Cyproterone Acetate Discontinuation Protocol
There is no specific discontinuation protocol required for cyproterone acetate; however, gradual dose reduction is recommended to maintain physiological stability, especially for long-term users. 1, 2
General Discontinuation Approach
- For patients on long-term cyproterone acetate therapy, a gradual tapering approach is preferred over abrupt discontinuation to minimize potential hormonal fluctuations 1
- The tapering schedule should be individualized based on the original indication, dose, and duration of treatment 2
Specific Recommendations for Tapering
- For prolactinoma treatment: If considering discontinuation after normalization of prolactin levels for at least 2 years with no visible tumor on MRI, gradual dose reduction is recommended while maintaining normoprolactinaemia 3
- For transgender hormone therapy: Careful consideration of discontinuation is necessary as it may result in significant exacerbation of gender dysphoria, potential depression and/or anxiety 2
- For prostate cancer treatment: No specific tapering protocol is required when discontinuing as part of treatment modification 1, 4
Monitoring During Discontinuation
- Regular monitoring of hormone levels relevant to the original indication for therapy 2
- Assessment for withdrawal symptoms or recurrence of the original condition 1
- For patients with prolactinoma, serum prolactin monitoring should continue for at least 2 years after discontinuation 3
Special Considerations
- Antiandrogen withdrawal syndrome: In some prostate cancer patients, discontinuation of cyproterone acetate may actually lead to temporary PSA decline and clinical improvement (antiandrogen withdrawal syndrome) 5
- Return of androgenic effects: Patients should be informed that androgenic effects previously suppressed by cyproterone (such as libido, erectile function, and other androgen-dependent functions) will gradually return after discontinuation 6
- Timing of reversal effects: Effects of cyproterone typically reverse in the opposite order of onset - ability to achieve orgasm returns first, followed by ability to achieve erection, and finally libido 6
Contraindications to Abrupt Discontinuation
- Long-term use (several years) 2
- High-dose therapy (>100mg daily) 1
- Patients with significant risk of psychological distress from hormonal fluctuations 2
Sample Tapering Schedule
- For patients on high doses (100-200mg daily): Reduce by 50mg every 2-4 weeks 1, 2
- For patients on moderate doses (50-100mg daily): Reduce by 25mg every 2-4 weeks 1
- For patients on low doses (<50mg daily): Reduce by 12.5mg every 2-4 weeks 2