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Paul Edwards

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In today's teleconference it was suggested that Megace might be useful to reduce hot flushes.


I notice that Chuck Maack recently referred in a US forum to a warning by top Medical Oncologist Stephen Strum against men on androgen deprivation therapy using Megace for hot flushes.


Strum warns:

"I am not a user of Megace in this setting since it is metabolized to DHEA and then to androstenedione and then to testosterone. When the PSA is in good control and the testosterone is low, I use Depo Provera intramuscular injection 400mg ONCE and that usually eliminates hot flashes forever.


The emphasis on "usually" added since there are rare cases wherein the hot flashes are not reduced/eliminated.  Therefore, a 400mg Depo Provera intramuscular injection just once would be what I would have done were I experiencing hot flashes. Make sure the prescribing/administering physician is providing Depo Provera and at the recommended dose, and not Provera.  Though both are Medroxyprogesterone, the difference is that Depo Provera is an addition of acetate.  There are physicians not familiar with that difference who prescribe Provera when the requirement is, specifically, Depo Provera.


HOWEVER, IMPORTANT TO NOTE: Depo Provera has also been known to cause gastrointestinal bleeding and a low HCT percentage can also be attributed to loss of blood.  If you are experiencing fatigue and shortness of breath subsequent to Depo Provera, you may be experiencing a blood loss with this gastrointestinal bleeding and don't know it. Be sure your physician keeps an eye on red blood counts (RBC) as well as HGB and HCT levels".


You should not start any treatment for hot flushes unless you have first discussed it with your doctor.

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I further remark regarding Megace in my paper “ADT Side Effects” http://tinyurl.com/3p9pl3p

Adding to NOT prescribing Megace is this commentary by Dr. A. Oliver Sartor: “"Megace® is used at times for patients who have hot flashes, and at times for patients to boost their appetite. But in prostate cancer, Megace may interact with the androgen receptor, particularly mutants, and cause excessive cancer growth. And you can actually get responses by withdrawing Megace. I do not prescribe the use of Megace in prostate cancer patients (even for hot flashes), because I don’t know who has a mutant and who doesn’t."
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