Finasteride

Finasteride Brand Names- Propecia | Proscar

What is Finasteride

Finasteride is a 5-alpha reductase inhibitor used to treat symptomatic benign prostatic hyperplasia (BPH), a condition found in the majority of men over the age of 50.

Finasteride has been shown to increase and maintain maximum urine flow rate in men with BPH, although less than 50% of men show improvement despite a reduction in prostate size. In a typical patient undergoing treatment for BPH with finasteride (>= 6 months), a 50% decrease in serum PSA concentrations can be expected; however, individual patients may experience varying decreases in PSA values.

During treatment, serum PSA concentrations may decrease even in the presence of prostate cancer. If clinicians use serum PSA concentrations as an aid in the detection of prostate cancer in men receiving finasteride, values should be doubled for comparison with normal ranges in untreated men.

Any increase from baseline, even if the value is within the normal range for untreated men, may signal the presence of prostate cancer. If clinicians elect to use percent free PSA (free to total PSA ratio) as a marker, no adjustment in PSA values appear to be necessary as the value is not significantly decreased by finasteride.

In June 2011, a review of two large, randomized controlled trials, the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial prompted the FDA to alert healthcare professionals of the potential risk of an increased incidence of high-grade prostate cancer in patients receiving finasteride or dutasteride treatment.

Results from the PCPT trial showed that men receiving finasteride had a 26% decreased risk of being diagnosed with prostate cancer overall when compared to placebo (p < 0.0001); however, the risk reduction was limited to Gleason score (GS) <= 6 cancers. There was an increased incidence of GS 8—10 prostate cancers with finasteride compared to placebo (1.8% vs. 1.1%, respectively).

Finasteride is also used for treating hair loss in men and has been shown to be effective for mild to moderate hair loss of the vertex and anterior mid-scalp area; efficacy in bitemporal recession has not been established.

Finasteride (Proscar) was approved by the FDA in June 1992 for the treatment of BPH. Another finasteride oral dosage form, Propecia, was approved by the FDA in December 1997 for the treatment of male pattern baldness (i.e., androgenetic alopecia).

Finasteride is also used investigationally as an alternative agent for treating hirsutism.

Indications

1. alopecia
2. benign prostatic hyperplasia (BPH)
3. hirsutism
4. prostate cancer prophylaxis

For the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to improve symptoms, to reduce the risk of acute urinary retention, and to reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy

Side Effects

1. angioedema
2. breast enlargement
3. decreased ejaculate volume
4. depression
5. ejaculation dysfunction
6. gynecomastia
7. impotence (erectile dysfunction)
8. infertility
9. libido decrease
10. mastalgia
11. new primary malignancy
12. oligospermia
13. orgasm dysfunction
14. pruritus
15. rash
16. spermatogenesis inhibition
17. teratogenesis
18. testicular pain
19. urticaria

Monitoring Parameters

• prostate-specific antigen (PSA)

Contraindications

• blood donation
• breast-feeding
• children
• females
• geriatric
• hepatic disease
• infants
• infertility
• pregnancy
• prostate cancer
• urinary tract obstruction

Interactions

• Saw Palmetto, Serenoa repens
• Terazosin