Co-cyprindiol

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Co-cyprindiol on Prescriptsy

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Co-cyprindiol is a combined hormonal preparation containing cyproterone acetate 2 mg and ethinylestradiol 35 micrograms, licensed in the United Kingdom for the treatment of severe acne in women that has not responded to prolonged oral antibiotic therapy, and for moderately severe hirsutism.

It is also known by the brand name Dianette, though several generic versions are available.

While co-cyprindiol provides effective contraception as a secondary benefit, it is not licensed as a contraceptive and should not be prescribed for that purpose alone.

Acne vulgaris is one of the most common skin conditions in the UK, affecting up to 95% of people between 11 and 30 years of age to some degree.

In most cases it resolves with topical treatments or short courses of oral antibiotics, but a proportion of women develop persistent, severe, or scarring acne driven by androgen sensitivity.

Hirsutism, defined as excess terminal hair growth in a male pattern distribution, affects approximately 5 to 10% of women and can be equally distressing.

Co-cyprindiol addresses these conditions by targeting the underlying androgen-driven pathology.

This page provides a comprehensive clinical overview of how co-cyprindiol works, who it is suitable for, how to take it, expected timelines, side effects, important safety warnings, and how to obtain a prescription in the UK.

Important safety information about co-cyprindiol

Before reading further, note the following essential safety points. Co-cyprindiol is a prescription-only medicine (POM) in the UK and must only be used under medical supervision.

• Co-cyprindiol carries a higher risk of venous thromboembolism (blood clots) than most standard combined oral contraceptive pills. Your prescriber must assess your individual risk before starting treatment.
• Do not take co-cyprindiol if you have a personal or strong family history of blood clots, a known clotting disorder, uncontrolled hypertension, migraine with aura, or if you smoke and are over 35.
• Treatment should continue only for as long as necessary to control the androgen-dependent condition, typically no longer than 3 to 4 cycles after acne or hirsutism has resolved.
• Do not take co-cyprindiol alongside another hormonal contraceptive.
• Stop taking co-cyprindiol and seek immediate medical attention if you develop sudden chest pain, severe leg pain or swelling, unexplained breathlessness, sudden visual disturbance, or an unusually severe headache.

Understanding androgen-driven acne and hirsutism

Androgens, particularly testosterone and its more potent metabolite dihydrotestosterone (DHT), stimulate the sebaceous glands in the skin to produce sebum.

Excess sebum contributes to blocked pores (comedones), bacterial proliferation, and the inflammatory lesions characteristic of acne. In women, circulating androgens are produced by the ovaries and adrenal glands.

While total androgen levels may be within the normal range, some women have increased skin sensitivity to androgens, resulting in disproportionate sebum production and acne.

Hirsutism results from androgen stimulation of vellus hair follicles, causing them to convert to thicker, darker terminal hairs in androgen-sensitive areas including the upper lip, chin, chest, abdomen, and lower back.

The severity is assessed using the modified Ferriman-Gallwey score. Moderately severe hirsutism (score 15 and above) is a recognised indication for co-cyprindiol.

In both conditions, anti-androgen therapy addresses the hormonal root cause rather than simply treating the surface symptoms. This is why co-cyprindiol can succeed where topical treatments and antibiotics have failed.

How co-cyprindiol works: mechanism of action

Co-cyprindiol contains two active substances that work synergistically to reduce androgen activity in the skin.

Cyproterone acetate is a potent anti-androgen. It competitively blocks the androgen receptor, preventing testosterone and DHT from binding to and activating receptors in sebaceous glands and hair follicles.

It also acts as a progestogen, suppressing the midcycle LH surge and thereby reducing ovarian androgen production.

Additionally, cyproterone acetate inhibits 5-alpha reductase activity in the skin, reducing local conversion of testosterone to DHT.

Ethinylestradiol is a synthetic oestrogen that provides two key functions.

First, it stimulates hepatic synthesis of sex hormone-binding globulin (SHBG), a carrier protein that binds circulating testosterone and renders it biologically inactive.

Serum SHBG levels can double or triple during treatment, substantially reducing free testosterone available to act on skin structures.

Second, ethinylestradiol provides cycle control and, together with cyproterone acetate, suppresses ovulation, conferring contraceptive efficacy.

The combined anti-androgenic effect reduces sebum production by up to 50% over several months, leading to clearing of existing acne lesions and prevention of new ones.

