I think I have a strong bias against it. This drug is a progesterone mimicker and they gave it to my friends who were wasting. Fat, high blood sugar, blood clots and necrosis of hips were common. I know this was a higher dose.
James was part of my non profit back in the 90's.
Megace The Wrong Drug
By James Brockman (Reprinted with permission)
One of the most commonly used drugs for treatment of AIDS-related weight loss is megestrol acetate, which is sold as the brand name Megace by Bristol-Myers Squibb. Megace is a synthetic drug categorized as a gestagen, which is a class of drugs that mimic the actions of the naturally occurring female hormone progesterone. Originally the drug was developed to be an injectable contraceptive for women, but the drug has now found a role as a chemotherapeutic agent in the treatment of several cancers in women and men, such as cancers of the breast, uterus, and prostate. Two commonly observed side effects of Megace, increased appetite and weight gain, prompted its current use for AIDS-wasting.
The effects of progesterone and other gestagens, like Megace, on appetite and energy metabolism, are well known. Gestagens induce increased food intake by direct stimulation of the appetite centers in the brain. They also improve the efficiency of food energy used to produce new tissue; this effect of gestagens on increasing weight is seen even when gestagen-induced increase in food intake is prevented by restricting calories to maintenance levels.10 So much for the good points.
What Kind Of Weight Gain?
The problem with the weight gained from Megace is that it is primarily fat and water weight, with little lean tissue increase. , Through interactions with mineral corticoid receptors in the kidneys, specific metabolites of Megace promote retention of water. In addition some studies have shown that Megace increases the number of fat cells as well as their size. This is exactly what someone who is wasting or have
lipodystrophy doesn't want. We should be clear that the focus of just putting weight on HIV(+) individuals is inappropriate. Studies are conclusive that survival is correlated with lean body mass, not total weight or fat weight. So if you want to be fat and hungry, take Megace, but do not expect to gain much muscle or live any longer.
Many Side Effects
Megace has almost too many side effects to list. For both men and women the most commonly observed side effect is loss of libido. When Megace was used as a female contraceptive, it worked too well. All the women lost their fertility, but they lost their normal sex drive too! Megace interacts with the progesterone receptors in the hypothalamus to inhibit gonadotropin release in both sexes. Gonadotropins stimulate testosterone production, and testosterone is necessary for a healthy sex drive in both men and women. The end-result of lower gonadotropins in men is not only lower testosterone production, and lower libido, but also testicular atrophy. In other words, the testicles shrivel up. Finally, low plasma testosterone levels are bad for HIV(+) men and women because they are associated with a weakened immune system and the loss of muscle tissue.
Because Megace and/or its metabolites have glucocorticoid activity, 9 Megace is also potentially immunosuppressive. Glucocorticoids are well known to inhibit proliferation of white blood cells including T cells, and weaken the body's response to infection, as well as slowing the healing process. Furthermore, a glucocorticoid responsive element has been identified in the RNA of the HIV virus, so it is possible that Megace could have a direct effect on stimulating viral replication. Other side effects related to the cortisol-like activity of Megace are glucose intolerance, full-blown diabetes, and suppression of the hypothalamic-pituitary-adrenal (HPA) axis.9 Resistance to cortisol is common in HIV, and withdrawal from Megace therapy could result in a dangerous state of adrenal deficiency. These conditions are associated with the later
stages of HIV in cytokine-related wasting, so it makes little sense to use a drug that has the potential to make the complications of HIV infection even worse. Other problems seen with Megace include thrombosis (blood clots), carpal tunnel syndrome, and
peripheral neuropathy.
Conclusions
When it comes to gaining muscle to rebuild a body weakened by AIDS, Megace cannot begin to stack up to anabolic steroids. While some people assert that Megace has a role as an appetite stimulant, there are other substances, like Marinol, that work with far fewer side effects. If your doctor is not yet aware of the benefits of Marinol and anabolic steroids and the problems associated with Megace, work to educate them, and be sure to ask questions if they tell you they would like to prescribe Megace for you. After all, your choice of therapies is up to you.