cyproterone acetate + ethinylestradiol: clinical use

Prescribing considerations

• Restrict use to licensed androgen-sensitive indications; for acne, topical therapy or systemic antibiotics should previously have failed.
• Do not prescribe solely for contraception or alongside another hormonal contraceptive.
• Assess thrombotic history, smoking, obesity, blood pressure, migraine, cardiovascular risk and planned immobilisation or surgery.
• Exclude pregnancy and investigate suspicious unexplained vaginal bleeding before initiation.
• Review whether the indication and overall benefit–risk balance remain present.

Contraindications and cautions

• Current or previous venous or arterial thrombosis, stroke, or major predisposition to thrombosis
• Migraine with focal neurological symptoms
• Severe or multiple vascular risk factors, including severe hypertension or diabetes with vascular disease
• Severe active liver disease, liver function that has not normalised, or liver tumours
• Current or previous breast cancer
• Meningioma or history of meningioma
• Pregnancy or breastfeeding
• Concurrent hormonal contraception
• Specified interacting hepatitis C antiviral combinations
• Hypersensitivity to an ingredient

Monitoring

• Blood pressure and vascular risk factors
• New or worsening migraine, neurological symptoms or thrombotic features
• Mood changes, especially severe depression or suicidal thinking
• Persistent or new abnormal bleeding
• Clinical features of hepatic dysfunction
• Changes in interacting medicines and relevant laboratory-test interpretation

Clinical pharmacology

Cyproterone acetate has progestogenic and anti-androgen activity, blocking androgen receptors and reducing ovarian androgen synthesis. Ethinylestradiol suppresses the hypothalamic–pituitary–ovarian axis and increases sex-hormone-binding globulin; ovulation is inhibited and free androgen exposure falls.

Formulation and product differences

• Co-cyprindiol is a light-pink film-coated tablet containing lactose.
• Dianette is a beige sugar-coated tablet containing lactose and sucrose.
• Excipient differences may matter in rare hereditary carbohydrate-intolerance disorders.

Tablet

Route: Oral

Strengths: 2000 micrograms + 35 micrograms