Leitura clínica
Comentário
Progestagênio sintético similar à progesterona, utilizado em sangramento uterino, dismenorreia, infertilidade e contracepção. Como anticoncepcional, é utilizado como produto único ou associado a estrogênios. Administração oral diária ou injetável (intramuscular ou subcutânea) de ação prolongada a cada 3 a 6 meses. É excretada no leite materno em quantidade clinicamente não significativa (Koetsawang 1982, Saxena 1977) e não foram observados problemas em lactentes cujas mães a tomavam (Singhal 2014, Díaz 1997, WHO 1994, Pardthaisong 1992, Zacharias 1986, Jiménez 1984, Dahlberg 1982, Karim 1971) . Os níveis urinários de medroxiprogesterona nesses lactentes foram indetectáveis. (Virutamasen 1996) Pode haver aumento de prolactina e da produção de leite em mães tratadas com medroxiprogesterona (Omar 2006, Ratchanon 2000) . Não há provas de sua efetividade como galactagogo. (Zuppa 2010) Embora não tenham sido demonstrados efeitos na produção e duração da amamentação ao administrá-la em qualquer momento do puerpério (Parker 2021, Phillips 2016, Singata 2016, Singhal 2014, Brownell 2013, Halderman 2002, Danli 2000, Hannon 1997, Karim 1971) , há discussão sobre se ocorre diminuição da produção de leite quando progestagênios são utilizados antes que a amamentação esteja bem estabelecida. (Brownell 2012, Rodriguez 2009) -+-+-+-+-+-+-+- Durante a amamentação, são preferíveis os anticoncepcionais apenas com progestagênio aos combinados com estrogênio e, neste caso, os de menor dose de estrogênio. (CDC 2016, 2013 y 2010, WHO/OMS 2015, Altshuler 2015, Berens 2015; CLM 2012, FFPRHC 2004, Moretti 2000, Guiloff 1974) Nas primeiras 4 -6 semanas pós-parto, os métodos não hormonais são de primeira escolha, seguidos de DIUs e implantes de progestagênios. (Berens 2015, Mwalwanda 2013, Rowe 2013, CLM 2012, Kaunitz 1998) Academia Americana de Pediatria: medicação usualmente compatível com a amamentação. (AAP 2001) Lista de medicamentos essenciais da OMS 2002: compatível com a amamentação a partir de 6 semanas pós-parto. (WHO 2002) Pode consultar abaixo a informação deste produto relacionado: Estradiol + Medroxiprogesterona (Bastante seguro. Efeitos adversos leves ou pouco prováveis. Compatível em determinadas circunstâncias. Acompanhamento recomendado. Leia o Comentário.)
Encontrabilidade
Outros nomes e marcas
Sinônimos e grafias 5
- Metilacetoxiprogesterona. Metipregnona
- μεδροξυπρογεστερόνη υδροχλωρική
- Медроксипрогестерона Ацетат
- メドロキシプロゲステロン酢酸エステル
- G03AC06; G03DA02; L02AB02
Marcas comerciais na fonte 12
- Climanor
- Depo-Progevera
- Depo-Provera
- Depo-Provera (Депо-Провера)
- Depo-Provera (狄波-普维拉)
- Depo-subQ
- Farlutal
- Livomedrox
- Megestron
- Progevera
- Provera
- Sayana
Dados da fonte
Farmacocinética
| Variável | Valor | Unidade |
|---|---|---|
| Biodisp. oral | oral: < 10 | % |
| Peso Molecular | 387 | daltons |
| Unión proteínas | 86 - 94 | % |
| Vd | 0,2 - 0,4 | l/Kg |
| Tmax | oral: 1 - 3; im, Sc: 120 - 144 | horas |
| T½ | oral: 40-60; im, sc: 480 -1200 | horas |
| Índice L/P | 1 | - |
| Dosis Teórica | 0,0002 - 0,001 | mg/Kg/d |
| Dosis Relativa | 0,7 - 3,6 | % |
Rastreabilidade
Bibliografia
- Parker LA, Sullivan S, Cacho N, Krueger C, Mueller M. Effect of Postpartum Depo Medroxyprogesterone Acetate on Lactation in Mothers of Very Low-Birth-Weight Infants. Breastfeed Med. 2021 Oct;16(10):835-842. Resumen Texto completo (enlace a fuente original)
- Singata-Madliki M, Hofmeyr GJ, Lawrie TA. The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial. J Fam Plann Reprod Health Care. 2016 Jul;42(3):171-6. Resumen
- Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception. 2016;94:226-52. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Berens P, Labbok M; Academy of Breastfeeding Medicine. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeed Med. 2015 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Singhal S, Sarda N, Gupta S, Goel S. Impact of injectable progestogen contraception in early puerperium on lactation and infant health. J Clin Diagn Res. 2014 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Brownell EA, Fernandez ID, Fisher SG, Howard CR, Ternullo SR, Lawrence RA, Duckett JW, Dozier AM. The effect of immediate postpartum depot medroxyprogesterone on early breastfeeding cessation. Contraception. 2013 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Brownell EA, Fernandez ID, Howard CR, Fisher SG, Ternullo SR, Buckley RJ, Dozier AM. A systematic review of early postpartum medroxyprogesterone receipt and early breastfeeding cessation: evaluating the methodological rigor of the evidence. Breastfeed Med. 2012 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Zuppa AA, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C. Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J Pharm Pharm Sci. 2010;13(2):162-74. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Rodriguez MI, Kaunitz AM. An evidence-based approach to postpartum use of depot medroxyprogesterone acetate in breastfeeding women. Contraception. 2009 Resumen
