Depo-Provera( medroxyprogesterone)

  • Jun 30, 2018

Depo-Provera( medroxyprogesterone) Instruction:

Manufacturer:

Active substance Depo-Provera

Depo-Provera release forms

Suspension for injection, 150 mg / ml 3.3 ml( 500 mg);To 6.7 ml( 1000 mg) in bottles No. 1

To whom Depo-Provera

is indicated Depo-Provera drug is assigned:

In oncology:

  • with recurrences and / or metastases of breast cancer;
  • for recurrences and / or metastases of endometrial cancer;
  • for recurrences and / or kidney cancer;
  • in metastases of prostate cancer;
  • for anorexia and cachexia.

In gynecology:

  • for the treatment of endometriosis;
  • for the treatment of vasomotor manifestations in menopause;
  • For the purpose of contraception.

How to use Depo-Provera

Method of administration and dose.

Oncology.

Breast cancer

It is recommended such a regimen for the Depo-Provera drug: 500-1000 mg per day intramuscularly for 28 days. Then go to the maintenance dose: 500 mg twice a week until the treatment is effective.

Endometrial cancer and kidney cancer

The recommended initial dose of Depo-Provera is 400 -1000 mg once a week intramuscularly. If within a few weeks or months there is an improvement and stabilization of the process has been achieved, then it is possible to switch to maintenance therapy with the introduction of a small dose of 400 mg once a month.

Metastatic prostate cancer

Introduction of an initial dose of Depo-Provera suspension 500 mg twice a week for 3 months, maintenance therapy - 500 mg once a week.

Gynecology.

The use of combined estrogen / progestin therapy in the treatment of postmenopausal women should be limited to a short period of use, taking into account the indications and risks in each specific case and should be periodically monitored.

Endometriosis. Depo-Provera injections intramuscularly 50 mg once a week or 100 mg once every two weeks for 6 months.

Vasomotor manifestations in menopause. Intramuscularly 150 mg once every 12 weeks.

Contraception. Before the prescribed dose, the vial should be shaken vigorously until a homogeneous suspension is obtained. The recommended dose is 150 mg of Depo-Provera Suspension Suspension every three months with intramuscular injection into the gluteal or deltoid muscle. The first injection is applied during the first 5 days of the normal menstrual cycle;5 days after birth, if the woman does not breast-feed, or after stopping breastfeeding, or 6 weeks after the birth in the event that it is impossible to refuse breastfeeding.

Application features.

If in the course of treatment the patient has any signs and / or symptoms that indicate thrombosis or thromboembolism, the indication for the subsequent prescription of Depo-Provera should be reviewed. Using very high doses of the drug( 500 mg per day or more), which are used to treat certain forms of malignant tumors, there is a corticoid-like activity.

With the use of progestogens, some fluid retention in the body can be observed, so patients with diseases such as epilepsy, migraine, asthma, impaired cardiac or renal function need special attention.

When appointing the drug to patients who have already experienced depressive conditions, you need to closely monitor their mental state, and in case of severe depression, treatment should be canceled.

Treatment with progestogens in some patients is accompanied by a decrease in glucose tolerance. The mechanism of this action is still unclear, therefore close monitoring of diabetic patients is necessary when they receive progestogen therapy.

Treatment with Depo-Provera can be accompanied by an increase in body weight.

When carrying out a pathohistological study, it is necessary to warn the pathologist about the fact that the patient was treated with progestogens.

In case of sudden occurrence of bleeding from the vagina, a diagnosis should be made of the cause of the bleeding.

Doctors and laboratory technicians should take into account that during the use of the Depo-Provera drug, the level of concentration of such endocrinological markers can be reduced:

  • of steroids in plasma and urine( eg, cortisol, estrogen, pregnanediol, progesterone, testosterone);
  • gonadotropins in plasma and urine;
  • globulins, which bind sex hormones.

In case of sudden partial or complete loss of vision or sudden manifestation of protoptosis, diplopia or migraine, as well as when discoloration of the optic nerve disk or retinal vascular lesions is detected, drug treatment should be discontinued.

Features of use in contraception.

Most women who received a suspension for injection, noted a violation of the cycle of menstruation( irregular monthly, rarely - long monthly).If such patients continued to receive a suspension for injection, there was an increase in the irregularity of menstrual, and even manifestations of amenorrhea.

The purpose of Depo-Provera as a suspension for injection can be considered in the presence of risk factors for the loss of bone mineral tissue.

Long-term follow-up of individuals who used the Depo-Provera suspension showed little or no risk of developing breast cancer, no risk of ovarian, liver or cervical cancer, and a prolonged protective effect of reducing the risk of endometrial cancer.

Depo-Provera suspension( 150 mg intramuscularly) has a long contraceptive effect. The average time of onset of conception after the last injection of the drug was 10 months( range from 4 to 31 months), without dependence on the duration of the drug.

There is a tendency to increase the body weight in women who use Depo-Provera. Patients should be warned that injections of the drug do not protect against HIV infection and other diseases that are sexually transmitted.

Features of application in oncology.

