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Home , Hot flash, Megestrol, Megestrol acetate, Testosterone (patch)

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Megestrol for the Treatment of Hot Flashes in Men Undergoing Ablation Therapy or Orchiectomy

Michelle J. Lajiness

ot flashes, a sudden feeling of warmth Clinical Indications often followed by sweating and some- acetate 625 to 800 mg/day in the sus- times associated with facial , nau- pension form is indicated for the treatment of sea, anxiety, or irritability, are frequently a anorexia, , or unexplained weight loss in Hside effect of treatment with hormone ablation ther- patients with acquired immunodeficiency syn- apy or orchiectomy in patients undergoing treat- drome or . ment for (Higano, 2006). Hot flashes 40 mg/day in the form is occur in about two-thirds of men treated with testos- indicated for the palliation of advanced carcinoma terone reduction (Baum, 2003). of the breast or , and as an adjunct to The pathophysiology of hot flashes is compli- surgery or radiation. cated and not fully understood. Although research Megestrol acetate is not FDA approved for the in women and hot flashes has received much atten- treatment of hot flashes in men; however, it is fre- tion, very little has been studied in the male popu- quently discussed as a method of treatment in the lation. It is thought that thermoregulatory centers in literature (Higano, 2006; Moyad, 2002; Thompson et the control the vasomotor symptoms al., 2003) and is considered an off-label use. involved with hot flashes and that these are regulat- ed by neurotransmitters, including norepinephrine, Contraindications , , serotonin, and endorphins. Megestrol acetate is contraindicated in men Changes in levels of the neurotransmitters and hor- with a history of hypersensitivity to megesterol mones, including testosterone, can cause dysregula- acetate, , thromboembolitic disor- tion of the thermoregulatory centers (Thompson, ders, cerebral hemorrhage, or history of hepatic dis- Tait, Shanafelt, & Loprinzi, 2003). For those men ease. unable to tolerate hot flashes, researchers have vali- There are no significant drug interactions (PDR, dated that low-dose megestrol acetate (Megace®) 20 2007). mg every day or twice daily is well tolerated and can Megestrol acetate should be used with caution substantially decrease the frequency of hot flashes in patients with history of epilepsy, migraine, asth- in men (Loprinzi et al., 1994; Quella et al., 1998). ma, cardiac, or renal dysfunction. Megestrol acetate for treatment of hot flashes in men and women is considered an off-label use. Adverse Reactions The study by Quella et al. (1998) found no side Description effects with use of 40 mg of megestrol acetate per Megestrol acetate is a synthetic derivative of the day after 3 years in men being treated for - naturally occurring hormone . es related to treatment for prostate cancer. Dosage and Administration The exact mechanism of action is unknown. The dosage for use in males for treatment of hot Megestrol acetate is eliminated mainly in the flashes has not been proven. Anectodal discussions (Physician’s Desk Reference [PDR], 2007). have suggested a range of 5 to 20 mg twice a day with a maximum dose of 40 mg four times a day (Higano, 2006). However, researchers (Loprinzi et al., 1994; Quella et al., 1998) who evaluated the use Michelle J. Lajiness, MS, RN, APRN, BC, is a Nurse of megestrol acetate in men and women for preven- Practitioner, William Beaumont Hospital, Royal Oak, MI. tion of hot flashes used 20 mg twice daily orally.

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Cost of treatment ranges from $132 for generic tablets to $156 for Megace as 40 mg tablets for 30 days. Oral suspensions for 40 mg range from $360 to $400 for 30 days. Nursing Considerations Patients should be taught to take the medication either once daily or twice daily spaced 12 hours apart. If a dosage is missed, instruct the patient to skip the missed dose and to take the medication at the next scheduled time. Patients should be taught to avoid stimuli that can induce hot flashes, such as stress, changes in room or food temperatures, caf- feine, spicy foods, and . Conclusion Although the indications for megestrol acetate do not include treatment of vasomotor hot flashes, studies have proven that it is both effective and safe as an off-label use. •

References Baum, N. (2003). Curbside consults – How to manage hot flashes in prostate cancer. Postgraduate , 113(5). Retrieved October 25, 2007, from http://www.postgradmed.com/ issues/2003/05_03/cc_may.htm Higano, C. (2006). deprivation therapy: Monitoring and managing the complications. Hematology/Oncology Clinics of North America, 20, 900-923. Loprinzi, C., Michalak, J., Quella, S., O’Fallon, J., Hatfield, A., Nelimark, R., et al. (1994). Megestrol acetate for the preven- tion of hot flashes. The New England Journal of Medicine, 331(6), 347-352. Moyad, M. (2002). Complementary/alternative therapies for reducing hot flashes in prostate cancer patients: Reevaluating the existing indirect data from studies of and postmenopausal women. Urology, 59(Suppl. 4a), 20-33. Physician’s Desk Reference (PDR). (2007). Megace ES. Retrieved October 4, 2007, from www.thomsonhc.com/pdrel/librari- an/ND_PR/Pdr/SBK/1/PFPUI/ge1Lzfg25qixnE/D Quella, S., Loprinzi, C., Sloan, J., Vaught., Dekrey, W., Fischer, T., et al. (1998). Long-term use of megestrol acetate by cancer survivors for the treatment of hot flashes. Cancer, 82(9), 1784-1788. Thompson, C., Tait, D., Shanafelt, C., & Loprinzi, C. (2003). Andropause: Symptom management for prostate cancer patients treated with hormonal ablation. The Oncologist, 8, 474-487.

Additional Reading Karch, A. (Ed.). (2007). Lippincott’s nursing drug guide 2007. Philadelphia: Lippincott Williams & Wilkins.

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