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Finasteride

Finasteride is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. It is used in benign prostatic hyperplasia (BPH) in low doses, and in prostate cancer in higher doses. Additionally, it is registered in many countries for male-pattern baldness. Drug trade names include Propecia® and Proscar ® both products of Merck & Co. (the former is marketed for hair loss in male pattern baldness, and the latter for BPH). more...

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The Prostate Cancer Prevention Trial (PCPT) showed at a dosage of 5mg per day, as is commonly prescribed for BPH, though much higher than the 1mg generally prescribed for hair loss, participants taking finasteride were 25% less likely to have developed prostate cancer at the end of the trial compared to those taking a placebo. However, the cancers that developed in the men taking finasteride looked like they were more likely to grow and spread. The reason for this is not known. The study researchers are continuing to watch these men to see if these cancers truly are more aggressive. At lower doses, this effect is less well-defined.

Recognised side-effects, experienced by around 4% of users, include erectile dysfunction, and less often gynecomastia (breast gland enlargement). In trial studies, side effects ceased after dosage was discontinued.

Side effects

Finasteride is not indicated for use by women. Do not take or handle this medication if you are pregnant or could become pregnant during treatment. Finasteride is in the FDA pregnancy category X. This means that it is known to cause birth defects in an unborn baby. Women who are or who may become pregnant must not handle crushed or broken Finasteride tablets. The medication could be absorbed through the skin. Propecia is known to cause birth defects in a developing male baby. Exposure to whole tablets should be avoided whenever possible, however exposure to whole tablets is not expected to be harmful as long as the tablets are not swallowed. It is not known whether Finasteride passes into breast milk. Finasteride is not intended for use by women and this medication should not be taken if you are breast-feeding a baby. It appears that Finasteride does pass into the semen of men, thus caution should be used to avoid ingestion of semen during oral sex if a woman is pregnant or may become pregnant.

Finasteride can also be used to mask steroid abuse, and many professional sports have banned finasteride use for this reason.

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Large prostate? New drug provides relief - finasteride
From Science News, 6/8/91 by Kathy A. Fackelmann

An experimental drug can help relieve urinary problems caused by a swollen prostate gland, a new study indicates. If proved safe, the drug may one day replace surgery as the standard treatment for the more serious stages of this condition, which to some degree afflicts most men aged 50 and older.

The normally walnut-sized prostate gland, just below the bladder, tends to swell as men grow older. If the enlarged gland compresses the urethra, it can restrict the flow of urine -- and in some cases eventually shut down urination. Standard treatment for advanced cases involves surgically trimming the enlarged gland -- a costly procedure that causes impotence in some cases.

But the new drug, finasteride, appears to provide an alternative to surgery, according to results from a year-long, placebo-controlled drug trial involving 1,645 men suffering from an enlarged prostate. The study, reported in Toronto this week at an American Urological Association meeting, showed finasteride reduced prostated size by at least 20 percent in most of the 550 men who received the higher of two experimental dosages -- 5 milligrams daily.

"Our clinical data suggest that finasteride can halt progression of the disease," says Elizabeth Stoner, a researcher at Merck Sharp & Dohme, the pharmaceutical firm that developed finasteride. Stoner presented her team's data, compiled by 76 centers in North America, Australia, New Zealand and Europe.

In most men, an enlarged prostate will cause urinary symptoms to worsen over time. But after one year on finasteride, 57 percent of the treated men reported a "modest" improvement in urine flow. This suggests the drug helps reverse progressive enlargement of the prostate, Stoner says. The 550 men receiving daily placebo pills reported no such relief from urinary troubles.

Stoner's team suspects finasteride works by inhibiting an enzyme (5-alpha reductase) that converts the male hormone testosterone to dihydrotestoster-one, a substance that fuels the growth of the prostate.

Finasteride "holds promise" as a new treatment for enlarged prostates, says H. Logan Holtgrewe, a urologist at Johns Hopkins University in Baltimore. However, he cautions, to sustain its effects, men would have to take the drug for the rest of their lives. Though Stoner agrees, she notes that the trial revealed just a few, mild side effects, including general weakness. Merck plans to study finasteride's long-term safely and efficacy in another trial, she adds.

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