Ethinyl Estradiol/Cyproterone acetate
 BRAND NAMES
- International: Diane, Diane-35 PI, Minerva
- Austria: Alisma
- Croatia: Bellune
- Philippines: Althea, Ancea
- Switzerland: Cyprelle
- UK: Acnocin, Clairette, Dianette
 MECHANISM OF ACTION
Ethinyl estradiol/Cyproterone is a progestogen-oestrogen combination for the treatment of signs of androgenisation in the woman. At the same time, it is a reliable contraceptive for women who suffer primarily from these signs or in whom acne and similar conditions occur or deteriorate under the use of other ovulation inhibitors.
Cyproterone blocks the effect of endogenously produced and exogenously administered androgens at the target organs by means of competitive inhibition. This results in a gradual regression of signs of androgenisation, irrespective of whether increased androgen values or increased peripheral sensitivity, are the cause of the disorder. The decrease in androgen concentration at the target organs has an additional therapeutic effect.
While Ethinyl estradiol/Cyproterone contraceptive pill is being taken, the increased sebaceous gland function, which plays an important role in the development of acne and seborrhoea, is reduced. This leads - usually after 3 to 4 months of therapy - to the healing of existing acne efflorescences. The excessive greasiness of the hair and skin generally disappears earlier. The loss of hair which frequently accompanies seborrhoea likewise diminishes. Treatment with Ethinyl estradiol/Cyproterone contraceptive pill is indicated in women of child-bearing age who exhibit mild forms of hirsutism, and in particular in slightly increased facial hair; results do not, however, become apparent until after several months of use.
Apart from the described antiandrogen effect, cyproterone acetate has also a pronounced progestational action. The combination of ethinyloestradiol and cyproterone acetate prevents a possible pregnancy by the inhibition of ovulation, the inspissation of cervical mucus so as to constitute a barrier to sperm, and the rendering of the endometrium unreceptive to implantation.
- Androgen-dependent acne, especially those forms which are accompanied by seborrhoea or by inflammation or formation of nodes (acne papulopustulosa, acne nodulocystica), androgen-dependent alopecia and mild forms of hirsutism.
- Oral contraception in women requiring anti-androgen therapy.
If the hirsutism has only recently appeared or has lately intensified to a considerable extent the cause (androgen-producing tumour or an adrenal-enzyme defect) must be clarified by differential diagnosis.
The first course of Ethinyl Estradiol/Cyproterone acetate contraceptive pill is started on the first day of the cycle (the first day of the menstrual bleeding is counted as day 1 of the cycle). The first tablet should be taken from the starter section of the calendar pack by selecting the appropriate tablet for that day of the week (eg "Mon" for Monday). The tablet is swallowed whole with a little liquid. It does not matter at what time of the day the tablet is taken, but once the patient has selected a particular time, the tablet should be taken as near as possible at the same time each day. A tablet is then taken every day in the direction shown by the arrows until the pack is empty.
If the patient is using hormonal contraceptives, the doctor should decide when she should start treatment. The same applies to patients who have just had a delivery or an abortion.
The first cycle may be somewhat shorter than usual, whereas all following cycles will last four weeks.
An additional, non-hormonal method of contraception (with the exception of the rhythm and temperature methods) should be employed during the first 14 days of the first treated cycle.
Subsequent courses After the last tablet has been taken from the first pack, tablet-taking is continued from a new pack on the very next day. The first tablet must again be taken from the starter section of the calendar pack marked with the appropriate day of the week.
Length of use The length of use depends on the severity of the clinical picture. In general, treatment should be carried out over several months. It is recommended that Ethinyl Estradiol/Cyproterone acetate contraceptive pill be taken for at least another 3 to 4 cycles after the signs have subsided. Should there be a recurrence weeks or months after discontinuation of tablet-taking, treatment with Ethinyl Estradiol/Cyproterone acetate contraceptive pill may be resumed.
Preparations containing oestrogen/progestogen combinations should not be used in the presence of any of the conditions listed below. Should any of the conditions appear for the first time during their use, the product should be stopped immediately.
- Presence or a history of venous or arterial thrombotic/thromboembolic events (e.g. deep venous thrombosis, pulmonary embolism, myocardial infarction) or of a cerebrovascular accident.
- Presence or history of prodromi of a thrombosis (e.g. transient ischaemic attack, angina pectoris).
- History of migraine with focal neurological symptoms.
- Diabetes mellitus with vascular involvement.
- The presence of a severe or multiple risk factor(s) for venous or arterial thrombosis may also constitute a contraindication (see PRECAUTIONS).
- Pancreatitis or a history thereof if associated with severe hypertriglyceridemia.
- Presence or history of severe hepatic disease as long as liver function values have not returned to normal.
- Presence or history of liver tumours (benign or malignant).
- Known or suspected sex-steroid influenced malignancies (e.g. of the genital organs or the breasts).
- Undiagnosed vaginal bleeding.
- Known or suspected pregnancy.
- Hypersensitivity to any of the ingredients
 PREGNANCY AND LACTATION
 SIDE EFFECTS
 RELATED LINKS
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|Topical antibiotics||Clindamycin (Topical) • Erythromycin (Topical)|
|Topical retinoids||Adapalene • Tazarotene • Tretinoin|
|Oral retinoids||Isotretinoin (Oral)|
|Oral contraceptives||Estradiol valerate/Dienogest • Ethinyl Estradiol/Cyproterone acetate|
|Topical Antibacterial/Keratolytic||Benzoyl peroxide • Hydrogen Peroxide Cream|
|Topical combination products||Clindamycin/Benzoyl peroxide • Adapalene/Benzoyl peroxide • Clindamycin/Tretinoin • Miconazole/Benzoyl peroxide • Erythromycin/Benzoyl peroxide • Erythromycin/Isotretinoin|