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content/zh-hant/docs/medicine/antiandrogen/medroxyprogesterone/index.md
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| title: 醋酸甲羥孕酮 | ||
| description: 醋酸甲羥孕酮（Medroxyprogesterone Acetate），是一種類固醇孕激素，具有抗促性腺激素作用，可以抑制體內雄激素水平。在無法獲取到醋酸環丙孕酮（Cyproterone Acetate）時可作為替代品服用，但效果稍差。 | ||
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| {{< notice warning "用藥安全提示" >}} | ||
| 請仔細閱讀說明書並在醫師指導下使用藥物。 | ||
| {{< /notice >}} | ||
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| 醋酸甲羥孕酮（Medroxyprogesterone Acetate, MPA），是一種類固醇孕激素，具有抗促性腺激素作用，可以抑制體內雄激素水平。[^1] 在無法獲取到 [醋酸環丙孕酮]({{< ref cyproterone >}}) （色譜龍，“安得卡”錠）時可作為替代品服用，但效果稍差。[^2] [^3] [^11] | ||
| 有關 MPA 對睪酮水平之抑制作用，可參考[下文]({{< ref "#testosterone-suppression" >}})。 | ||
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| > **大中華區上市狀況** | ||
| ```csv | ||
| 地區,許可證字號 | ||
| 中國大陸,各異，見簡體頁 | ||
| 香港,Provera 5mg: HK-00445<br>FUAN Tab 5mg: HK-49689<br>未竟 | ||
| 臺灣,Provera 5mg: 衛署藥輸字第 014860 號<br>Provera 10mg: 衛署藥輸字第 012946 號<br>美得能錠 5mg: 衛署藥製字第 045552 號<br>美得能錠 10mg: 衛署藥製字第 034799 號 | ||
| ``` | ||
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| ## 基本資訊 {#drug-info} | ||
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| ### 普維拉錠 Provera® | ||
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| | 5 mg | 10 mg | | ||
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| - 商品名：普維拉錠 Provera® | ||
| - 規格：5 mg，10 mg | ||
| - 廠商：輝瑞 | ||
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| ### 美得能錠 Medrone | ||
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| {{< figure src="/images/medicine/medroxyprogesterone/medrone-tw.jpg" width="50%" >}} | ||
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| - 商品名：美得能錠 Medrone | ||
| - 規格：5 mg，10 mg | ||
| - 委託者：優良 | ||
| - 製造廠：健喬信元 | ||
| - [仿單](https://www.cych.org.tw/pharm/%e4%bb%bf%e5%96%ae/PROVE-1080726.pdf) | ||
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| ## 使用方式與用量 {#usage} | ||
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| - 服用方式：口服 | ||
| - 建議使用劑量：**5～10 mg/天**[^9] | ||
| - 達到效果的情況下儘量減少用量。 | ||
| - 停藥時須逐步減藥。 | ||
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| ### MPA 劑量與睪酮水平的關係 {#testosterone-suppression} | ||
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| - **在用於 MtF 的雌二醇和螺內酯聯合治療中加入 MPA（劑量 5～10 mg/天，舌下含服或肌注），可使睪酮水平平均降至 0.79 ± 0.18 ng/mL**[^3]，此平均值略高於絕經前女性參考範圍（0.1～0.55 ng/mL）[^5]。 | ||
| - 將 MPA 用於治療男性性衝動時，5～10 mg/天劑量（肌注）可使得睪酮水平平均下降 31%（範圍 6～63%），約達 0.26～4.35 ng/mL[^6]。 | ||
| - 將 MPA 用於治療男性性慾異常時，60 mg/天劑量（口服）在三個月內可使得睪酮水平下降 50～75%，達 1～4 ng/mL[^7]。 | ||
| - 將 MPA 用於治療女性伴有多毛症的雄激素過多時，30 mg/天劑量（口服）可使得睪酮平均水平自初值 1.33 ng/mL 下降至 0.57 ng/mL，降幅約 57%[^8]。注意，該初值仍顯著低於成年男性參考範圍[^5]。 | ||
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| ## 副作用 {#adverse-reactions} | ||
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| - **血栓栓塞性疾病**：可能導致血栓栓塞和血栓性疾病（例如，血栓性靜脈炎、肺栓塞、腦中風和栓塞、冠狀動脈閉塞、視網膜血栓形成、腸繫膜血栓形成等）。與雌二醇合用時風險可能更高。[^1] [^4] [^10] | ||
| - **抑鬱**：MPA 可能會導致抑鬱風險升高。[^4] | ||
| - **對肝臟的影響**：可能會導致肝功能障礙（如黃疸）。使用前應當檢查**肝功能**並定期檢查，如果出現或懷疑有此類影響，請停止服用並重新評估風險。[^1] | ||
| - **乳腺癌風險**：與雌二醇合用時可一定程度提高其風險。[^4] | ||
