Deviry Overdose

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What happens if I overdose Deviry?

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately.

Proper storage of depo-subQ Deviry 104 injectable suspension (subcutaneous):

Store depo-subQ Deviry 104 injectable suspension (subcutaneous) at room temperature between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep depo-subQ Deviry 104 injectable suspension (subcutaneous) out of the reach of children and away from pets.

Overdose of Deviry in details

When a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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Overdosage of estrogen plus progestin therapy may cause nausea and vomiting, breast tenderness, dizziness, abdominal pain, drowsiness/fatigue and withdrawal bleeding may occur in women. Treatment of overdose consists of discontinuation of CE plus MPA together with institution of appropriate symptomatic care.

What should I avoid while taking Deviry?

This medication will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

This medicine can pass into body fluids (urine, feces, vomit). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Deviry warnings

Warnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.

Loss of Bone Mineral Density

Use of MPA Injectable Suspension, USP reduces serum estrogen levels and is associated with significant loss of bone mineral density (BMD). This loss of BMD is of particular concern during adolescence and early adulthood, a critical period of bone accretion. It is unknown if use of MPA Injectable Suspension, USP by younger women will reduce peak bone mass and increase the risk for osteoporotic fracture in later life.

After discontinuing MPA Injectable Suspension, USP in adolescents, mean BMD loss at total hip and femoral neck did not fully recover by 60 months (240 weeks) post-treatment. Similarly, in adults, there was only partial recovery of mean BMD at total hip, femoral neck and lumbar spine towards baseline by 24 months post-treatment.

MPA Injectable Suspension, USP should not be used as a long-term birth control method (i.e., longer than 2 years) unless other birth control methods are considered inadequate. BMD should be evaluated when a woman needs to continue to use MPA Injectable Suspension, USP long-term. In adolescents, interpretation of BMD results should take into account patient age and skeletal maturity.

Other birth control methods should be considered in the risk/benefit analysis for the use of MPA Injectable Suspension, USP in women with osteoporosis risk factors. MPA Injectable Suspension, USP can pose an additional risk in patients with risk factors for osteoporosis (e.g., metabolic bone disease, chronic alcohol and/or tobacco use, anorexia nervosa, strong family history of osteoporosis or chronic use of drugs that can reduce bone mass such as anticonvulsants or corticosteroids). Although there are no studies addressing whether calcium and Vitamin D may lessen BMD loss in women using MPA Injectable Suspension, USP, all patients should have adequate calcium and Vitamin D intake.

Thromboembolic Disorders

There have been reports of serious thrombotic events in women using MPA Injectable Suspension, USP. However, MPA Injectable Suspension, USP has not been causally associated with the induction of thrombotic or thromboembolic disorders. Any patient who develops thrombosis while undergoing therapy with MPA Injectable Suspension, USP should discontinue treatment unless she has no other acceptable options for birth control.

Do not re-administer MPA Injectable Suspension, USP pending examination if there is a sudden partial or complete loss of vision or if there is a sudden onset of proptosis, diplopia, or migraine. Do not re-administer if examination reveals papilledema or retinal vascular lesions.

Cancer Risks

Breast Cancer

​Women who have or have had a history of breast cancer should not use hormonal contraceptives, including MPA Injectable Suspension, USP, because breast cancer may be hormonally sensitive. Women with a strong family history of breast cancer should be monitored with particular care.

​The results of five large case-control studies1, 2, 3, 4, 5 assessing the association between depo-Deviry (DMPA) use and the risk of breast cancer are summarized in Figure 1. Three of the studies suggest a slightly increased risk of breast cancer in the overall population of users; these increased risks were statistically significant in one study. One recent US study1 evaluated the recency and duration of use and found a statistically significantly increased risk of breast cancer in recent users (defined as last use within the past five years) who used DMPA for 12 months or longer; this is consistent with results of a previous study4.

Figure 1 Risk estimates for breast cancer in DMPA users

Odds ratio estimates were adjusted for the following covariates:

Lee et al. (1987): age, parity, and socioeconomic status.

