Home Drug Guide Medroxyprogesterone Acetate

Drug Guide

Generic Name

Medroxyprogesterone Acetate

Brand Names Provera, Depo-Provera, Depo-SubQ Provera 104, Cycrin, Amen, Curretab

Classification

Therapeutic: Hormonal contraception, Hormone replacement therapy, Menstrual disorders, Endometrial hyperplasia treatment

Pharmacological: Progestin

FDA Approved Indications

Contraception
Prevention of endometrial hyperplasia in estrogen-treated women
Treatment of abnormal uterine bleeding due to hormonal imbalance
Functional uterine bleeding
Amenorrhea associated with hormonal deficiency

Mechanism of Action

Medroxyprogesterone acetate acts by binding to progesterone receptors, thereby reducing estrogen-driven endometrial proliferation, thickening cervical mucus to inhibit sperm penetration, and suppressing the hypothalamic-pituitary-ovarian axis to prevent ovulation.

Dosage and Administration

Adult: Typically, 150 mg IM once every 3 months for contraception or as prescribed for other indications.

Pediatric: Use is not typical; dosing is based on clinical judgment.

Geriatric: Use with caution; adjust based on individual risk factors.

Renal Impairment: No specific adjustment; monitor closely.

Hepatic Impairment: Use with caution; metabolism may be affected, leading to increased plasma levels.

Pharmacokinetics

Absorption: Well absorbed IM and subcutaneous routes.

Distribution: Wide distribution, crosses the placenta and breast milk.

Metabolism: Primarily hepatic via hydroxylation and conjugation.

Excretion: Metabolites excreted in urine and feces.

Half Life: Approximately 50 days for depot formulations; shorter for oral.

Contraindications

History of thromboembolic disorders
Known or suspected breast cancer
Liver disease
Undiagnosed abnormal vaginal bleeding

Precautions

History of depression
Diabetes mellitus
Migraine headaches
Smoker over 35 years of age

Adverse Reactions - Common

Weight gain (Common)
Headache (Common)
Weight change (Common)
Breast tenderness (Common)

Adverse Reactions - Serious

Blood clots (deep vein thrombosis, pulmonary embolism) (Rare)
Stroke (Rare)
Bone mineral density loss with long-term use (Possible)

Drug-Drug Interactions

Anticoagulants (adjust INR)
Antidiabetic agents (may affect glucose levels)
Barbiturates and rifampin (may decrease effectiveness)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, weight, and signs of thromboembolism; assess menstrual history.

Diagnoses:

Risk for thromboembolic events
Altered menstrual pattern

Implementation: Administer via IM or subQ injection as scheduled; educate about contraception and side effects.

Evaluation: Assess effectiveness of contraception, monitor for adverse effects, and record patient responses.

Patient/Family Teaching

Use as directed and do not skip doses.
Report unusual symptoms such as blood clots, severe headaches, vision changes.
Avoid smoking, especially if over age 35.
Carry information about medication when traveling.

Special Considerations

Black Box Warnings:

Increased risk of cardiovascular events, especially in women over 35 who smoke.
Loss of bone mineral density with long-term use.
Potential for depression and mood changes.

Genetic Factors: Carrier status for thrombophilia may increase thromboembolic risk.

Lab Test Interference: May alter blood glucose levels and liver function tests.

Overdose Management

Signs/Symptoms: Unlikely to be life-threatening but may include nausea, vomiting, dizziness.

Treatment: Supportive care; symptomatic treatment. No specific antidote.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable until the expiration date on the package.