Finasteride (Proscar) is a type II 5 alpha reductase inhibitor that inhibits the activation of testosterone to dihydrotestosterone. It is used to treat BPH and male pattern hair baldness.

Finasteride (Proscar) Uses:

• Androgenetic alopecia (Propecia):

  • It is indicated for the treatment of male pattern hair loss in men only.
  • Limitations of use:
    • It is not indicated for the treatment of alopecia in women. Furthermore, the efficacy of the drug in patients with bitemporal recession has not been established.

• Benign prostatic hyperplasia (Proscar):

  • It is indicated as monotherapy for the treatment of patients with symptomatic benign prostatic hyperplasia to:
    • improve the patients symptoms
    • reduce the risks of developing acute urinary retention
    • reduce or delay the need for BPH-related surgery.
  • It may be used in combination with doxazosin or another alpha blocker to reduce the risk of symptomatic progression.1
  • Limitations of use:
    • It has not been approved for the prevention if prostate cancer.

• Off Label Use of Finasteride in Adults:

  • Hirsutism

Finasteride (Proscar) Dose in Adults

Finasteride (Proscar) Dose in the treatment of Benign prostatic hyperplasia (Proscar):

• Males:
  • 5 mg orally once a day as monotherapy or in combination with doxazosin.
  • Patients may notice clinical response early with treatment, however, it may take up to six months.

Finasteride (Proscar) Dose in the treatment of Hirsutism (off-label):

• Females:
  • 2.5 to 5 mg orally once a day.
  • Assess clinical response at 6 months interval before adjusting the dose, switching therapy, or adding additional agents.

Finasteride (Proscar) Dose in the treatment of Male pattern baldness (Propecia):

• Males:
  • 1 mg orally once a day.
  • It may take up to 3 months or longer if clinically significant benefits are observed.
  • To sustain clinically significant benefits, the drug should be used continuously.

Dose in children:

Not recommended for use in children.

Finasteride (Proscar) Pregnancy Risk Factor X

• It is not recommended for pregnant women.
• Because it inhibits testosterone, it can cause abnormalities in male fetuses' external genitalia.
• Avoid contact with brojen or crushed tablets for pregnant women
• PCOS-positive females who use the drug for hirsuitism should be informed of appropriate contraception in order to prevent pregnancy.

Breastfeeding: Finasteride is not recommended

• It is unknown if the drug will be excreted into breastmilk.
• This should be avoided by females with childbearing potential.

Dose in Kidney Disease:

Adjustment in the dose is not necessary.

Dose in Liver disease:

• The manufacturer has not provided any dose adjustment in patients with liver disease.
• However, since the drug is extensively metabolized in the liver, it should be used with caution in these patients.

Common Side Effects of Finasteride (Proscar):

• Genitourinary:

  • Impotence

Less Common Side Effects of Finasteride (Proscar):

• Cardiovascular:

  • Orthostatic Hypotension
  • Peripheral Edema
  • Hypotension

• Endocrine & Metabolic:

  • Decreased Libido
  • Gynecomastia

• Genitourinary:

  • Ejaculatory Disorder
  • Decreased Ejaculate Volume
  • Sexual Disorder
  • Breast Tenderness

• Hematologic & Oncologic:

  • Prostate Cancer

• Respiratory:

  • Rhinitis

Contraindications to Finasteride (Proscar):

• Allergy reactions to finasteride and any component of the formulation
• Women of childbearing potential or pregnancy

Warnings and precautions

• Reduced urinary flow

  • Patients with a high residual urinary volume, or signs of obstruction of the urinary system may not be eligible for 5-alpha reductase inhibitors.

• Hepatic impairment

  • Patients with liver disease should not take the drug as it is highly metabolized in their liver.

• Prostate cancer:

  • For the prevention of prostate cancer, 5-alpha reductase inhibits have not yet been approved.
  • The incidence of high-grade prostate cancer has increased due to its use.

Monitoring parameters:

• Monitor for the clinical symptoms and signs of benign prostatic hyperplasia that include urinary flow, difficulty in passing urine, and urinary urgency.
• Establish a baseline PSA after six months of the treatment and monitor PSA levels periodically thereafter.

How to administer Finasteride (Proscar)?

• It may be administered with or without meals.
• Pregnant females and Females of childbearing ages should not handle broken or crushed tablets.

Mechanism of action of Finasteride (Proscar):

• It inhibits competitively the Type II 5-alpha reductase enzyme, which converts testosterone into dihydrotestosterone.
• This results in suppression of serum dihydrotestosterone.

Time:

• After discontinuing the drug, it takes 14 days for dihydrotestosterone levels normal to return.
• Patients with BPH can have their prostates returned to normal size within three months of treatment.
• It takes twelve months to reverse the increase in hair count when used to treat male-pattern baldness.

Protein binding:

• About 90%

Metabolism:

• It is metabolized extensively in the liver via CYP3A4 to two active metabolites (<20% activity of finasteride)

Bioavailability:

• Mean:
  • 5 mg: ~63%;
  • 1 mg: 65% (not affected by food)

Half-life elimination, serum:

• 5 to 6 hours (range: 3 to 16 hours);
• Older patients (≥70 years): 8 hours (range: 6 to 15 hours)

Time to peak, serum:

• 1 to 2 hours

Excretion:

• Feces (57%) and urine (39%; as metabolites)

International Brand Names of Finasteride:

• Propecia
• Proscar
• ACH-Finasteride
• ACT Finasterid e
• APO-Finasterid
• Auro-Finasterid e
• DOM-Finasterid
• JAMP-Finasterid
• MINT-Finasterid
• MYLAN-Finasterid e HG
• MYLAN-Finasterid
• PMS-Finasterid e
• RAN-Finasterid
• RATIO-Finasteride
• RIVA-Finasterid
• SANDOZ Finasteride
• SANDOZ Finasterid A
• TEVA-Finasteride
• VAN-Finasterid
• Alofecid
• Alopec
• Alopros 5
• Androfin
• Aprodil
• Atepros
• Bearfina
• Benstat
• Binfin
• Binfin 5
• Chibro-Proscar
• Damocare
• Damopecia
• Daric
• Fina-5
• Finapecia
• Finapros
• Finarid
• Finas
• Finascar
• Finaspro
• Finaspros
• Finast
• Finasta
• Finastar
• Finastid
• Finated
• Finatra
• Fincar
• Finide
• Finiscar
• Finnacar
• Finpro
• Finstal-5
• Finster
• Fintrid
• Firide
• Fistrin
• For-BPH
• Fynasid
• GPO-Finax
• Harifin
• Jun Neng
• Maxteride
• Monastar
• Nopecia
• Penester
• Pro-Cure
• Profal
• Prohair
• Pronax
• Pronor
• Propecia
• Propeshia
• Proscar
• Proseride
• Prosfin
• Prostacare
• Prostan
• Prostanus
• Prostarinol
• Prosterid
• Prosteride
• Prostide
• Prostop
• Proteside
• Reprostom
• Skarex
• Stercia
• Stercia-5
• Sterzar
• Tensen
• Uromedin

Finasteride Brand Names in Pakistan: