Megestrol acetate (MEGACE) and medroxyprogesterone (MPA) as appetite stimulants

Megestrol acetate (MEGACE) and medroxyprogesterone (MPA) are synthetic, orally active derivatives of the naturally occurring hormone, progesterone.

• MEGACE was developed as an oral contraceptive
  • agent was first tested in the treatment of breast cancer and, was later tested for the treatment of endometrial cancer
    
    
  • currently used to improve appetite and to increase weight in cancer-associated anorexia - the mechanism for increasing appetite is largely unknown
    
    
    • from September 1993, MEGACE was approved by the Food and Drug Administration in the United States for the treatment of anorexia, cachexia or unexplained weight loss in patients with AIDS
    • been found to improve appetite, caloric intake and nutritional status in several clinical trials
    • a systematic review of 35 trials, comprising 3963 patients, for the effectiveness of MEGACE was conducted (1)
    • review shows that MEGACE improves appetite and is associated with slight weight gain in cancer, AIDS and in patients with other underlying pathology. Higher doses were more related to weight improvement than lower doses. Quality of life improvement in patients was seen only when comparing MEGACE vs placebo
      • despite the fact that these patients are receiving palliative care they should be informed of the risks involved in taking MEGACE
        • oedema, thromboembolic phenomena and deaths were more frequent in the patients treated with MEGACE
          
          
• MPA has similarly been shown to increase appetite and food intake with a stabilization of body weight (2)

Reference:

• Garcia Ruiz V et al. Megestrol acetate for treatment of anorexia-cachexia syndrome.Cochrane Database Syst Rev. 2013 Mar 28;3:CD004310. doi: 10.1002/14651858
• Mantovani G, Macciò A, Massa E, Madeddu C. Managing cancer-related anorexia/cachexia. Drugs. 2001;61:499-514