Comprehensive medication guide to Megestrol including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$15 copay for generic tablets on most commercial insurance (Tier 1–2); oral suspensions generally covered similarly. Megace ES (125 mg/mL) may require prior authorization on some plans. Medicare Part D covers megestrol acetate; 2026 Part D out-of-pocket cap is $2,100.
Estimated Cash Pricing
$18–$27 retail for generic tablets (100-count); oral suspension from $34 for 240 mL (40 mg/mL); concentrated Megace ES suspension from $253 for 150 mL. With GoodRx or SingleCare coupons, tablet prices can drop to as low as $18 for a 30-day supply.
Medfinder Findability Score
35/100
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Megestrol acetate (brand names Megace and Megace ES) is a synthetic progestin medication with two primary FDA-approved uses. The oral suspension formulation is approved to treat anorexia, cachexia, and unexplained significant weight loss in people living with HIV/AIDS. The tablet formulation is approved for palliative management of advanced, inoperable, or metastatic breast cancer and endometrial carcinoma.
Megestrol has been FDA-approved since 1971 (endometrial cancer) and 1993 (AIDS-related wasting). It is available as a generic medication in tablet form (20 mg, 40 mg) and oral suspension (40 mg/mL and the concentrated Megace ES at 125 mg/mL). Off-label uses include cancer-related cachexia beyond AIDS, hot flashes, prostate cancer, and endometriosis.
Megestrol is not a controlled substance — any licensed prescriber can prescribe it without special DEA registration. However, it is prescription-only and requires medical oversight, particularly because of the risks associated with long-term use including adrenal suppression and thromboembolic events.
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Megestrol acetate is a synthetic progestin — it mimics the effects of progesterone by binding to progesterone receptors throughout the body. Its mechanism differs significantly depending on the clinical indication.
For appetite stimulation, the exact mechanism is not fully understood, but research shows Megestrol increases Neuropeptide Y (a powerful appetite signal) in the hypothalamus, suppresses pro-inflammatory cytokines (TNF-alpha, IL-1, IL-6) that drive cachexia, and has weak glucocorticoid-like activity that contributes to appetite improvement. These combined effects increase food intake and reduce muscle and fat breakdown in patients with severe wasting.
For cancer treatment, Megestrol works hormonally: it activates progesterone receptors in hormone-sensitive tumors to slow cell proliferation, suppresses pituitary production of FSH and LH (reducing estrogen and testosterone that fuel tumor growth), and has antiestrogenic effects in endometrial tissue. These mechanisms are most effective in estrogen receptor-positive and progesterone receptor-positive tumors.
20 mg — tablet
Used for breast and endometrial cancer indications
40 mg — tablet
Used for breast and endometrial cancer indications
40 mg/mL — oral suspension
Standard oral suspension for AIDS-related cachexia; usual dose 800 mg (20 mL) daily
125 mg/mL — oral suspension (Megace ES)
Concentrated suspension; usual dose 625 mg (5 mL) daily. Not interchangeable with 40 mg/mL without dose recalculation.
Megestrol acetate tablets (20 mg and 40 mg) entered official ASHP shortage status in May 2025, when Strides Pharma, Major Pharmaceuticals, and Teva simultaneously placed multiple strengths on back order. This multi-manufacturer, simultaneous shortage is one of the more severe supply disruptions for this medication. The oral suspension formulations have experienced separate, intermittent supply challenges.
As a long-established, low-margin generic, Megestrol's supply chain is vulnerable to production disruptions — thin profit margins mean manufacturers maintain minimal safety stock. Chain pharmacies in many areas have been out of stock for extended periods, while independent pharmacies and specialty pharmacies may still have limited supply.
If your pharmacy is out of Megestrol, medfinder can help. You provide your medication, dosage, and location — medfinder contacts pharmacies near you to find which ones can fill your prescription. Results are texted directly to you.
Because megestrol acetate is not a DEA-scheduled controlled substance, any licensed prescriber with the authority to prescribe prescription medications can prescribe it — no special DEA registration is required. The specific type of provider most likely to prescribe Megestrol depends on the indication.