Paul et al. (1989): age, parity, ethnic group, and year of interview.

WHO (1991): age, center, and age at first live birth.

Shapiro et al. (2000): age, ethnic group, socioeconomic status, and any combined estrogen/progestogen oral contraceptive use.

Li et al. (2012): age, year, BMI, duration of OC use, number of full-term pregnancies, family history of breast cancer, and history of screening mammography.

Based on the published SEER-18 2011 incidence rate (age-adjusted to the 2000 US Standard Population ) of breast cancer for US women, all races, age 20 to 49 years6, a doubling of risk would increase the incidence of breast cancer in women who use MPA Injectable Suspension, USP from about 72 to about 144 cases per 100,000 women.

Cervical Cancer

A statistically non-significant increase in RR estimates of invasive squamous-cell cervical cancer has been associated with the use of MPA Injectable Suspension, USP in women who were first exposed before the age of 35 years (RR 1.22 to 1.28 and 95% CI 0.93 to 1.70). The overall, non-significant relative rate of invasive squamous-cell cervical cancer in women who ever used MPA Injectable Suspension, USP was estimated to be 1.11 (95% CI 0.96 to 1.29). No trends in risk with duration of use or times since initial or most recent exposure were observed.

Other Cancers

Long-term case-controlled surveillance of users of MPA Injectable Suspension, USP found no overall increased risk of ovarian or liver cancer.

Ectopic Pregnancy

Be alert to the possibility of an ectopic pregnancy among women using MPA Injectable Suspension, USP who become pregnant or complain of severe abdominal pain.

Anaphylaxis and Anaphylactoid Reaction

Anaphylaxis and anaphylactoid reaction have been reported with the use of MPA Injectable Suspension, USP. Institute emergency medical treatment if an anaphylactic reaction occurs.

Liver Function

Discontinue MPA Injectable Suspension, USP use if jaundice or acute or chronic disturbances of liver function develop. Do not resume use until markers of liver function return to normal and MPA Injectable Suspension, USP causation has been excluded.

Convulsions

There have been a few reported cases of convulsions in patients who were treated with MPA Injectable Suspension, USP. Association with drug use or pre-existing conditions is not clear.

Depression

Monitor patients who have a history of depression and do not re-administer MPA Injectable Suspension, USP if depression recurs.

Bleeding Irregularities

Most women using MPA Injectable Suspension, USP experience disruption of menstrual bleeding patterns. Altered menstrual bleeding patterns include amenorrhea, irregular or unpredictable bleeding or spotting, prolonged spotting or bleeding, and heavy bleeding. Rule out the possibility of organic pathology if abnormal bleeding persists or is severe, and institute appropriate treatment.

As women continue using MPA Injectable Suspension, USP, fewer experience irregular bleeding and more experience amenorrhea. In clinical studies of MPA Injectable Suspension, USP, by month 12 amenorrhea was reported by 55% of women, and by month 24, amenorrhea was reported by 68% of women using MPA Injectable Suspension, USP.

Weight Gain

Women tend to gain weight while on therapy with MPA Injectable Suspension, USP. From an initial average body weight of 136 lb, women who completed 1 year of therapy with MPA Injectable Suspension, USP gained an average of 5.4 lb. Women who completed 2 years of therapy gained an average of 8.1 lb. Women who completed 4 years gained an average of 13.8 lb. Women who completed 6 years gained an average of 16.5 lb. Two percent of women withdrew from a large-scale clinical trial because of excessive weight gain.

Carbohydrate Metabolism

A decrease in glucose tolerance has been observed in some patients on MPA Injectable Suspension, USP treatment. Monitor diabetic patients carefully while receiving MPA Injectable Suspension, USP.

Lactation

Detectable amounts of drug have been identified in the milk of mothers receiving MPA Injectable Suspension, USP. In nursing mothers treated with MPA Injectable Suspension, USP, milk composition, quality, and amount are not adversely affected. Neonates and infants exposed to Deviry from breast milk have been studied for developmental and behavioral effects through puberty. No adverse effects have been noted.