Depo-Provera can cause a cushingoid syndrome.

Some patients may experience suppression of adrenal function and a decrease in the level of ACTH and hydrocortisone in the blood.

Pregnancy.

The appointment of Depo-Provera is contraindicated for pregnant women.

Children whose mothers received the drug in the first two months of unexpected pregnancy have a high risk of having a low birth weight and neonatal pathologies. In cases of continued use of the drug during pregnancy or the desire of the patient to become pregnant, it should be warned about the potential risk to the fetus.

Lactation.

Depo-Proverata its metabolites stand out with milk, which is a risk for children who get breast milk.

Side effects of Depo-Provera

When used in oncology, the following side effects are possible:

  • genitourinary organs: violation of the monthly( irregularity, increase, decrease), amenorrhea, violation of cervical secretion, prolonged anovulation;
  • mammary gland: galactorrhea, mastodynia, hypersensitivity;
  • central nervous system: convulsions, depression, dizziness, euphoria, fatigue, headache, decreased concentration, insomnia, nervousness, drowsiness, impaired vision;
  • organs of the gastrointestinal tract and liver: constipation, diarrhea, impaired liver function, cholestatic jaundice, nausea, vomiting, dry mouth;
  • cardiovascular system: cerebral and myocardial infarction, heart failure, increased blood pressure, palpitations, pulmonary embolism, retinal thrombosis, tachycardia, thromboembolism, and thrombophlebitis;
  • hematopoietic system: an increase in the number of leukocytes and platelets;
  • skin and mucous membranes: acne, alopecia, hirsutism, itching, rash, urticaria;
  • allergic manifestations: hypersensitivity reactions( eg, anaphylaxis and anaphylactic reactions, angioedema);
  • other manifestations: pain at the injection site, edema / fluid retention, pyrexia, weight change.

When used in gynecology, there are possible side effects:

  • genitourinary organs: a violation of the monthly( irregular, increased, decreased), amenorrhea, violation of cervical secretion, prolonged anovulation;
  • mammary gland: galactorrhea, mastodynia, hypersensitivity;
  • central nervous system: convulsions, depression, dizziness, fatigue, headache, insomnia, nervousness, drowsiness;
  • organs of the gastrointestinal tract and liver: cholestatic jaundice, nausea;
  • metabolism: a decrease in glucose tolerance;
  • cardiovascular system: thromboembolic manifestations;
  • skin and mucous membranes: acne, alopecia, hirsutism, itching, rash, urticaria;
  • allergic manifestations: hypersensitivity reactions( eg, anaphylaxis and anaphylactic reactions, angioedema);
  • other manifestations: pain at the injection site, swelling / fluid retention, pyrexia, weight change.

In case of contraception, the following side effects are possible:

  • genitourinary organs: violation of the monthly( irregular, increased, decreased), amenorrhea, leukorrhea, pelvic pain, prolonged anovulation, masinitis;
  • mammary gland: galactorrhea, mastodynia, hypersensitivity;
  • central nervous system: convulsions, depression, dizziness, fatigue, headache, insomnia, nervousness, drowsiness;
  • organs of the gastrointestinal tract and liver: pain or discomfort in the abdomen, flatulence, impaired liver function, jaundice, nausea;
  • cardiovascular: thromboembolic disorders;
  • skin and mucous membranes: acne, alopecia, hirsutism, itching, rash, urticaria;
  • allergic manifestations: hypersensitivity reactions( eg, anaphylaxis and anaphylactic reactions, angioedema);
  • other manifestations: decreased libido or anorgasmia, fluid retention, hot flashes, pyrexia, weight change.

Who is contraindicated to Depo-Provera

Depo-Provera drug is contraindicated for prescribing to patients:

  • with a true or probable pregnancy;
  • with bleeding from the vagina of an unclear etiology;
  • for severe hepatic impairment;
  • in the presence of hypersensitivity to medroxyprogesterone acetate or other components of the drug.

The purpose of Depo-Provera as a contraceptive is contraindicated in cases of diagnosed or suspected malignant diseases of the breast.

Interaction of Depo-Provera

Simultaneous application of high doses of Depo-Prover with aminoglutethimide can reduce the concentration of medroxyprogesterone acetate in the blood serum and decrease the effectiveness of aminoglutethimide.

The use of Depo-Provera can affect the results of such studies:

  • determination of gonadotropin levels;
  • determination of the level of progesterone in the blood plasma;
  • determination of the level of pregnaniol in the urine;
  • determination of testosterone levels in blood plasma( in men);
  • Estimation of the level of estrogens in blood plasma( in women);
  • determination of the level of cortisol in the blood plasma;
  • sample with sugar loading;
  • test with metirapone.

Overdose Depo-Provera

Patients who receive pharmacological doses of medroxyprogesterone acetate for the treatment of malignant neoplasms( 400 mg per day or more) may sometimes experience phenomena that resemble symptoms of a glucocorticoid overdose. In such cases it is recommended to monitor the patient and, if necessary, reduce the dose of the drug.

No acute drug overdose has been reported.