Provera Tablets 100 mg or Medroxyprogesterone Acetate Tablets 100 mg.

Provera Tablets 200 mg or Medroxyprogesterone Acetate Tablets 200 mg.

Provera^® Tablets 400 mg

1 tablet contains 100mg medroxyprogesterone acetate.

1 tablet contains 200 mg medroxyprogesterone acetate.

1 tablet contains 400 mg medroxyprogesterone acetate.

For excipients, see 6.1.

Tablet.

Progestogen indicated for the treatment of certain hormone dependant neoplasms, such as:

1. Endometrial carcinoma.

2. Renal cell carcinoma.

3. Carcinoma of breast in post menopausal women.

Route of administration: Oral.

Adults

The incidence of minor side-effects, such as indigestion and weight gain, increase with the increase in dose.

Response to hormonal therapy may not be evident until after at least 8-10 weeks of therapy.

Elderly patients : This product has been used primarily in the older age group for the treatment of malignancies. There is no evidence to suggest that the older age group is any less prepared to handle the drug metabolically than is the younger patient. Therefore the same dosage, contra-indications, and precautions would apply to either age group.

Children:The product is not anticipated for paediatric use in the indications recommended.

Medroxyprogesterone acetate is contraindicated in the following conditions:

• thrombophlebitis, thrombo-embolic disorders, and where there is a high risk of developing such manifestations [presence or history of atrial fibrillation, valvular disorders, endocarditis, heart failure, pulmonary embolism; thrombo-embolic ischaemic attack (TIA), cerebral infarction; atherosclerosis; immediate post surgery period]

• hypercalcaemia in patients with osseous metastases

• known sensitivity to medroxyprogesterone acetate or any component of the drug.

• impaired liver function or active liver disease.

• missed abortion, metrorrhagia, known or suspected pregnancy.

• undiagnosed vaginal bleeding.

• previous idiopathic or current venous thromboembolism (deep vein thrombosis, pulmonary embolism).

• active or recent arterial thromboembolic disease (e.g., angina, myocardial infarction).

• suspected or early breast carcinoma

Progestogens are known to be porphyrogenic. Patients with a history of attacks or aged under 30 are at greatest risk of an acute attack while on progesterone treatment. A careful assessment of potential benefit should be made where this risk is present.

Warnings:

In the treatment of carcinoma of breast occasional cases of hypercalcaemia have been reported.

Unexpected vaginal bleeding during therapy with medroxyprogesterone acetate should be investigated.

Medication should not be readministered pending examination if there is sudden partial or complete loss of vision or if there is a sudden onset of proptosis, diplopia or migraine. If examination reveals papilloedema or retinal vascular lesions, medication should not be readministered.

Medroxyprogesterone acetate may produce Cushingoid symptoms.

Some patients receiving medroxyprogesterone acetate may exhibit suppressed adrenal function. Medroxyprogesterone acetate may decrease ACTH and hydrocortisone blood levels.

Treatment with medroxyprogesterone acetate should be discontinued in the event of:

• jaundice or deterioration in liver function

• significant increase in blood pressure

• new onset of migraine-type headache

Precautions:

Animal studies show that Provera possesses adrenocorticoid activity. This has also been reported in man, therefore patients receiving large doses continuously and for long periods should be observed closely for signs normally associated with adrenocorticoid therapy, such as hypertension, sodium retention, oedema, etc. Care is needed in treating patients with diabetes and/or arterial hypertension.

Before using Provera the general medical condition of the patient should be carefully evaluated.

This product should be used under the supervision of a specialist and the patient kept under regular surveillance.

Patients with the following conditions should be carefully monitored while taking progestogens:

• Conditions which may be influenced by potential fluid retention

o Epilepsy

o Migraine

o Asthma

o Cardiac dysfunction

o Renal dysfunction

• History of mental depression

• Diabetes (a decrease in glucose tolerance has been observed in some patients).

• Hyperlipidaemia

The pathologist (laboratory) should be informed of the patient's use of medroxyprogesterone acetate if endometrial or endocervical tissue is submitted for examination.