Fluid Retention

Because progestational drugs including MPA Injectable Suspension, USP may cause some degree of fluid retention, monitor patients with conditions that might be influenced by this condition, such as epilepsy, migraine, asthma, and cardiac or renal dysfunction.

Return of Fertility

Return to ovulation and fertility is likely to be delayed after stopping MPA Injectable Suspension, USP. In a large US study of women who discontinued use of MPA Injectable Suspension, USP to become pregnant, data are available for 61% of them. Of the 188 women who discontinued the study to become pregnant, 114 became pregnant. Based on Life-Table analysis of these data, it is expected that 68% of women who do become pregnant may conceive within 12 months, 83% may conceive within 15 months, and 93% may conceive within 18 months from the last injection. The median time to conception for those who do conceive is 10 months following the last injection with a range of 4 to 31 months, and is unrelated to the duration of use. No data are available for 39% of the patients who discontinued MPA Injectable Suspension, USP to become pregnant and who were lost to follow-up or changed their mind.

Sexually Transmitted Diseases

Patients should be counseled that MPA Injectable Suspension, USP does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Pregnancy

Although MPA Injectable Suspension, USP should not be used during pregnancy, there appears to be little or no increased risk of birth defects in women who have inadvertently been exposed to MPA injections in early pregnancy. Neonates exposed to MPA in-utero and followed to adolescence showed no evidence of any adverse effects on their health including their physical, intellectual, sexual or social development.

Monitoring

A woman who is taking hormonal contraceptive should have a yearly visit with her healthcare provider for a blood pressure check and for other indicated healthcare.

Interference with Laboratory Tests

The use of MPA Injectable Suspension, USP may change the results of some laboratory tests, such as coagulation factors, lipids, glucose tolerance, and binding proteins.

What should I discuss with my healthcare provider before taking Deviry?

For all patients taking Deviry injection:

For all reasons other than cancer treatment:

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take Deviry injection with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

Deviry precautions

Certain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
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Loss of Bone Mineral Density (BMS): Use of Depo-Deviry Inj reduces serum estrogen levels and is associated with significant loss BMD. This loss of BMD is of particular concern during adolescence and early adulthood, a critical period of bone accretion. It is unknown if use of Depo-Deviry Inj by younger women will reduce peak bone mass and increase the risk for osteoporotic fracture in later life.

After discontinuing Depo-Deviry Inj in adolescents, mean BMD loss at total hip and femoral neck did not fully recover by 60 months (240 weeks) post-treatment. Similarly, in adults, there was only partial recovery of mean BMD at total hip, femoral neck and lumbar spine towards baseline by 24 months post-treatment.

Depo-Deviry Inj should not be used as a long-term birth control method (ie, >2 years) unless other birth control methods are considered inadequate. BMD should be evaluated when a woman needs to continue to use Depo-Deviry Inj long-term. In adolescents, interpretation of BMD results should take into account patient age and skeletal maturity.

Other birth control methods should be considered in the risk/benefit analysis for the use of Depo-Deviry Inj in women with osteoporosis risk factors. Depo-Deviry Inj can pose an additional risk in patients with risk factors for osteoporosis (eg, metabolic bone disease, chronic alcohol and/or tobacco use, anorexia nervosa, strong family history of osteoporosis or chronic use of drugs that can reduce bone mass eg, anticonvulsants or corticosteroids). Although there are no studies addressing whether calcium and vitamin D may lessen BMD loss in women using Depo-Deviry Inj, all patients should have adequate calcium and vitamin D intake.

Thromboembolic Disorders: There have been reports of serious thrombotic events in women using Depo-Deviry Inj (150 mg). However, Depo-Deviry Inj has not been causally associated with the induction of thrombotic or thromboembolic disorders. Any patient who develops thrombosis while undergoing therapy with Depo-Deviry Inj should discontinue treatment unless she has no other acceptable options for birth control.

Do not re-administer Depo-Deviry Inj pending examination if there is a sudden partial or complete loss of vision or if there is a sudden onset of proptosis, diplopia or migraine. Do not re-administer if examination reveals papilledema or retinal vascular lesions.