| - **對視力的影響**：可能會出現原因不明的突然或逐漸喪失部分或全部視力、眼球突出、複視或偏頭痛等症狀。如診斷爲視乳頭水腫或視網膜血管受損，應停用 MPA。[^4] [^10] | ||
| - 腎上腺抑制：MPA 可能會導致腎上腺抑制並可能干擾碳水化合物代謝，但不會導致糖尿病。[^1] | ||
| - 皮膚和男性化症狀：MPA 仍有微弱雄激素效力和糖皮質激素效力，可能引起痤瘡、體毛生長、脫髮等雄激素敏感症狀[^1] [^11]。 另偶見蕁麻疹，癢疹，水腫，皮疹等過敏性反應[^10]。 | ||
| - 體重變化[^4] [^10] | ||
| - 體液滯留[^4] [^10] | ||
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| ## 成分資訊 {#descriptions} | ||
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| - 有效成分：醋酸甲羥孕酮（Medroxyprogesterone Acetate） | ||
| - 化學名稱：6α-甲基-17α-羥基孕甾-4-烯-3,20-二酮醋酸酯 | ||
| - 分子式：C<sub>24</sub>H<sub>34</sub>O<sub>4</sub> | ||
| - 分子量：386.53 | ||
| - CAS RN：[71-58-9](https://webbook.nist.gov/cgi/cbook.cgi?ID=71-58-9) | ||
| - 生體可用率：0.6～10%[^10] | ||
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| [^1]: Wikipedia. [Medroxyprogesterone Acetate](https://en.wikipedia.org/wiki/Medroxyprogesterone_acetate). | ||
| [^2]: Gooren, L. (2005). Hormone treatment of the adult transsexual patient. *Hormone Research*, 64(Suppl 2): 31-36. DOI: [10.1159/000087751](https://doi.org/10.1159/000087751) | ||
| [^3]: Jain, J., Kwan, D., & Forcier, M. (2019). Medroxyprogesterone Acetate in Gender-Affirming Therapy for Transwomen: Results From a Retrospective Study. *Journal of Clinical Endocrinology & Metabolism*, 104(11): 5148–5156. DOI: [10.1210/jc.2018-02253](https://doi.org/10.1210/jc.2018-02253) | ||
| [^4]: Drugs.com. [Cautions for medroxyPROGESTERone](https://www.drugs.com/monograph/medroxyprogesterone.html#warnings). | ||
| [^5]: Esoterix/LabCorp. (2021). Endocrinology Expected Values and S.I. Unit Conversion Tables. \[[PDF 檔案](https://specialtytesting.labcorp.com/sites/default/files/2021-07/L5167-0421-18%20Endocrine%20Expected%20Values_0.pdf)] | ||
| [^6]: McConaghy, N., Blaszczynski, A., & Kidson, W. (1988). Treatment of sex offenders with imaginal desensitization and/or medroxyprogesterone. *Acta Psychiatrica Scandinavica*, 77(2): 199-206. DOI: [10.1111/j.1600-0447.1988.tb05101.x](https://doi.org/10.1111/j.1600-0447.1988.tb05101.x) | ||
| [^7]: Gottesman, H. G., & Schubert, D. S. (1993). Low-dose oral medroxyprogesterone acetate in the management of the paraphilias. *Journal of Clinical Psychiatry*, 54(5): 182-188. <https://pubmed.ncbi.nlm.nih.gov/8509348/> | ||
| [^8]: Ettinger, B., & Golditch I. M. (1977). Medroxyprogesterone Acetate for the Evaluation of Hypertestosteronism in Hirsute Women. *Fertility and Sterility*, 28(12): 1285-1288. DOI: [10.1016/S0015-0282(16)42970-5](https://doi.org/10.1016/S0015-0282(16)42970-5) | ||
| [^9]: National LGBTQIA+ Health Education Center. (2021). Medical Care of Trans and Gender Diverse Adults. *Fenway Institute*. <https://www.lgbtqiahealtheducation.org/publication/medical-care-of-trans-and-gender-diverse-adults-2021/> | ||
| [^10]: 嘉義基督教醫院. 藥品詳細資訊：Medrone 5mg Tablets. \[[資訊頁](https://www.cych.org.tw/pharm/searchdrugdetail.aspx?drug_serial=9622)] \[[仿單](https://www.cych.org.tw/pharm/%e4%bb%bf%e5%96%ae/PROVE-1080726.pdf)] | ||
| [^11]: Aly. (2018). An Introduction to Hormone Therapy for Transfeminine People. *Transfeminine Science*. 譯文：《[女性傾向跨性別者的激素治療簡介](https://tfsci.mtf.wiki/articles/transfem-intro/)》 |
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