Ethinylestradiol and Cyproterone acetate

[markospan]

Dear Dr Hale and colleagues,
I am trying to find current information about the safety of using a combined pill containing 0.035mg Ethinylestradiol and 2mg Cyproterone acetate once per day by a nursing mother. Breastfeeding is well established (the baby is already 5 months old) and the mother has been prescribed this medication for alopecia, together with topical minoxidil which is supposed to be safe.
Thank you in advance for your help.
M.Panagopoulos MD,
Patras, Greece

[admin]

Dear Dr. Panagopoulos*

The medication you mentioned contains cyproterone acetate, which is an anti-androgen drug. We know that androgens are necessary for the healthy development of infants, especially male infants and androgen blockers are extremely teratogenic during pregnancy. Lack of androgens results in abnormalities in the external genitalia of the male fetus and potentially a young male or female infant. At this time, we believe that this product is probably too hazardous to use in breastfeeding mothers solely because it inhibits the androgen receptor.

As far as topical minoxidil is concerned, limited absorption via skin would minimize systemic levels and significantly reduce risk of transfer to infant via breastmilk. It is unlikely that the amount absorbed via topical application would produce clinically relevant concentrations in breastmilk.

One of the common treatments of patchy hair loss used in the US are intra dermal*injections of triamcinolone. We generally consider this safe, because only minimal doses are used and plasma levels are*exceedingly*low.

Tassneem Abdel Karim MD
InfantRisk Center*

Thomas W. Hale Ph.d.