DRUGS & SUPPLEMENTS

Finasterid

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Finasterid uses


1 INDICATIONS AND USAGE

Finasterid, is a 5α-reductase inhibitor, indicated for the treatment of symptomatic benign prostatic hyperplasia in men with an enlarged prostate to (1.1):

  • Improve symptoms
  • Reduce the risk of acute urinary retention
  • Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.

Finasterid administered in combination with the alpha-blocker doxazosin is indicated to reduce the risk of symptomatic progression of BPH (a confirmed ≥4 point increase in American Urological Association (AUA) symptom score) (1.2).

Limitations of Use: Finasterid is not approved for the prevention of prostate cancer (1.3).

1.1 Monotherapy

Finasterid® is indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to:

  • Improve symptoms
  • Reduce the risk of acute urinary retention
  • Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.

1.2 Combination with Alpha-Blocker

Finasterid administered in combination with the alpha-blocker doxazosin is indicated to reduce the risk of symptomatic progression of BPH symptom score).

1.3 Limitations of Use

Finasterid is not approved for the prevention of prostate cancer.

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2 DOSAGE AND ADMINISTRATION

Finasterid may be administered with or without meals.

Finasterid may be administered with or without meals.

Monotherapy: One tablet (5 mg) taken once a day (2.1).

Combination with Doxazosin: One tablet (5 mg) taken once a day in combination with the alpha-blocker doxazosin  (2.2).

2.1 Monotherapy

The recommended dose of Finasterid is one tablet (5 mg) taken once a day .

2.2 Combination with Alpha-Blocker

The recommended dose of Finasterid is one tablet (5 mg) taken once a day in combination with the alpha-blocker doxazosin .

3 DOSAGE FORMS AND STRENGTHS

5-mg blue, modified apple-shaped, film-coated tablets, with the code MSD 72 on one side and Finasterid on the other.

5-mg film-coated tablets (3).

4 CONTRAINDICATIONS

Finasterid is contraindicated in the following:

  • Hypersensitivity to any component of this medication.
  • Pregnancy. Finasterid use is contraindicated in women when they are or may potentially be pregnant. Because of the ability of Type II 5α-reductase inhibitors to inhibit the conversion of testosterone to 5α-dihydrotestosterone (DHT), Finasterid may cause abnormalities of the external genitalia of a male fetus of a pregnant woman who receives Finasterid. If this drug is used during pregnancy, or if pregnancy occurs while taking this drug, the pregnant woman should be apprised of the potential hazard to the male fetus. In female rats, low doses of Finasterid administered during pregnancy have produced abnormalities of the external genitalia in male offspring.

Hypersensitivity to any components of this product (4).

Women who are or may potentially be pregnant (4, 5.4, 8.1, 16).

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5 WARNINGS AND PRECAUTIONS

  • Finasterid reduces serum prostate specific antigen levels by approximately 50%. However, any confirmed increase in PSA while on Finasterid may signal the presence of prostate cancer and should be evaluated, even if those values are still within the normal range for men not taking a 5α-reductase inhibitor (5.1).
  • Finasterid may increase the risk of high-grade prostate cancer (5.2, 6.1).
  • Women should not handle crushed or broken Finasterid tablets when they are pregnant or may potentially be pregnant due to potential risk to a male fetus (5.3, 8.1, 16).
  • Finasterid is not indicated for use in pediatric patients or women (5.4, 8.1, 8.3, 8.4, 12.3).
  • Prior to initiating treatment with Finasterid for BPH, consideration should be given to other urological conditions that may cause similar symptoms (5.6).

5.1 Effects on Prostate Specific Antigen (PSA) and the Use of PSA in Prostate Cancer Detection

In clinical studies, Finasterid reduced serum PSA concentration by approximately 50% within six months of treatment. This decrease is predictable over the entire range of PSA values in patients with symptomatic BPH, although it may vary in individuals.

For interpretation of serial PSAs in men taking Finasterid, a new PSA baseline should be established at least six months after starting treatment and PSA monitored periodically thereafter. Any confirmed increase from the lowest PSA value while on Finasterid may signal the presence of prostate cancer and should be evaluated, even if PSA levels are still within the normal range for men not taking a 5α-reductase inhibitor. Non-compliance with Finasterid therapy may also affect PSA test results. To interpret an isolated PSA value in patients treated with Finasterid for six months or more, PSA values should be doubled for comparison with normal ranges in untreated men. These adjustments preserve the utility of PSA to detect prostate cancer in men treated with Finasterid.

Finasterid may also cause decreases in serum PSA in the presence of prostate cancer.

The ratio of free to total PSA (percent free PSA) remains constant even under the influence of Finasterid. If clinicians elect to use percent free PSA as an aid in the detection of prostate cancer in men undergoing Finasterid therapy, no adjustment to its value appears necessary.

5.2 Increased Risk of High-Grade Prostate Cancer

Men aged 55 and over with a normal digital rectal examination and PSA ≤3.0 ng/mL at baseline taking Finasterid 5 mg/day in the 7-year Prostate Cancer Prevention Trial had an increased risk of Gleason score 8-10 prostate cancer (finasteride 1.8% vs placebo 1.1%). Similar results were observed in a 4-year placebo-controlled clinical trial with another 5α-reductase inhibitor (dutasteride, AVODART) (1% dutasteride vs 0.5% placebo). 5α-reductase inhibitors may increase the risk of development of high-grade prostate cancer. Whether the effect of 5α-reductase inhibitors to reduce prostate volume, or study-related factors, impacted the results of these studies has not been established.