Cancer Risks: Breast Cancer: Women who currently have or have had breast cancer should not use hormone contraceptives, including Depo-Deviry Inj, because breast cancer may be hormonally sensitive. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care.

A pooled analysis from 2 case-control studies, the World Health Organization (WHO) study and the New Zealand study, reported the relative risk (RR) of breast cancer for women who had ever used Depo-Deviry Inj as 1.1 [95% confidence interval (CI) 0.97-1.4]. Overall, there was no increase in risk with increasing duration of use of Depo-Deviry Inj. The RR of breast cancer for women of all ages who had initiated use of Depo-Deviry Inj within the previous 5 years was estimated to be 2 (95% CI 1.5-2.8).

The WHO study, a component of the pooled analysis described previously, showed an increased RR of 2.19 (95% CI 1.23-3.89) of breast cancer associated with use of Depo-Deviry Inj in women whose 1st exposure to drug was within the previous 4 years and who were <35 years. However, the overall RR for ever-users of Depo-Deviry Inj was 1.2 (95% CI 0.96-1.52).

The National Cancer Institute reports an average annual incidence rate for breast cancer for US women, all races, 15-34 years of 8.7 per 100,000. A RR of 2.19, thus, increases the possible risk from 8.7-19 cases per 100,000 women.

Cervical Cancer: A statistically nonsignificant increase in RR estimates of invasive squamous-cell cervical cancer has been associated with the use of Depo-Deviry Inj in women who were 1st exposed before 35 years (RR 1.22-1.28 and 95% CI 0.93-1.7). The overall, nonsignificant relative rate of invasive squamous-cell cervical cancer in women who ever used Depo-Deviry Inj was estimated to be 1.11 (95% CI 0.96-1.29). No trends in risk with duration of use or times since initial or most recent exposure were observed.

Other Cancers: Long-term case-controlled surveillance of users of Depo-Deviry Inj found no overall increased risk of ovarian or liver cancer.

Ectopic Pregnancy: Be alert to the possibility of an ectopic pregnancy among women using Depo-Deviry Inj who become pregnant or complain of severe abdominal pain.

Anaphylaxis and Anaphylactoid Reaction: Anaphylaxis and anaphylactoid reaction have been reported with the use of Depo-Deviry Inj. Institute emergency medical treatment if an anaphylactic reaction occurs.

Liver Function: Discontinue Depo-Deviry Inj use if jaundice or acute or chronic disturbances of liver function develop. Do not resume use until markers of liver function return to normal and Depo-Deviry Inj causation has been excluded.

Convulsions: There have been a few reported cases of convulsions in patients who were treated with Depo-Deviry Inj. Association with drug use or preexisting conditions is not clear.

Depression: Monitor patients who have a history of depression and do not re-administer Depo-Deviry Inj if depression recurs.

Bleeding Irregularities: Most women using Depo-Deviry Inj experience disruption of menstrual bleeding patterns. Altered menstrual bleeding patterns include amenorrhea, irregular or unpredictable bleeding or spotting, prolonged spotting or bleeding, and heavy bleeding. Rule out the possibility of organic pathology if abnormal bleeding persists or is severe, and institute appropriate treatment.

As women continue using Depo-Deviry Inj, fewer experience irregular bleeding and more experience amenorrhea. In clinical studies of Depo-Deviry Inj, by month 12 amenorrhea was reported by 55% of women, and by month 24, amenorrhea was reported by 68% of women using Depo-Deviry Inj.

Weight Gain: Women tend to gain weight while on therapy with Depo-Deviry Inj. From an initial average body weight of 136 lb, women who completed 1 year of therapy with Depo-Deviry Inj gained an average of 5.4 lb. Women who completed 2 years of therapy gained an average of 8.1 lb. Women who completed 4 years gained an average of 13.8 lb. Women who completed 6 years gained an average of 16.5 lb. Two percent (2%) of women withdrew from a large-scale clinical trial because of excessive weight gain.

Carbohydrate Metabolism: A decrease in glucose tolerance has been observed in some patients on Depo-Deviry Inj treatment. Monitor diabetic patients carefully while receiving Depo-Deviry Inj.

