Formulary
Medroxyprogesterone acetate: Indications, Dosing, Side Effects and Interactions
Medroxyprogesterone acetate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Medroxyprogesterone acetate: Indications, Dosing, Side Effects and Interactions
Medroxyprogesterone acetate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Dysfunctional uterine bleeding**
- **Adult** (By Mouth): 2.5-10 mg daily for 5-10 days, repeated for 2 cycles, begin treatment on day 16-21 of cycle.
**Secondary amenorrhoea**
- **Adult** (By Mouth): 2.5-10 mg daily for 5-10 days, repeated for 3 cycles, begin treatment on day 16-21 of cycle.
**Mild to moderate endometriosis**
- **Adult** (By Mouth): 10 mg 3 times a day for 90 consecutive days, begin treatment on day 1 of cycle.
**Progestogenic opposition of oestrogen HRT**
- **Adult** (By Mouth): 10 mg daily for the last 14 days of each 28-day oestrogen HRT cycle.
**Endometrial cancer,Renal cell cancer**
- **Adult** (By Mouth): 200-600 mg daily.
**Breast cancer**
- **Adult** (By Mouth): 0.4-1.5 g daily.
**Hot flushes caused by long-term androgen suppression in men with prostate cancer**
- **Adult** (By Mouth): 20 mg once daily initially for 10 weeks, evaluate effect at the end of the treatment period.
**Contraception for medroxyprogesterone acetate**
- **Females of childbearing potential** (By deep intramuscular injection): 150 mg, to be administered within the first 5 days of cycle or within first 5 days after parturition (delay until 6 weeks after parturition if breast-feeding).
- **Females of childbearing potential** (By subcutaneous injection): 104 mg, to be administered within first 5 days of cycle or within 5 days postpartum (delay until 6 weeks postpartum if breast-feeding), injected into anterior thigh or abdomen, dose only suitable if no hormonal contraceptive use in previous month.
**Long-term contraception for medroxyprogesterone acetate**
- **Females of childbearing potential** (By deep intramuscular injection): 150 mg every 12 weeks, first dose to be administered within the first 5 days of cycle or within first 5 days after parturition (delay until 6 weeks after parturition if breast-feeding).
- **Females of childbearing potential** (By subcutaneous injection): 104 mg every 13 weeks, first dose to be administered within first 5 days of cycle or within 5 days postpartum (delay until 6 weeks postpartum if breast-feeding), injected into anterior thigh or abdomen, dose only suitable if no hormonal contraceptive use in previous month.
**Contraception (when patient changing from other hormonal contraceptive) for medroxyprogesterone acetate**
- **Females of childbearing potential** (By subcutaneous injection): (consult product literature).
Cautions
General cautions: Cardiac dysfunction; conditions that may worsen with fluid retention; diabetes (progestogens can decrease glucose tolerance-monitor patient closely); history of breast cancer-seek specialist advice before use; hypertension; liver tumours-seek specialist advice before use; migraine; positive antiphospholipid antibodies; rheumatoid arthritis; risk factors for thromboembolism; systemic lupus erythematosus Specific cautions: With intramuscular use Cervical cancer; history of stroke (including transient ischaemic attack)-seek specialist advice before use; history of venous thromboembolism; ischaemic heart disease-seek specialist advice before use; multiple risk factors for cardiovascular disease-seek specialist advice before use; undiagnosed vaginal bleeding-seek specialist advice before use With oral use History of depression With subcutaneous use Cervical cancer; history of stroke (including transient ischaemic attack)-seek specialist advice before use; history of venous thromboembolism; ischaemic heart disease-seek specialist advice before use; multiple risk factors for cardiovascular disease-seek specialist advice before use; undiagnosed vaginal bleeding-seek specialist advice before use
Contraindications
General contra-indications: Acute porphyrias ; current breast cancer (unless progestogens are being used in the management of this condition) Specific contra-indications: With oral use History of thromboembolism; undiagnosed vaginal bleeding When used for Contraception Current or history of meningioma
Side effects
