Estradiol valerate/cyproterone acetate

{{Short description|Combination drug}}

{{Drugbox

| image = Estradiol valerate.svg

| width = 225px

| caption =

| image2 = Cyproterone acetate.svg

| width2 = 250px

| caption2 = Estradiol valerate (top) and
cyproterone acetate (bottom)

| type = combo

| drug_name = Estradiol valerate /
cyproterone acetate

| component1 = Estradiol valerate

| class1 = Estrogen

| component2 = Cyproterone acetate

| class2 = Progestogen

| tradename = Climen, Femilar

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| legal_UK =

| legal_US = Rx-only

| routes_of_administration = By mouth

| class = Estrogen; Progestogen

| CAS_number = 108116-22-9

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| synonyms = EV/CPA

}}

Estradiol valerate/cyproterone acetate (EV/CPA), sold under the brand names Climen and Femilar among others, is a combination product of estradiol valerate (EV), an estrogen, and cyproterone acetate (CPA), a progestogen, which is used in menopausal hormone therapy and as a birth control pill to prevent pregnancy. It is taken by mouth. Climen, which is used in menopausal hormone therapy, is a sequential preparation that contains 2 mg estradiol valerate and 1 mg CPA.{{cite book| vauthors = Husmann F |chapter=Clinical Experiences with a Combination of Estradiol Valerate and Cyproterone Acetate for Hormone Replacement |title=Women's Health and Menopause|volume=11|year=1997|pages=257–261|issn=0928-9550|doi=10.1007/978-94-011-5560-1_38|series=Medical Science Symposia Series|publisher=Springer |isbn=978-94-010-6343-2}}{{cite journal | vauthors = Schneider HP | title = Androgens and antiandrogens | journal = Annals of the New York Academy of Sciences | volume = 997 | issue = 1 | pages = 292–306 | date = November 2003 | pmid = 14644837 | doi = 10.1196/annals.1290.033 | s2cid = 8400556 | bibcode = 2003NYASA.997..292S }}{{cite journal | vauthors = Schneider HP | title = The role of antiandrogens in hormone replacement therapy | journal = Climacteric | volume = 3 | issue = Suppl 2 | pages = 21–27 | date = December 2000 | pmid = 11379383 }} It was the first product for use in menopausal hormone therapy containing CPA to be marketed and is available in more than 40 countries. Femilar, which is an estradiol-containing birth control pill, contains 1 to 2 mg estradiol valerate and 1 to 2 mg CPA, and has been approved for use in Finland since 1993.{{cite journal | vauthors = Fruzzetti F, Trémollieres F, Bitzer J | title = An overview of the development of combined oral contraceptives containing estradiol: focus on estradiol valerate/dienogest | journal = Gynecological Endocrinology | volume = 28 | issue = 5 | pages = 400–408 | date = May 2012 | pmid = 22468839 | pmc = 3399636 | doi = 10.3109/09513590.2012.662547 }}

CPA alone has been found to suppress ovulation in 3 of 5 women at a dose of 0.5 mg/day and in 5 of 5 women at a dose of 1 mg/day.{{cite journal | vauthors = Endrikat J, Gerlinger C, Richard S, Rosenbaum P, Düsterberg B | title = Ovulation inhibition doses of progestins: a systematic review of the available literature and of marketed preparations worldwide | journal = Contraception | volume = 84 | issue = 6 | pages = 549–557 | date = December 2011 | pmid = 22078182 | doi = 10.1016/j.contraception.2011.04.009 }}{{cite journal | vauthors = Spona J, Schneider WH, Bieglmayer C, Schroeder R, Pirker R | title = Ovulation inhibition with different doses of levonorgestrel and other progestogens: clinical and experimental investigations | journal = Acta Obstetricia et Gynecologica Scandinavica. Supplement | volume = 88 | issue = | pages = 7–15 | date = 1979 | pmid = 393050 | doi = 10.3109/00016347909157223 | s2cid = 30486799 }}{{cite journal | vauthors = Spona J, Huber J, Schmidt JB | title = [Inhibition of ovulation with 35 micrograms of ethinyl estradiol and 2 mg of cyproterone acetate (Diane 35)] | language = German | journal = Geburtshilfe und Frauenheilkunde | volume = 46 | issue = 7 | pages = 435–438 | date = July 1986 | pmid = 3093307 | doi = 10.1055/s-2008-1026659 | s2cid = 260156932 | trans-title = Inhibition of ovulation with 35 micrograms of ethinyl estradiol and 2 mg of cyproterone acetate (Diane 35) }}{{cite journal | vauthors = Spona J, Huber J | title = Efficacy of low-dose oral contraceptives containing levonorgestrel, gestoden and cyproterone acetate | journal = Gynecologic and Obstetric Investigation | volume = 23 | issue = 3 | pages = 184–193 | date = 1987 | pmid = 2954886 | doi = 10.1159/000298860 }}{{cite book | vauthors = Spona J, Huber J, Schmidt JB | veditors = Schindler AE | title=Antiandrogen-Estrogen Therapy for Signs of Androgenization | chapter=Ovulation inhibitory effect of SH B 209 AE (Diane-35)—a new antiandrogen-estrogen combination | publisher=De Gruyter | publication-place=Berlin, Boston | date=1987-12-31 | doi=10.1515/9783110866902-006 | pages=51–58| isbn=9783110866902 }}{{cite book | vauthors = Hammerstein J | title=Hair and Hair Diseases | chapter=Antiandrogens: Clinical Aspects | publisher=Springer Berlin Heidelberg | publication-place=Berlin, Heidelberg | year=1990 | doi=10.1007/978-3-642-74612-3_35 | pages=827–886| isbn=978-3-642-74614-7 }} Ovulation inhibition with Femilar occurred in 94.4% of 108 women during the third treatment cycle in one study and in almost 100% of 26 women over 12 treatment cycles in another study (except for one woman who ovulated during her first treatment cycle).{{cite journal | vauthors = Hirvonen E, Allonen H, Anttila M, Kulmala Y, Ranta T, Rautiainen H, Sipilä P, Ylöstalo P | display-authors = 6 | title = Oral contraceptive containing natural estradiol for premenopausal women | journal = Maturitas | volume = 21 | issue = 1 | pages = 27–32 | date = January 1995 | pmid = 7731379 | doi = 10.1016/0378-5122(94)00856-3 }}{{cite journal | vauthors = Hirvonen E, Stenman UH, Mälkönen M, Rasi V, Vartiainen E, Ylöstalo P | title = New natural oestradiol/cyproterone acetate oral contraceptive for pre-menopausal women | journal = Maturitas | volume = 10 | issue = 3 | pages = 201–213 | date = October 1988 | pmid = 2972897 | doi = 10.1016/0378-5122(88)90023-0 }}