Cyproterone acetate and meningioma

Risk of meningioma with cyproterone acetate increases with increasing cumulative dose

MHRA guidance has stated (1):

• use of cyproterone is contraindicated in patients with previous or current meningioma (for all indications) and should only be considered for control of libido in severe hypersexuality or paraphilias in adult men when other interventions are inappropriate (1)
• a cumulative dose-dependent association between cyproterone acetate and the known increased risk of meningioma - risk is thought to be rare overall, but is highest for doses of 25mg per day and above
• clinicians should be vigilant for symptoms and signs of meningioma in patients taking cyproterone; stop treatment permanently if a meningioma is diagnosed in a patient taking cyproterone

Notes:

• overall, the risk of meningioma is still considered to be rare (between 1 in 1,000 patients and 1 in 10,000 people, depending on the dose and duration of treatment). The risk increases with increasing cumulative doses
• meningiomas are usually benign, but as they are space occupying lesions, they can put pressure on neurological structures. This can cause a variety of symptoms including changes in vision, hearing loss or ringing in the ears (tinnitus), loss of smell, headaches that worsen with time, memory loss, seizures, or weakness in extremities

Reference:

• MHRA (June 29th 2020).Cyproterone acetate: new advice to minimise risk of meningioma.