Depo-Provera, Depo-subQ Provera 104, Provera
Classifications: hormone; progestin; Therapeutic: progestin
Pregnancy Category: X
2.5 mg, 5 mg, 10 mg tablets; 104 mg/0.65 mL, 150 mg/mL, 400 mg/mL injection
Induces and maintains endometrium, preventing uterine bleeding; inhibits production of pituitary gonadotropin, thus preventing
ovulation and producing thick cervical mucus resistant to passage of sperm.
Slows release of luteinizing hormone (LH) preventing follicular maturation and ovulation. Has prolonged, variable duration
of action and androgenic and antiestrogenic activity.
Dysfunctional uterine bleeding; secondary amenorrhea; parenteral form (Depo-Provera) used in adjunctive, palliative treatment
of inoperable, recurrent, and metastatic endometrial or renal carcinoma; contraception; endometriosis-associated pain.
Obstructive sleep apnea.
History of thromboembolic disorders; breast cancer, cervical cancer, uterine cancer, vaginal cancer; hepatic disease; abnormal
vaginal bleeding, incomplete abortion; pregnancy (category X).
Asthma, seizure disorders, CVA; migraine, cardiac or kidney dysfunction, liver disease.
Route & Dosage
Adult: PO 510 mg/d for 510 d beginning any time if endometrium is adequately estrogen primed (withdrawal bleeding occurs
in 37 d after discontinuing therapy)
Abnormal Bleeding Due to Hormonal Imbalance
Adult: PO 510 mg/d for 510 d beginning on the assumed or calculated 16th or 21st d of menstrual cycle; if bleeding is
controlled, administer 2 subsequent cycles
Adult: IM 4001000 mg/wk; continue at 400 mg/mo if improvement occurs and disease stabilizes
Adult: IM 100 mg q3mo
Adult: PO 20 mg t.i.d.
- Oral drug may be given with food to minimize GI distress.
- Administer IM deep into a large muscle.
- Store both formulations at 15°30° C (59°86° F); protect from freezing.
Adverse Effects (≥1%)CNS: Cerebral thrombosis or hemorrhage, depression
embolism, edema. GI:
Vomiting, nausea, cholestatic jaundice
, abdominal cramps. Urogenital: Breakthrough bleeding,
changes in menstrual flow, dysmenorrhea, vaginal candidiasis
Angioneurotic edema. Body as a Whole:
Weight changes; breast tenderness,
enlargement or secretion. Musculoskeletal:
Loss of bone mineral density.
concentrations of medroxyprogesterone; barbiturates
, carbamazepine, oxcarbazepine, phenytoin, primidone, rifampin, modafinil, rifabutin, topiramate
can increase metabolism
and decrease serum
levels of medroxyprogesterone. Herbal:
Intermenstrual bleeding and loss of contraceptive efficacy
may occur with St. John's wort.
24 h PO, 3 wk IM. Distribution:
>90% protein bound. Metabolism:
In liver. Elimination:
Primarily in feces. Half-Life:
30 d PO, 50 d IM.
Assessment & Drug Effects
- See progesterone for numerous additional nursing implications.
- Be aware that IM injection may be painful. Monitor sites for evidence of sterile abscess. A residual lump and discoloration
of tissue may develop.
- Monitor for S&S of thrombophlebitis (see Appendix F).
- Note: Planned menstrual cycling with medroxyprogesterone may benefit the patient with a history of recurrent episodes of abnormal
Patient & Family Education
- Be aware that after repeated IM injections, infertility and amenorrhea may persist as long as 18 mo.
- Learn breast self-examination.
- Review package insert to ensure complete understanding of progestin therapy.