Medroxyprogesterone Acetate (Page 3 of 6)

6.2 Postmarketing Experience

The following adverse reactions have been identified during post approval use of medroxyprogesterone acetate injectable suspension. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

There have been cases of osteoporosis including osteoporotic fractures reported postmarketing in patients taking medroxyprogesterone acetate injectable suspension.

Table 3. Adverse Reactions Reported during Postmarketing Experience

Body System *	Adverse Reactions
Body as a Whole	Chest pain, Allergic reactions including angioedema, Fever, Injection site abscess† , Injection site infection† , Injection site nodule/lump, Injection site pain/tenderness, Injection site persistent atrophy/indentation/dimpling, Injection-site reaction, Lipodystrophy acquired, Chills, Axillary swelling
Cardiovascular	Syncope, Tachycardia, Thrombophlebitis, Deep vein thrombosis, Pulmonary embolus, Varicose veins
Digestive	Changes in appetite, Gastrointestinal disturbances, Jaundice, Excessive thirst, Rectal bleeding
Hematologic and Lymphatic	Anemia, Blood dyscrasia
Musculoskeletal	Osteoporosis
Neoplasms	Cervical cancer, Breast cancer
Nervous	Paralysis, Facial palsy, Paresthesia, Drowsiness
Respiratory	Dyspnea and asthma, Hoarseness
Skin and Appendages	Hirsutism, Excessive sweating and body odor, Dry skin, Scleroderma
Urogenital	Lack of return to fertility, Unexpected pregnancy, Prevention of lactation, Changes in breast size, Breast lumps or nipple bleeding, Galactorrhea, Melasma, Chloasma, Increased libido, Uterine hyperplasia, Genitourinary infections, Vaginal cysts, Dyspareunia
* Body System represented from COSTART medical dictionary. † Injection site abscess and injection site infections have been reported; therefore strict aseptic injection technique should be followed when administering medroxyprogesterone acetate injectable suspension in order to avoid injection site infections [see Dosage and Administration (2.1)].

7 DRUG INTERACTIONS

7.1 Changes in Contraceptive Effectiveness Associated with Coadministration of Other Products

If a woman on hormonal contraceptives takes a drug or herbal product that induces enzymes, including CYP3A4, that metabolize contraceptive hormones, counsel her to use additional contraception or a different method of contraception. Drugs or herbal products that induce such enzymes may decrease the plasma concentrations of contraceptive hormones, and may decrease the effectiveness of hormonal contraceptives. Some drugs or herbal products that may decrease the effectiveness of hormonal contraceptives include:

• barbiturates
• bosentan
• carbamazepine
• felbamate
• griseofulvin
• oxcarbazepine
• phenytoin
• rifampin
• St. John’s wort
• topiramate

HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors: Significant changes (increase or decrease) in the plasma levels of progestin have been noted in some cases of coadministration of HIV protease inhibitors. Significant changes (increase or decrease) in the plasma levels of the progestin have been noted in some cases of coadministration with non-nucleoside reverse transcriptase inhibitors.

Antibiotics: There have been reports of pregnancy while taking hormonal contraceptives and antibiotics, but clinical pharmacokinetic studies have not shown consistent effects of antibiotics on plasma concentrations of synthetic steroids.

Consult the labeling of all concurrently-used drugs to obtain further information about interactions with hormonal contraceptives or the potential for enzyme alterations.

7.2 Laboratory Test Interactions

The pathologist should be advised of progestin therapy when relevant specimens are submitted.

The following laboratory tests may be affected by progestins including medroxyprogesterone acetate injectable suspension:

(a) Plasma and urinary steroid levels are decreased (e.g., progesterone, estradiol, pregnanediol, testosterone, cortisol).

(b) Gonadotropin levels are decreased.

(c) Sex-hormone-binding-globulin concentrations are decreased.

(d) Protein-bound iodine and butanol extractable protein-bound iodine may increase. T₃ -uptake values may decrease.

(e) Coagulation test values for prothrombin (Factor II), and Factors VII, VIII, IX, and X may increase.

(f) Sulfobromophthalein and other liver function test values may be increased.

(g) The effects of medroxyprogesterone acetate on lipid metabolism are inconsistent. Both increases and decreases in total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol have been observed in studies.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Medroxyprogesterone acetate injectable suspension should not be administered during pregnancy [see Contraindications (4) and Warnings and Precautions (5.17)].

8.3 Nursing Mothers

Detectable amounts of drug have been identified in the milk of mothers receiving medroxyprogesterone acetate injectable suspension [see Warnings and Precautions (5.13)].

8.4 Pediatric Use

Medroxyprogesterone acetate injectable suspension is not indicated before menarche. Use of medroxyprogesterone acetate injectable suspension is associated with significant loss of BMD. This loss of BMD is of particular concern during adolescence and early adulthood, a critical period of bone accretion. In adolescents, interpretation of BMD results should take into account patient age and skeletal maturity. It is unknown if use of medroxyprogesterone acetate injectable suspension by younger women will reduce peak bone mass and increase the risk of osteoporotic fractures in later life. Other than concerns about loss of BMD, the safety and effectiveness are expected to be the same for postmenarchal adolescents and adult women.

8.5 Geriatric Use

This product has not been studied in post-menopausal women and is not indicated in this population.

8.6 Renal Impairment

The effect of renal impairment on medroxyprogesterone acetate injectable suspension pharmacokinetics has not been studied.

8.7 Hepatic Impairment

The effect of hepatic impairment on medroxyprogesterone acetate injectable suspension pharmacokinetics has not been studied. Medroxyprogesterone acetate injectable suspension should not be used by women with significant liver disease and should be discontinued if jaundice or disturbances of liver function occur [see Contraindications (4) and Warnings and Precautions (5.7)].