Infectious disease specialists — primary prescribers for AIDS-related cachexia
Medical oncologists — prescribe for advanced breast and endometrial cancer
Gynecologic oncologists — specialists for endometrial carcinoma
Palliative care physicians — prescribe for cancer-related symptom management
Primary care physicians (PCPs) — can prescribe for appropriate patients under their care
Nurse practitioners (NPs) and physician assistants (PAs) — with prescriptive authority in their state
Telehealth providers can also prescribe Megestrol in all 50 states since it is not a controlled substance. Telehealth is a convenient option for prescription renewals or for patients in rural areas without easy access to specialists. For initial complex cases — particularly cancer management — in-person specialist care is recommended.
No. Megestrol acetate is not a DEA-scheduled controlled substance. It is not listed in any schedule under the Controlled Substances Act. This means any licensed prescriber — including primary care physicians, nurse practitioners, physician assistants, and telehealth providers — can prescribe Megestrol without a special DEA registration.
There are no federal limits on the number of refills for Megestrol prescriptions, and it can be called in, e-prescribed, or faxed. However, it is a prescription-only medication — it is not available over the counter. Because of the serious risks associated with long-term use (adrenal suppression, thromboembolic events, fetal harm), medical supervision is essential.
Weight gain (15-70% at high doses) — often the desired therapeutic effect
Nausea (7%)
Edema / fluid retention (5%)
Vaginal bleeding / breakthrough bleeding (7-8%)
Impotence / decreased libido
Hypertension
Diarrhea and flatulence
Rash
Adrenal insufficiency — with chronic use or abrupt discontinuation; can be life-threatening
Cushing's syndrome — with high-dose chronic use
Thromboembolic events — DVT, pulmonary embolism
New-onset or worsening diabetes
Hypogonadism — low sex hormones, osteoporosis risk with long-term use
Fetal harm — contraindicated in pregnancy (Category X)
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Dronabinol (Marinol)
FDA-approved for AIDS-related anorexia. Synthetic cannabinoid (THC). Schedule III. More modest weight gain than Megestrol; may cause psychoactive effects.
Mirtazapine (Remeron)
Antidepressant with reliable appetite-stimulating properties. Off-label use for cachexia. Not a controlled substance; also helpful for nausea, insomnia, and depression.
Medroxyprogesterone (Provera)
Structurally related progestin. Most established substitute for Megestrol in endometrial cancer and some cachexia indications. Carries similar thromboembolic risk.
Oxandrolone (Oxandrin)
Anabolic steroid (Schedule III) FDA-approved for weight gain in wasting states. Promotes lean muscle mass gain rather than fat mass. Useful in male patients with HIV-associated wasting.
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Warfarin (Coumadin)
majorMegestrol increases INR in patients on warfarin, raising bleeding risk. Monitor INR closely when starting, stopping, or changing Megestrol dose.
Indinavir (Crixivan)
majorMegestrol reduces indinavir blood levels by ~21-32%, potentially causing HIV treatment failure. Higher indinavir dose may be needed when co-administered.
Rifampin (Rifadin)
moderateRifampin is a CYP3A4 inducer that speeds Megestrol metabolism, reducing its blood levels and therapeutic effect.
Insulin / Oral Diabetes Medications
moderateMegestrol can raise blood glucose levels, worsening diabetes control. Monitor blood sugar closely when starting Megestrol.
Corticosteroids (prednisone, dexamethasone)
moderateAdditive glucocorticoid activity increases risk of adrenal suppression, Cushing's syndrome features, and hyperglycemia.
St. John's Wort
moderateCYP3A4 inducer that can reduce Megestrol blood levels similar to rifampin. Avoid concurrent use.
Megestrol acetate has been a workhorse medication in oncology and HIV care for decades, providing meaningful clinical benefit for patients experiencing severe weight loss or living with advanced hormone-sensitive cancers. Its long safety record, generic availability, and broad prescriber access make it an accessible therapy — when it can actually be found.
The 2025-2026 tablet shortage has created real barriers for patients who depend on this medication. The most important steps are: stay in close contact with your prescriber, do not stop Megestrol abruptly, and actively search multiple pharmacy types — independent, specialty, and mail-order — when your usual pharmacy is out of stock.
If you're having trouble locating Megestrol at a pharmacy near you, medfinder is built exactly for this situation — it contacts pharmacies near you to check which ones can fill your prescription and texts you the results, saving you hours of frustrating phone calls.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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