Alopecia finasteride

Finasteride and minoxidil are used to treat androgenic alopecia. Finasteride shrinks the prostate in benign prostatic hypertrophy (BPH). Flutamidc is a testosterone receptor blocker used in prostate... 

Finasteride (Propecia) is a 5K-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (see Chapter 40), the androgen responsible for androgenic alopecia in genetically predisposed men. Oral finasteride, 1 mg/d, promotes hair growth and prevents further hair loss in a significant proportion of men with androgenic alopecia. 

There are no data to support the use of finasteride in women with androgenic alopecia. Pregnant women should not be exposed to finasteride either by use or by handling crushed tablets because of the risk of hypospadias developing in a male fetus. 

In an open comparative study of androgenetic alopecia in 90 men oral finasteride (1 mg/day for 12 months n = 65) was compared with 5% topical minoxidil solution twice daily (n = 25) (22). The cure rates were 80% for oral finasteride and 52% for topical minoxidil. The adverse effects were all mild, and did not lead to withdrawal of treatment. Of the 65 men given oral finasteride, six had loss of libido, and one had an increase in body hair at other sites irritation of the scalp was seen in one of those who used minoxidil. These adverse events disappeared as soon as the treatment was withdrawn. The laboratory data did not show any statistically or clinically significant changes from baseline values to the endpoint, except for the serum total testosterone concentration, which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were reduced from baseline values. 

A 43-year-old man developed impaired vision in both eyes over 3 months. Anterior subcapsular opacities were found in both eyes, necessitating cataract extraction. He had been taking finasteride 1 mg/day for 3 years to treat the early stage of androgenic alopecia. It was suspected that the drug was responsible and the treatment was therefore withdrawn. 

A 23-year-old man who was taking finasteride 1 mg/ day for 2 months for androgenetic alopecia developed painful enlargement of his right breast (71). Treatment was withdrawn and resolution occurred after 2 months. 

A 53-year-old man developed unilateral gynecomastia following finasteride therapy for alopecia (75). On needle biopsy the mammary mass was diagnosed as... 

A 30-year man who was being successfully treated for obesity with sibutramine started to take finasteride to treat alopecia. Soon afterwards he developed paranoid psychotic behavior. The reaction abated and disappeared when finasteride was withdrawn. 

Libecco JF, Bergfeld WF. Finasteride in the treatment of alopecia. Expert Opin Pharmacother 2004 5(4) 933-40. 

Area E, Acikgoz G, Tastan HB, Kose O, Kurumlu Z. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology 2004 209 117-25. 

Kaufman KD. Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. Eur J Dermatol 2002 12 38-49. 

Tosti A, Pazzaglia M, Soli M, Rossi A, Rebora A, Atzori L, Barbareschi M, Benci M, Voudouris S, Vena GA. Evaluation of sexual function with an International Index of Erectile Function in subjects taking finasteride for andro-genetic alopecia. Arch Dermatol 2004 140 857-8. 

Finasteride (Propecia) is a 5 -reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone, the androgen responsible for androgenic alopecia in genetically predisposed men. Oral finasteride, 1 mg/d, promotes hair growth and prevents further hair loss in a significant proportion of men with androgenic alopecia. Treatment for at least 3-6 months is necessary to see increased hair growth or prevent further hair loss. Continued treatment with finasteride is necessary to sustain benefit. Reported side effects include decreased libido, ejaculation disorders, and erectile dysfunction, which resolve in most men who remain on therapy and in all men who discontinue finasteride. 

Fig. 7. Effects of finasteride in androgenetic alopecia. (A) 5a-Reductase-mediated conversion of testosterone (T) to dihydrotestosterone (DHT) leads to miniaturization of scalp hair follicles and eventual hair loss. (B) Finasteride inhibits continued miniaturization of scalp hair follicles and (C) converts miniaturized follicles back to terminal ana-gen hairs with time, leading to an increase of terminal scalp hair growth and slowing of further hair loss. (Panel A adapted from Randall et al., 1991 panels B and C from Kaufman and Dawber, 1999.)...

Soon after the introduction of finasteride to treat alopecia, a 30-year-old man taking sibutramine developed paranoid psychotic behavior (27). This drug interaction was demonstrated by careful clinical follow-up and the use of Naranjo s algorithm. 

Finasteride (2) Propecia Merck Androgenetic alopecia (men only) 1 mg tablet 1 tabletlday Prescription... 

Sexual function An American group has systematically reviewed the use of finasteride for the treatment of androgenic alopecia and found 12 published studies in 3927 patients that they regarded as eligible for inclusion [48 ]. As far as adverse reactions were concerned, moderate-quality evidence suggested an increase in erectile dysfunction (RR = 2.2 95% CI = 1.03, 4.8 NNTh=82 95% Cl = 56, 231) and a possible increase in the risk of any sexual disturbances (RR=1.4 95% Cl = 0.99,2.0). However, the risk of discontinuing treatment because of sexual adverse reactions was similar to that of placebo. The authors found moderate evidence that daily use of oral finasteride... 

Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androge-netic alopecia a systematic review. Arch Dermatol 2010 146 1141-50. 

Further observations performed in a subset of subjects treated with finasteride for male pattern hair loss seems, also, to indicate that sexual dysfunction as well as anxious/depressive symptomatology may occur at the end of the treatment and continue after discontinuation [26. A possible hypothesis to explain the depression symptoms after finasteride treatment might be impairment in the levels of neuroactive steroids. Therefore, neuroactive steroid levels were evaluated in paired plasma and cerebrospinal fluid samples obtained from male patients who received finasteride for the treatment of androgenic alopecia and who, after drug discontinuation, still show long-term sexual side effects as well as anxious/depressive symptomatology. 

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