The physician/laboratory should be informed that medroxyprogesterone acetate may decrease the levels of the following endocrine biomarkers:

• Plasma/urinary steroids (e.g., cortisol, oestrogen, pregnanediol, progesterone, testosterone)

• Plasma/urinary gonadotrophins (e.g., LH and FSH)

• Sex-hormone-binding-globulin

The use of medroxyprogesterone acetate in oncology indications may also cause partial adrenal insufficiency (decrease in pituitary-adrenal axis response) during Metyrapone testing. Thus the ability of adrenal cortex to respond to ACTH should be demonstrated before metyrapone is administered.

Although medroxyprogesterone acetate has not been causally associated with the induction of thromboembolic disorders, any patient with a history or who develops this kind of event while undergoing therapy with medroxyprogesterone acetate should have her status and need for treatment carefully assessed before continuing therapy.

Risk of venous thromboembolism (VTE)

The risk of VTE has not been assessed for progesterone alone. However, VTE is a known risk factor of oestrogen-only and combined hormone replacement therapy. When prescribing medroxyprogesterone acetate for oncology indications the following precautions and risk factors should be considered in the light of the patient's condition, the dose of medroxyprogesterone acetate and the duration of therapy:

• Generally recognised risk factors for VTE include a personal or family history of VTE or known thromboembolic states, severe obesity (BMI > 30 kg/m²) and systemic lupus erythematosus

• The risk of VTE may be temporarily increased with prolonged immobilisation, major trauma or major surgery.

• If VTE develops after initiating therapy, medroxyprogesterone acetate should be discontinued. Patients should be told to contact their doctor immediately if they become aware of a symptom suggestive of potential thromboembolism (e.g. painful swelling of a leg, sudden pain in the chest, dyspnoea).

Interaction with other medicaments

The metabolism of progestogens may be increased by concomitant administration of compounds known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes. These compounds include anticonvulsants (e.g., phenobarbital, phenytoin, carbamazepine) and anti-infectives (e.g., rifampicin, rifabutin, nevirapine, efavirenz,).

Ritonavir and nelfinavir, although known as strong inhibitors, by contrast exhibit inducing properties when used concomitantly with steroid hormones. Herbal preparations containing St John's Wort (Hypericum Perforatum) may induce the metabolism of progestogens. Progestogen levels may therefore be reduced.

Aminoglutethimide has been reported to decrease plasma levels of some progestogens.

Concurrent administration of ciclosporin and MPA has been reported to lead to increased plasma ciclosporin levels and/or decreased plasma MPA levels.

Interactions with oral anti-coagulants have been reported rarely, but causality has not been established.

When used in combination with cytotoxic drugs, it is possible that progestogens may reduce the haematological toxicity of chemotherapy.

Special care should be taken when progestogens are administered with other drugs which also cause fluid retention, such as NSAIDs and vasodilators.

Other forms of interaction

Progestogens can influence certain laboratory tests (e.g., tests for hepatic function, thyroid function and coagulation).

Pregnancy

Medroxyprogesterone acetate is contraindicated in women who are pregnant. If medroxyprogesterone acetate is used during pregnancy, or if the patient becomes pregnant while using this drug, the patient should be apprised of the potential hazard to the foetus.

Some reports suggest an association between intrauterine exposure to progestational drugs in the first trimester of pregnancy and genital abnormalities in male and female foetuses.

Infants from unintentional pregnancies that occur 1 to 2 months after injection of medroxyprogesterone acetate injectable suspension may be at an increased risk of low birth weight, which, in turn, is associated with an increased risk of neonatal death. The attributable risk is low because pregnancies while on medroxyprogesterone acetate are uncommon.

Lactation

Medroxyprogesterone acetate and/or its metabolites are secreted in breast milk. Therefore, the use of Provera whilst breast-feeding is not recommended.

No adverse effect has been reported.

Reactions occasionally associated with the use of progestogens, particularly in high doses, are:

Breast: Tenderness, mastodynia or galactorrhoea.

Genitourinary: Abnormal uterine bleeding (irregular, increase, decrease), amenorrhoea, alterations of cervical secretions, cervical erosions, prolonged anovulation.

Central nervous system: Confusion, euphoria, loss of concentration, nervousness, insomnia, somnolence, fatigue, dizziness, depression, vision disorders and headache.