- Omar HA, Zakharia RM, Kanungo S, Huff M, McClanahan K. Incidence of galactorrhea in young women using Depot-Medroxyprogesterone Acetate. ScientificWorldJournal. 2006 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- FFPRHC: Faculty of Family Planning & Reproductive Health Care. Guidance (July 2004): Contraceptive choices for breastfeeding women. J Fam Plann Reprod Health Care. 2004 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Halderman LD, Nelson AL. Impact of early postpartum administration of progestin-only hormonal contraceptives compared with nonhormonal contraceptives on short-term breast-feeding patterns. Am J Obstet Gynecol. 2002 Resumen
- WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Baheiraei A, Ardsetani N, Ghazizadeh S. Effects of progestogen-only contraceptives on breast-feeding and infant growth. Int J Gynaecol Obstet. 2001 Resumen
- AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Ratchanon S, Taneepanichskul S. Depot medroxyprogesterone acetate and basal serum prolactin levels in lactating women. Obstet Gynecol. 2000 Resumen
- Danli S, Qingxiang S, Guowei S. A multicentered clinical trial of the long-acting injectable contraceptive Depo Provera in Chinese women. Contraception. 2000 Resumen
- Kaunitz AM. Injectable depot medroxyprogesterone acetate contraception: an update for U.S. clinicians. Int J Fertil Womens Med. 1998 Resumen
- Díaz S, Zepeda A, Maturana X, Reyes MV, Miranda P, Casado ME, Peralta O, Croxatto HB. Fertility regulation in nursing women. IX. Contraceptive performance, duration of lactation, infant growth, and bleeding patterns during use of progesterone vaginal rings, progestin-only pills, Norplant implants, and Copper T 380-A intrauterine devices. Contraception. 1997 Resumen
- Hannon PR, Duggan AK, Serwint JR, Vogelhut JW, Witter F, DeAngelis C. The influence of medroxyprogesterone on the duration of breast-feeding in mothers in an urban community. Arch Pediatr Adolesc Med. 1997 May;151(5):490-6. Resumen
- Virutamasen P, Leepipatpaiboon S, Kriengsinyot R, Vichaidith P, Muia PN, Sekadde-Kigondu CB, Mati JK, Forest MG, Dikkeschei LD, Wolthers BG, d'Arcangues C. Pharmacodynamic effects of depot-medroxyprogesterone acetate (DMPA) administered to lactating women on their male infants. Contraception. 1996 Sep;54(3):153-7. Resumen
- WHO. Progestogen-only contraceptives during lactation: II. Infant development. World Health Organization, Task Force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development, and Research Training in Human Reproduction. Contraception. 1994 Resumen
- Pardthaisong T, Yenchit C, Gray R. The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation. Contraception. 1992 Apr;45(4):313-24. Resumen
- World Health Organization (WHO) Task Force on Oral Contraceptives. Effects of hormonal contraceptives on breast milk composition and infant growth. Stud Fam Plann. 1988 Resumen
- Zacharias S, Aguilera E, Assenzo JR, Zanartu J. Effects of hormonal and nonhormonal contraceptives on lactation and incidence of pregnancy. Contraception. 1986 Mar;33(3):203-13. Resumen
- Jimenez J, Ochoa M, Soler MP, Portales P. Long-term follow-up of children breast-fed by mothers receiving depot-medroxyprogesterone acetate. Contraception. 1984 Dec;30(6):523-33. Resumen
- Koetsawang S, Nukulkarn P, Fotherby K, Shrimanker K, Mangalam M, Towobola K. Transfer of contraceptive steroids in milk of women using long-acting gestagens. Contraception. 1982 Resumen
- Dahlberg K. Some effects of depo-medroxyprogesterone acetate (DMPA): observations in the nursing infant and in the long-term user. Int J Gynaecol Obstet. 1982 Feb;20(1):43-8. Resumen
- Saxena BN, Shrimanker K, Grudzinskas JG. Levels of contraceptive seroids in breast milk and plasma of lactating women. Contraception. 1977 Resumen
- Zañartu J, Aguilera E, Muñoz G, Peliowsky H. Effect of a long-acting contraceptive progestogen on lactation. Obstet Gynecol. 1976 Feb;47(2):174-6. Resumen
- Guiloff E, Ibarra-Polo A, Zañartu J, Toscanini C, Mischler TW, Gómez-Rogers C. Effect of contraception on lactation. Am J Obstet Gynecol. 1974 Resumen
- Karim M, Ammar R, el-Mahgoub S, el-Ganzoury B, Fikri F, Abdou I. Injected progestogen and lactation. Br Med J. 1971 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Balmer HC, Macdonald DJ. Hormonal therapy for suppressing lactation. Can Fam Physician. 1971 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)