Medroxyprogesterone Acetate as a Respiratory Stimulant in Hypercapnic COPD, Postmenopausal COPD, Obesity Induced Hypoventilation, Obstructive Sleep Apnea, and Polycythemia

Respiratory failure occurs in many conditions like chronic obstructive pulmonary disease, post-menopause, obesity-induced hypoventilation, polycythemia, etc. Maintaining adequate ventilation and rescuing vital organs from oxygen deprivation are crucial. Though long-term oxygen therapy is beneficial in alleviating hypoventilation, it prolongs hospitalization, acknowledges opportunistic infections, and affects patients' mobility. Invasive and non-invasive ventilation is limited to tertiary healthcare setup. Many hormones are proposed to have a physiological role in breathing via peripheral and central pathways. Progesterone, leptin, thyroxin, and corticotropin-releasing hormones are known to have a stimulant effect on respiration. There are several respiratory stimulants currently in use but welcoming new respiratory stimulants with sufficient clinical evidence is beneficial. As to existing clinical evidence, Medroxyprogesterone acetate (MPA) not only illustrates a contraceptive role but is also involved in regulating respiratory mechanisms through central stimulation. Genomic and nongenomic mechanisms of action of MPA are widely considered. However, mechanisms affecting genioglossal muscle activity have been attributed to reducing upper airway collapsibility. Hyperventilation increased mouth occlusion pressure and increased peak inspiratory flow rate was discovered in response to medroxyprogesterone treatment. Long-term MPA therapy showed enough respiratory stimulation in various conditions like post-menopausal sleep apnea, obstructive sleep apnea, and chronic type II respiratory failure with excessive carbon dioxide retention. There is also clinical evidence of combination therapies of MPA with Acetazolamide/Chlormadinone/Estrogen/Domperidone uprighting the advantages of MPA therapy. Hence MPA can play a vital role in revamping failed respiratory mechanisms, preventing long-term oxygen therapy, and also putting a stop to extensive hospitalization.