Hair follicle cycling is similarly modulated, with gradual thinning and slowing of androgen-dependent hair growth over 6 to 12 months.

Clinical evidence and UK prescribing guidance

Co-cyprindiol has been available in the UK since 1985.

Randomised controlled trials and large observational studies have demonstrated its effectiveness in reducing acne lesion counts by 60 to 80% over 6 months in women with moderate to severe acne.

It is particularly effective for inflammatory acne affecting the lower face, jawline, and neck, patterns that are commonly androgen-driven.

NICE Clinical Knowledge Summaries on acne vulgaris position co-cyprindiol as a second or third-line treatment option for women whose acne has not responded adequately to topical retinoids, benzoyl peroxide, and oral tetracyclines.

The British Association of Dermatologists (BAD) guidelines similarly recommend anti-androgen therapy as a consideration in women with acne resistant to conventional treatments.

For hirsutism, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Endocrine Society recognise combined oral contraceptives with anti-androgenic progestogens as first-line pharmacological therapy. Co-cyprindiol, with its dedicated anti-androgen action, is a well-established choice.

The MHRA has issued specific guidance regarding VTE risk, advising that co-cyprindiol should be prescribed only for the licensed indications and withdrawn once the condition has resolved. Repeat prescriptions should be reviewed at regular intervals.

Dosage and administration

Take one co-cyprindiol tablet daily for 21 consecutive days, at approximately the same time each day, followed by a 7-day tablet-free interval.

A withdrawal bleed similar to a period usually occurs during the break. Start the next 21-day course after the 7-day interval regardless of whether bleeding has stopped.

First-time users should start on day 1 of the menstrual cycle (the first day of natural bleeding). Contraceptive protection begins immediately if started on day 1.

If started later in the cycle (up to day 5), additional barrier contraception is recommended for the first 7 days.

Clinical improvement in acne typically becomes apparent after 2 to 3 months of treatment, with full benefit at around 6 months.

Treatment for hirsutism generally requires 6 to 12 months before a noticeable reduction in hair growth.

Once the condition has cleared or reached an acceptable level, continue co-cyprindiol for a further 3 to 4 cycles and then discontinue.

If ongoing contraception is needed, switch to a standard combined oral contraceptive with lower thrombotic risk.

Missed tablets

If a tablet is missed by fewer than 12 hours, take it as soon as you remember and continue as normal; contraceptive protection is maintained.

If more than 12 hours late, take the missed tablet immediately, continue with the rest of the pack, and use additional barrier contraception for the next 7 days.

If those 7 days extend beyond the last tablet in the pack, start the next pack without a tablet-free interval.

Side effects of co-cyprindiol

Common side effects

Side effects are broadly consistent with those of combined hormonal contraceptives.

Commonly reported effects include headache, nausea, breast tenderness and fullness, mood changes (including feelings of low mood or irritability), reduced libido, and breakthrough bleeding or spotting in the first few cycles.

Many of these settle within the first 2 to 3 months as the body adjusts.

Uncommon and rare side effects

Less common effects include migraine, fluid retention, weight gain (usually modest), changes in cervical secretions, skin hyperpigmentation (chloasma, especially with sun exposure), and contact lens intolerance.

Rare but serious adverse effects include venous thromboembolism (deep vein thrombosis or pulmonary embolism), arterial thromboembolism (stroke, myocardial infarction), liver dysfunction, and cholestatic jaundice.

Prolonged use of cyproterone acetate at higher doses has been associated with the development of meningioma (a usually benign brain tumour).

While the 2 mg dose in co-cyprindiol is substantially lower than the doses at which this risk was identified, the MHRA advises against unnecessary long-term use.

When to seek urgent medical advice

Stop taking co-cyprindiol and seek emergency care (call 999 or attend A&E) if you experience sudden severe chest pain or tightness, unexplained breathlessness, pain or swelling in one leg (particularly the calf), sudden severe headache unlike your normal headaches, sudden partial or complete loss of vision, slurred speech, or weakness on one side of the body.

These may be signs of a blood clot, stroke, or heart attack requiring immediate treatment.

Contact your GP or NHS 111 for persistent headaches, significant mood changes, jaundice (yellowing of skin or eyes), or any new symptoms that concern you.

Report any suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Venous thromboembolism risk

Co-cyprindiol is associated with a higher risk of VTE than standard combined oral contraceptives containing levonorgestrel.