General side-effects: Common or very common Alopecia; breast abnormalities; depression; dizziness; fluid retention; insomnia; menstrual cycle irregularities; nausea; sexual dysfunction; skin reactions; weight changes Uncommon Drowsiness; embolism and thrombosis; fever; galactorrhoea; hirsutism; muscle spasms; tachycardia Frequency not known Meningioma (with high doses, particularly in long term use) Specific side-effects: Common or very common With oral use Appetite increased; cervical abnormalities; constipation; fatigue; headache; hyperhidrosis; hypersensitivity; nervousness; oedema; tremor; vomiting With parenteral use Anxiety; asthenia; gastrointestinal discomfort; headaches; mood altered; pain; vulvovaginal infection Uncommon With oral use Congestive heart failure; corticoid-like effects; diabetes mellitus exacerbated; diarrhoea; dry mouth; euphoric mood; hypercalcaemia With parenteral use Appetite abnormal; arthralgia; hot flush; hypertension; ovarian cyst; painful sexual intercourse; uterine haemorrhage; varicose veins; vertigo; vulvovaginal disorders Rare or very rare With oral use Cerebral infarction; jaundice; malaise; myocardial infarction With parenteral use Breast cancer; lipodystrophy Frequency not known With oral use Adrenergic-like effects; cataract diabetic; concentration impaired; confusion; glycosuria; palpitations; visual impairment (discontinue if papilloedema or retinal vascular lesions) With parenteral use Hepatic disorders; osteoporosis; osteoporotic fractures; seizure Side-effects, further information With oral use In general, side effects may be more common with high doses such as those used in malignant disease. With parenteral use Reduction in bone mineral density is greater with increasing duration of use. The loss is mostly recovered on discontinuation. Breast cancer risk with contraceptive use The benefits of using progestogen-only contraceptives (POCs), such as medroxyprogesterone acetate, should be weighed against the possible risks for each individual woman. There is a possible small increase in the risk of breast cancer in women using, or who have recently used, progestogen-only contraception. Causal association is not clearly established, and absolute risk remains very small, and is like that of current or recent use of combined hormonal contraception. The most important risk factor for breast cancer appears to be the age the contraceptive is stopped rather than the duration of use; the risk gradually disappears during the 10 years after stopping.
Interactions
**Severe interactions:**
- Effect of HRT with oestrogens on other medicinal products Hormone contraceptives containing oestrogens have been shown to significantly decrease plasma concentrations of lamotrigine when...
**Other interactions (5):**
- The metabolism of oestrogens and progestogens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes, such as...
- Ritonavir and nelfinavir, although known as strong inhibitors, by contrast exhibit inducing properties when used concomitantly with steroid hormones.
- Herbal preparations containing St John's wort ( Hypericum perforatum ) may induce the metabolism of oestrogens and progestogens.
- The response to metyrapone may be reduced.
- Although the potential interaction between hormone replacement therapy and lamotrigine has not been studied, it is expected that a similar interaction exists, which may lead to a reduction in...
Pregnancy
With oral use: Avoid-genital malformations and cardiac defects reported. With intramuscular use or subcutaneous use: Not known to be harmful.
Breast feeding
Present in milk-no adverse effects reported. Progestogen-only contraceptives do not affect lactation. With intramuscular use or subcutaneous use: The manufacturers advise that in women who are breast-feeding, the first dose should be delayed until 6 weeks after birth; however, evidence suggests no harmful effect to infant if given earlier. The benefits of using medroxyprogesterone acetate in breast-feeding women outweigh any risks.
Hepatic impairment
With oral use: Manufacturer advises caution; avoid in acute or active disease. With intramuscular use or subcutaneous use: Manufacturer advises caution; avoid in severe or active disease.
Renal impairment
With oral use: Use with caution. M
Medicinal forms
Solution,Tablet,Injection
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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