How long can patient remain on cyproterone OC?
K. HAHLWEG, MD, of Winnipeg, MB, wants to know: "What exactly is the risk of venous thromboembolism (VTE) of the oral contraceptive (OC) containing cyproterone acetate/ethinyl estradiol (Diane-35) vs other OCs and vs pregnancy itself? What's the maximum amount of time you'd allow a patient to stay on this medication?"
Despite numerous reports in the media regarding the risk of VTE from cyproterone/ethinyl estradiol vs other OCs, the literature is still difficult to interpret. As a result, this contraceptive should only be prescribed if acne and hirsutism need to be treated, but not otherwise. The main risk factors for VTE remain age, obesity, family history and factor V Leiden mutation -- and the rate goes up dramatically in pregnancy and the immediate postpartum period. I'd have no reason to limit the time a patient remains on cyproterone if she has acne and/or hirsutism.
(see our clinical pharmacologist's response to this question in the clinical pharmacology category)