The estimated incidence is approximately 1.5 to 2 times that of levonorgestrel-containing pills.

Risk factors for VTE include obesity (BMI above 30), smoking, immobility (including long-haul travel), recent surgery, family history of VTE under age 45, and inherited thrombophilia.

Your prescriber will conduct a thorough risk assessment before initiating treatment and should reassess at each review.

Discontinue co-cyprindiol at least 4 weeks before elective surgery or any procedure requiring prolonged immobilisation. Do not restart until you are fully mobile.

If immobilisation is unplanned (for example, after an injury requiring a plaster cast), seek medical advice about whether to stop the preparation and use alternative contraception.

Cardiovascular considerations

Co-cyprindiol should not be used in women with uncontrolled hypertension, ischaemic heart disease, a history of stroke or transient ischaemic attack, valvular heart disease with complications, or atrial fibrillation.

Women who develop migraine with aura during treatment must stop immediately, as this is a risk factor for ischaemic stroke.

Liver function

Co-cyprindiol is contraindicated in women with active liver disease or a history of liver tumours. If jaundice, hepatitis, or generalised pruritus develops during treatment, stop the preparation and do not restart until liver function has returned to normal.

Drug interactions

Enzyme-inducing medicines reduce the contraceptive and anti-androgenic efficacy of co-cyprindiol.

These include rifampicin, rifabutin, certain anticonvulsants (carbamazepine, phenytoin, phenobarbital, primidone, topiramate, oxcarbazepine), the antiretroviral ritonavir, and the herbal remedy St John's Wort.

If you are prescribed any of these, discuss alternative acne treatment or additional contraceptive measures with your clinician.

Co-cyprindiol versus standard combined oral contraceptives

Several combined oral contraceptives contain progestogens with mild anti-androgenic properties, including drospirenone (Yasmin), dienogest (Qlaira), and norgestimate (Cilest). These may provide modest improvement in mild to moderate acne.

However, co-cyprindiol offers the most potent anti-androgen effect due to cyproterone acetate and is reserved for cases where other treatments have proved inadequate.

The trade-off is a higher VTE risk, which is why co-cyprindiol is not recommended as a first-choice contraceptive and should be used only for its licensed indications.

How to get a co-cyprindiol prescription in the UK

Co-cyprindiol is a prescription-only medicine available through the NHS.

Your GP can prescribe it following a clinical assessment of your acne or hirsutism, including a review of previous treatments tried and an assessment of VTE risk factors.

Blood pressure, BMI, smoking status, and relevant medical and family history will be evaluated.

Dermatology referral may be appropriate if acne is severe, scarring, or has not responded to multiple treatments. Your dermatologist can initiate co-cyprindiol or consider alternatives such as oral isotretinoin.

Authorised online prescribers registered with the General Pharmaceutical Council (GPhC) may also prescribe co-cyprindiol following a structured online consultation that includes a thorough assessment of eligibility and risk factors.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Living with acne and hirsutism: practical advice

While co-cyprindiol addresses the hormonal driver of these conditions, complementary measures can support treatment outcomes. Use a gentle, non-comedogenic cleanser and avoid harsh scrubbing, which can worsen inflammation.

Apply non-oily moisturisers and broad-spectrum sunscreen daily, especially as chloasma risk is increased during hormonal treatment.

Avoid picking or squeezing spots, as this increases the risk of scarring and secondary infection.

For hirsutism, co-cyprindiol slows new hair growth but does not remove existing terminal hairs.

Physical hair removal methods such as shaving, waxing, threading, or laser hair reduction can be used alongside pharmacological treatment.

Laser and intense pulsed light (IPL) treatment may be available on the NHS in some areas for severe cases; discuss a referral with your GP or dermatologist.

When to seek medical advice

Contact your GP or NHS 111 if your acne worsens significantly despite treatment, if you develop new or worsening mood symptoms, or if you have any concerns about your medication.

Seek emergency care (call 999 or attend A&E) if you develop signs of a blood clot or stroke as described in the warnings section above.

Report any adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

• Co-cyprindiol 2000/35 Tablets, Summary of Product Characteristics (EMC)
• Co-cyprindiol, British National Formulary (BNF)
• NICE CKS: Acne vulgaris
• Acne, NHS
• British Association of Dermatologists, Acne
• MHRA Yellow Card Scheme