Megestrol acetate therapy in geriatric patients: case reviews and associated deep vein thrombosis

To provide a brief review of the literature discussing treatment of unplanned weight loss in geriatric patients, focusing on megestrol acetate and to report two cases of deep vein thrombosis (DVT) associated with megestrol acetate therapy in geriatric nursing facility residents.

Biomedical literature accessed through MEDLINE and PubMed (1990-2003); product manufacturer information.

Unplanned weight loss, a common problem among frail geriatric nursing facility residents, is associated with increased morbidity and mortality. Once reversible causes of weight loss are identified and addressed, dietary changes, including the addition of nutritional supplements, may be of benefit. In some cases, medications are prescribed. Megestrol acetate oral suspension is approved by the Food and Drug Administration for the treatment of anorexia, cachexia, or unexplained significant weight loss in patients with AIDS. Megestrol acetate tablets are FDA-approved for palliative treatment of advanced breast or endometrial cancer. In recent years, several published prospective and retrospective reports have described the use of megestrol acetate for unplanned weight loss in geriatric patients. While clinical efficacy trials reported diarrhea, impotence, and rash as the most commonly occurring adverse events, post-marketing reports have included deep vein thrombosis and pulmonary embolism. DVP has occurred in geriatric patients.

Case #1: An 86-year-old female with Alzheimer's disease and decreased oral intake was prescribed megestrol acetate suspension 400 mg po bid after a 30-day weight loss of 4.8 kg. Ten days later she developed DVT. Megestrol acetate was discontinued, and she was hospitalized and treated, recovering successfully. Case #2: An 85-year old female with Alzheimer's disease who had stopped eating was prescribed megestrol acetate tablets 40 mg po bid. Four months later she developed DVT. Megestrol acetate was discontinued and she was hospitalized and treated, recovering successfully.

Thromboembolic events are potential adverse events associated with megestrol acetate therapy. Caution should be observed in using megestrol acetate in geriatric patients, especially nursing facility residents who often have impaired mobility.