Absorption The oral bioavailability of CPA is 68 to 100%. The absorption of oral CPA is slow but complete, and the medication is not subject to a significant first-pass effect. The mean absorption half-life of oral CPA is about 1.5 hours. Steady-state levels of CPA occur with oral CPA after about 8 days of continuous administration, with a 2- to 3-fold gradual accumulation in CPA levels. Oral CPA is taken daily and intramuscular CPA is administered weekly or biweekly. Following a single low oral dose of 2 mg CPA in combination with 35 or 50 μg ethinylestradiol in premenopausal women, mean peak levels of CPA of 7.2 to 15.2 ng/mL (17–36.5 nmol/L) have been recorded after 1.6 to 3.7 hours. In healthy men, a single high oral dose of 100 mg CPA produced maximal CPA levels of 254 ng/mL (609 nmol/L) after 2.6 hours. In aged men with prostate cancer, continuous oral CPA therapy resulted in CPA levels of 132 ± 18 ng/mL at 25 mg/day, 246 ± 13 ng/mL at 50 mg/day, and 348 ± 23 ng/mL at 100 mg/day. Similarly, in healthy young women, a single high oral dose of 100 mg CPA resulted in peak CPA levels of 255 ng/mL (612 nmol/L) within 2 to 3 hours. During continuous treatment with high oral doses of CPA in women with hirsutism, levels of CPA were 199 to 228 ng/mL (477–547 nmol/L) with 50 mg/day CPA and were 436 to 520 ng/mL (1050–1250 nmol/L) with 100 mg/day CPA. After a single intramuscular injection of 300 mg CPA in healthy young women, maximal levels of CPA of 191 ng/mL (458 nmol/L) and of 15β-OH-CPA of 164 ng/mL occurred after 2 to 4 days. During continuous weekly intramuscular injections of CPA in men with prostate cancer, mean levels of CPA roughly doubled from 170 ng/mL (408 nmol/L) after the first injection to 310 ng/mL (744 nmol/L) after the fifth injection, and were projected to increase to 350 to 400 ng/mL (840–960 nmol/L) after around 8 to 12 injections. The area-under-the-curve (AUC; total exposure) levels of CPA with 100 mg/day oral CPA and 300 mg/week intramuscular CPA may be approximately equivalent. Distribution With oral CPA, there is a probable distribution phase of CPA into tissues which lasts about 12 hours and has a half-life of 3 hours. CPA is very lipophilic, and it is sequestered into fat, which provides a depot effect. The volume of distribution of CPA is 20.6 ± 3.5 L/kg. CPA crosses the blood–brain barrier, which is evidenced by the suppression of gonadotropin secretion that is observed during therapy with it (the site of action of this effect being the pituitary gland, a part of the brain). In terms of plasma protein binding, CPA does not bind to SHBG or corticosteroid-binding globulin and is instead bound exclusively to albumin (93%), with the remainder (7%) circulating free or unbound. The affinity of CPA for SHBG is very low at about 0.006% of that of testosterone or DHT. Metabolism Metabolism of CPA. CPA is metabolized primarily by hydroxylation via CYP3A4, forming the major active metabolite 15β-hydroxycyproterone<unk> . This metabolite circulates at concentrations approximately twice those of CPA, and has similar antiandrogen activity to that of CPA but only 10% of its activity as a progestogen. As a result, the co-administration of CPA with drugs which inhibit CYP3A4 may increase its potency as a progestogen. Some CPA is reportedly metabolized by hydrolysis into<unk>  and acetic acid. However, unlike many other steroid esters, CPA is not extensively hydrolyzed, and much of the pharmacological activity of the drug is attributable to CPA itself in its unchanged form.<unk>  has approximately one-third the potency of CPA as an antiandrogen and is devoid of progestogenic activity. The elimination half-life of oral CPA is relatively long at approximately 1.6 to 2.2 days (38 to 53 hours), but possibly as long as 3.6 to 4.3 days (86 to 100 hours). The half-life of 15β-OH-CPA with oral administration of CPA is 2.6 days. The elimination half-life of CPA is prolonged in obese patients, which may be due to relatively greater storage of CPA in fat. The elimination half-life of CPA is also longer in older individuals; it is approximately twice as long in elderly men than in younger men (95 hours and 45 hours, respectively). When given via depot intramuscular injection, CPA has an elimination half-life of 3 to 4.3 days while 15β-OH-CPA has a half-life of 5.2 days. The duration of action of a single intramuscular injection of CPA is about 14 to 20 days. The serum total clearance of CPA is approximately 2.32 ± 0.38 mL/min/kg. Levels of CPA and 15β-OH-CPA with oral administration decrease biphasically over a period of 24 to 120 hours. Excretion CPA is excreted 70% in feces and 30% in urine.
Pharmacology of cyproterone acetate
Pharmacology of bicalutamide
Pharmacokinetics of testosterone
Pharmacokinetics of estradiol
Prolactin modulator
Steroidal antiandrogen
Feminizing hormone therapy
Masculinizing hormone therapy