraTM) by deep intramuscular injection (normally into the gluteal muscle) which provides a half-life of 40–50 days. As with most progestogens, side effects include GI disturbances (e.g., nausea), cardiovascular abnormalities (e.g., hypertension, palpitation, congestive heart failure), depression, fluid retention, breast and menstrual cycle irregularities in women, alopecia, sexual dysfunction, skin reactions, and weight changes. In addition to these general adverse effects, the glucocorticoid effects associated with MPA can lead to Cushingoid syndrome at higher doses. Also, rarely, vision disorders such as retinal thrombosis can occur, in which case treatment should be immediately discontinued. Medroxyprogesterone acetate should be avoided during conception or pregnancy, as genital malformations in the fetus may occur.
Novel treatment modalities
Published in Seema Chopra, Endometriosis, 2020
Subcutaneous implants are commonly marketed as Implanon and Nexplanon and are inserted intradermally. The therapeutic efficacy of depot medroxyprogesterone acetate and incidence of pain relief was compared with the implant by Walch et al. [66], and it was found that both groups had similar side effect profiles and degrees of satisfaction with either modality. Commonly reported side effects include irregular menstrual bleeding, weight gain, nausea, headache, breast tenderness, and acne and are similar to depot medroxyprogesterone acetate. In carefully selected women who do not desire fertility, an etonogestrel implant could be another option for treatment of endometriosis.
Clinical Pharmacodynamics of Anticancer Drugs
Published in Hartmut Derendorf, Günther Hochhaus, Handbook of Pharmacokinetic/Pharmacodynamic Correlation, 2019
Howard L. McLeod, William E. Evans
Medroxyprogesterone acetate is commonly used for second-line endocrine therapy in advanced breast cancer. Evaluation of medroxyprogesterone acetate pharmacokinetics in 129 patients with advanced breast cancer demonstrated wide interpatient variability in minimum Css.100 Medroxyprogesterone acetate concentrations were higher in the 45 patients who developed medroxyprogesterone acetate-related side effects (median toxic 81 ng/ml vs. nontoxic 32 ng/ml). Objective response was assessable in 55 patients treated with medroxyprogesterone acetate monotherapy. Plasma medroxyprogesterone acetate concentrations were significantly lower in the patients with progressive disease than those with complete response, partial response, or stable disease (median 46 ng/ml and 65 ng/ml, respectively). Medroxyprogesterone acetate dosage was not significantly related to toxicity or response in this study.
Analysis of prescribing error and pharmacist’s intervention on obstetrics and gynaecology outpatient prescriptions in a Malaysian tertiary hospital
Published in Journal of Obstetrics and Gynaecology, 2022
Jeevanandan Narayanan, Shamala Balan, Ong Li Ling, Nurhamizah Kasim, Prcella Johny
Of the 3883 prescriptions screened, prescribing error was identified in 359 prescriptions (9.2%) (Table 1). The number of prescriptions with error of commission was found to be more prevalent (n = 188, 52.4%), which were mostly due to wrong or inappropriate duration and dose (n = 47, 11.8%, respectively). Thirteen prescriptions were intervened for wrong or inappropriate duration prescribed for tablet medroxyprogesterone, 5 mg. Another 14 interventions were recorded in the same category where the duration of prophylactic anticoagulant therapy prescribed to postnatal patients were either inadequate or more than required. Besides this, the study also showed that 6.1% of the prescriptions contained non-formulary drugs, of which 45.8% were for obstetric supplements; i.e.vitamin D 800 IU and Obimin®.
Bleeding profile of women with cardiovascular risk factors using a drospirenone only pill with 4 mg over nine cycles compared to desogestrel 0.075 mg
Published in Gynecological Endocrinology, 2022
Pedro-Antonio Regidor, Santiago Palacios, Enrico Colli
Combined estrogen-progestin hormonal contraceptives include the pill, vaginal ring, and patch formulations. Available progestin-only methods include medroxyprogesterone injections, etonogestrel implants, progesterone-only pills, and levonorgestrel-releasing intrauterine devices [20]. Hormonal contraceptives are generally considered safe and effective for preventing pregnancy, with y few contraindications. However, women with specific risk factors for venous thromboembolism, acute myocardial infarction, or both (e.g. smokers aged 35 years or older, history of venous thromboembolism or pulmonary embolism, or hereditary thrombophilia) should be strongly advised to consider non-hormonal or progestin-only contraceptives. The risks of using hormonal contraceptives should be constantly balanced against the potential risks of unintended pregnancy [20,21].
Progestin or anti-estrogen treatment for endometrial cancer: choosing the best option for selected patients
Published in Gynecological Endocrinology, 2021
Marta Caretto, Tommaso Simoncini
Fertility-sparing treatments should be restricted to women with atypical hyperplasia/endometrioid intra-epithelial neoplasia (AH/EIN) or grade 1 endometrioid carcinoma without myometrial invasion. Hysteroscopic resection followed by the progestin therapy achieve the highest complete remission rate according to recent literature. The progestin therapy includes oral progestin as well as intrauterine progestin application. Medroxyprogesterone acetate (400–600 mg/day) or megestrol acetate (160–320 mg/day) are the recommended oral treatments [3]. Only patients undergoing oral treatment should be informed of major risks or the presentation of systemic adverse effects. Instead, in case of the intrauterine progestin therapy such as levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone receptor agonist or progestin a satisfactory pregnancy rate and a low recurrence rate have been reported. The combination of levonorgestrel intrauterine device with oral progestins with or without gonadotropin-releasing hormone analogs can also be considered. There is a lack of evidence for anti-estrogenic treatment in women who wish to preserve fertility [4].