Lactation: Detectable amounts of drug have been identified in the milk of mothers receiving Depo-Deviry Inj. In nursing mothers treated with Depo-Deviry Inj, milk composition, quality, and amount are not adversely affected. Neonates and infants exposed to Deviry from breast milk have been studied for developmental and behavioral effects through puberty. No adverse effects have been noted.

Fluid Retention: Because progestational drugs including Depo-Deviry Inj may cause some degree of fluid retention, monitor patients with conditions that might be influenced by this condition eg, epilepsy, migraine, asthma and cardiac or renal dysfunction.

Return of Fertility: Return to ovulation and fertility is likely to be delayed after stopping Depo-Deviry Inj. In a large US study of women who discontinued use of Depo-Deviry Inj to become pregnant, data are available for 61% of them. Of the 188 women who discontinued the study to become pregnant, 114 became pregnant. Based on life-table analysis of these data, it is expected that 68% of women who do become pregnant may conceive within 12 months, 83% may conceive within 15 months, and 93% may conceive within 18 months from the last injection. The median time to conception for those who do conceive is 10 months following the last injection with a range of 4-31 months, and is unrelated to the duration of use. No data are available for 39% of the patients who discontinued Depo-Deviry Inj to become pregnant and who were lost to follow-up or changed their mind.

Sexually Transmitted Diseases: Patients should be counseled that Depo-Deviry Inj does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Pregnancy: Although Depo-Deviry Inj should not be used during pregnancy, there appears to be little or no increased risk of birth defects in women who have inadvertently been exposed to MPA injections in early pregnancy. Neonates exposed to MPA in utero and followed to adolescence showed no evidence of any adverse effects on their health including their physical, intellectual, sexual or social development.

Monitoring: A woman who is taking hormonal contraceptive should have a yearly visit with her healthcare provider for a blood pressure check and for other indicated healthcare.

Interference with Laboratory Tests: The use of Depo-Deviry Inj may change the results of some laboratory tests eg, coagulation factors, lipids, glucose tolerance and binding proteins.

Patient Counseling Information: Advise patients at the beginning of treatment that their menstrual cycle may be disrupted and that irregular and unpredictable bleeding or spotting results, and that this usually decreases to the point of amenorrhea as treatment with Depo-Deviry Inj continues, without other therapy being required.

Counsel patients that Depo-Deviry Inj does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Counsel patients on the warnings and precautions associated with the use of Depo-Deviry Inj.

Counsel patients to use a back-up method or alternative method of contraception when enzyme inducers are used with Depo-Deviry Inj.

Renal Impairment: The effect of renal impairment on Depo-Deviry Inj pharmacokinetics has not been studied.

Hepatic Impairment: The effect of hepatic impairment on Depo-Deviry Inj pharmacokinetics has not been studied. Depo-Deviry Inj should not be used by women with significant liver disease and should be discontinued if jaundice or disturbances of liver function occur.

Use in lactation: Detectable amounts of drug have been identified in the milk of mothers receiving Depo-Deviry Inj.

Use in children: Depo-Deviry Inj is not indicated before menarche. Use of Depo-Deviry Inj 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 Depo-Deviry Inj 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 post-menarchal adolescents and adult women.

Use in the

Elderly: Depo-Deviry Inj has not been studied in post-menopausal women and is not indicated in this population.

What happens if I miss a dose of Deviry?

When you miss a dose, you should take it as soon as you remember, but you should take care that it should be well spaced from the next dose. You should not take an extra dose at the time of the second dose as it will become a double dose. The double dose can give unwanted side effects, so be careful. In chronic conditions or when you have a serious health issue, if you miss a dose, you should inform your health care provider and ask his suggestion.

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.


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References

  1. DailyMed. "MEDROXYPROGESTERONE ACETATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. DrugBank. "Medroxyprogesterone acetate". http://www.drugbank.ca/drugs/DB00603 (accessed September 17, 2018).
  3. MeSH. "Contraceptive Agents, Female". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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