Skin and mucous membranes: Sensitivity reactions ranging from pruritus, urticaria, angioneurotic oedema, to generalised rash and anaphylaxis have occasionally been reported. Acne, alopecia or hirsutism have been reported in a few cases.

Allergy: Hypersensitivity reactions (e.g., anaphylaxis or anaphylactoid reactions, angioedema).

Gastro-intestinal/hepatobiliary: Constipation, diarrhoea, dry mouth, disturbed liver function, jaundice, vomiting, nausea and indigestion .

Metabolic and nutritional: Adrenergic-like effects (e.g., fine hand tremors, sweating, tremors, cramps in calves at night), corticoid-like effects (e.g., Cushingoid Syndrome), decreased glucose tolerance, diabetic cataract, exacerbation of diabetes mellitus, glycosuria.

Cardiovascular: Cerebral and myocardial infarction, congestive heart failure, increased blood pressure, palpitations, pulmonary embolism, retinal thrombosis, tachycardia, thromboembolic disorders, thrombophlebitis.

Haematological: Elevation of white blood cells and platelet count.

Miscellaneous: Change in appetite, change in libido, oedema/fluid retention, hypercalcaemia, malaise, hyperpyrexia, weight gain, moon facies.

No action required other than cessation of therapy.

Pharmacotherapeutic group: Progestogens. ATC Code: L02A B

Medroxyprogesterone acetate has the pharmacological action of a progestogen.

Medroxyprogesterone acetate is absorbed from the gastro intestinal tract with a single oral dose of 10-250 mg. The time taken to reach the peak serum concentration (T_max) was 2-6 hours and the average peak serum concentration (C_max) was 13-46.89 mg/ml.

Unmetabolised medroxyprogesterone acetate is highly plasma protein bound. Medroxyprogesterone acetate is metabolised in the liver.

Medroxyprogesterone acetate is primarily metabolised by faecal excretion as glucuronide conjugated metabolite.

Metabolised medroxyprogesterone acetate is excreted more rapidly and in a greater percentage following oral doses than after aqueous intramuscular injection

400 mg only:

The comparative bioavailability of medroxyprogesterone acetate (MPA) in sixteen healthy male volunteers was determined following the oral ingestion of 400 mg MPA as two Provera 200 mg tablets or as one Provera 400mg tablet. It is concluded that the bioavailability appeared to be equivalent in this group of volunteers.

No further preclinical safety data available.

Microcrystalline cellulose

Maize Starch

Byco C

Macrogol 400

Sodium starch glycollate

Docusate sodium

Sodium benzoate

Magnesium stearate

Isopropyl alcohol

Purified water

Not applicable.

Provera 100mg: 36 months if stored in glass/HDPE bottles, or 24 month in blister packs.

Provera 200mg: 36 months if stored in glass/HDPE bottles, or 24 month in blister packs.

Provera 400mg: The shelf-life for Provera Tablets 400 mg is 36 months

Provera 100mg: Store below 25°C. Bottle packs only: keep in a well closed container.

Provera 200mg: Store below 25°C.Bottle packs only: keep in a well closed container.

Provera 400mg: Store at controlled room temperature (15 - 30ºC).Bottle packs only: keep in a well closed container.

Provera 100mg: Amber glass bottle with screw cap containing 100 tablets. HDPE bottle with tamper evident cap containing 100 tablets. PVC/aluminium strip containing 30, 60 or 100 tablets.

Provera 200mg: Amber glass bottle with screw cap containing 100 tablets. HDPE bottle with tamper evident cap containing 100 tablets. PVC/aluminium strip containing 30, 60 or 100 tablets.

Provera 400mg: Glass/HDPE bottles of 60 tablets. PVC aluminium blisters of 30 tablets

None stated.

Pharmacia Limited

Ramsgate Road

Sandwich

Kent

CT13 9NJ

UK

Provera 100mg: PL 0032/0111

Provera 200mg: PL 0032/0112

Provera 400mg: PL 0032/0131

Provera 100mg: 7 November 1983/30 January 1996

Provera 200mg: 7 November 1983/30 January 1996

Provera 400mg: Date of first authorisation: 29 April 1986. Date of renewal of authorisation: 21 May 1998

August 2007

POM

Company Reference: PVB1_0