Megestrol

INTRODUCTION

Indications

Palliative treatment of endometrial and breast carcinoma, either alone or with surgery or radiation (tablets only). Treatment of anorexia, weight loss, and cachexia associated with AIDS (oral suspension only).

Action

Antineoplastic effect may result from inhibition of pituitary function. Therapeutic Effects: Regression of tumor. Increased appetite and weight gain in patients with AIDS.

Adverse Reactions/Side Effects

CV: THROMBOEMBOLISM, edema. GI: GI irritation. Derm: alopecia. Endo: asymptomatic adrenal suppression (chronic therapy). Hemat: thrombophlebitis. MS: carpal tunnel syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of thrombophlebitis (localized pain, swelling, warmth, erythema, tenderness) and pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess signs of carpal tunnel syndrome, and implement physical therapy interventions (physical agents, exercise, splinting, and so forth) to decrease symptoms. Periodically reevaluate condition with sensory and motor tests to help document treatment effects.

Interventions

• Because of the risk of thromboembolism, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• If treating weight loss and debilitation in people with AIDS, implement strengthening and conditioning exercises as tolerated.

Patient/Client-Related Instruction

• Caution patient and family/caregivers about risks of thromboembolism, and review warning signs of a pulmonary embolism (sudden shortness of breath, dyspnea, bloody sputum, cough).

• Caution patient that cigarette smoking may increase the risk of infarction and thromboembolic disease, especially for women older than 35.

• Instruct patient to report other troublesome side effects such as GI irritation or hair loss.

Pharmacokinetics

Absorption: Well absorbed from the GI tract.

Distribution: Unknown.

Protein Binding: ≥90%.

Metabolism and Excretion: Completely metabolized by the liver.

Half-life: 38 hr (range 13–104 hr).

Contraindications/Precautions

Contraindicated in: Hypersensitivity; OB: Pregnancy, missed abortion, or lactation; Undiagnosed vaginal bleeding; Severe liver disease; Suspension contains alcohol and should be avoided in patients with known intolerance.

Use Cautiously in: Diabetes; Mental ...