5.3 Exposure of Women - Risk to Male Fetus

Women should not handle crushed or broken Finasterid tablets when they are pregnant or may potentially be pregnant because of the possibility of absorption of Finasterid and the subsequent potential risk to a male fetus. Finasterid tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets have not been broken or crushed.

5.4 Pediatric Patients and Women

Finasterid is not indicated for use in pediatric patients or women .

5.5 Effect on Semen Characteristics

Treatment with Finasterid for 24 weeks to evaluate semen parameters in healthy male volunteers revealed no clinically meaningful effects on sperm concentration, mobility, morphology, or pH. A 0.6 mL (22.1%) median decrease in ejaculate volume with a concomitant reduction in total sperm per ejaculate was observed. These parameters remained within the normal range and were reversible upon discontinuation of therapy with an average time to return to baseline of 84 weeks.

5.6 Consideration of Other Urological Conditions

Prior to initiating treatment with Finasterid, consideration should be given to other urological conditions that may cause similar symptoms. In addition, prostate cancer and BPH may coexist.

Patients with large residual urinary volume and/or severely diminished urinary flow should be carefully monitored for obstructive uropathy. These patients may not be candidates for Finasterid therapy.

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6 ADVERSE REACTIONS

The drug-related adverse reactions, reported in ≥1% in patients treated with Finasterid and greater than in patients treated with placebo over a 4-year study are: impotence, decreased libido, decreased volume of ejaculate, breast enlargement, breast tenderness and rash.


To report SUSPECTED ADVERSE REACTIONS, contact Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., at 1-877-888-4231 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch .

6.1 Clinical Trials Experience

Finasterid is generally well tolerated; adverse reactions usually have been mild and transient.

4-Year Placebo-Controlled Study (PLESS)

In PLESS, 1524 patients treated with Finasterid and 1516 patients treated with placebo were evaluated for safety over a period of 4 years. The most frequently reported adverse reactions were related to sexual function. 3.7% (57 patients) treated with Finasterid and 2.1% (32 patients) treated with placebo discontinued therapy as a result of adverse reactions related to sexual function, which are the most frequently reported adverse reactions.

Table 1 presents the only clinical adverse reactions considered possibly, probably or definitely drug related by the investigator, for which the incidence on Finasterid was ≥1% and greater than placebo over the 4 years of the study. In years 2-4 of the study, there was no significant difference between treatment groups in the incidences of impotence, decreased libido and ejaculation disorder.

Year 1

(%)

Years 2, 3 and 4Combined Years 2-4

(%)

Finasterid Placebo Finasterid Placebo
N = 1524 and 1516, Finasterid vs placebo, respectively
    Impotence 8.1 3.7 5.1 5.1
    Decreased

    Libido

6.4 3.4 2.6 2.6
    Decreased

    Volume of

    Ejaculate


3.7


0.8


1.5


0.5

    Ejaculation

    Disorder

0.8 0.1 0.2 0.1
    Breast

    Enlargement

0.5 0.1 1.8 1.1
    Breast

    Tenderness

0.4 0.1 0.7 0.3
    Rash 0.5 0.2 0.5 0.1

Phase III Studies and 5-Year Open Extensions

The adverse experience profile in the 1-year, placebo-controlled, Phase III studies, the 5-year open extensions, and PLESS were similar.

Medical Therapy of Prostatic Symptoms (MTOPS) Study

In the MTOPS study, 3047 men with symptomatic BPH were randomized to receive Finasterid 5 mg/day (n=768), doxazosin 4 or 8 mg/day (n=756), the combination of Finasterid 5 mg/day and doxazosin 4 or 8 mg/day (n=786), or placebo (n=737) for 4 to 6 years.

The incidence rates of drug-related adverse experiences reported by ≥2% of patients in any treatment group in the MTOPS Study are listed in Table 2.

The individual adverse effects which occurred more frequently in the combination group compared to either drug alone were: asthenia, postural hypotension, peripheral edema, dizziness, decreased libido, rhinitis, abnormal ejaculation, impotence and abnormal sexual function. Of these, the incidence of abnormal ejaculation in patients receiving combination therapy was comparable to the sum of the incidences of this adverse experience reported for the two monotherapies.

Combination therapy with Finasterid and doxazosin was associated with no new clinical adverse experience.

Four patients in MTOPS reported the adverse experience breast cancer. Three of these patients were on Finasterid only and one was on combination therapy.

The MTOPS Study was not specifically designed to make statistical comparisons between groups for reported adverse experiences. In addition, direct comparisons of safety data between the MTOPS study and previous studies of the single agents may not be appropriate based upon differences in patient population, dosage or dose regimen, and other procedural and study design elements.

Adverse Experience Placebo

(N=737)

(%)

Doxazosin

4 mg or 8 mgDoxazosin dose was achieved by weekly titration (1 to 2 to 4 to 8 mg). The final tolerated dose (4 mg or 8 mg) was administered at end-Week 4. Only those patients tolerating at least 4 mg were kept on doxazosin. The majority of patients received the 8-mg dose over the duration of the study.

(N=756)

(%)

Finasterid

(N=768)

(%)

Combination

(N=786)

(%)

  Body as a whole
        Asthenia 7.1 15.7 5.3 16.8
        Headache 2.3 4.1 2.0 2.3
  Cardiovascular
        Hypotension 0.7 3.4 1.2 1.5
        Postural Hypotension 8.0 16.7 9.1 17.8
  Metabolic and Nutritional
        Peripheral Edema 0.9 2.6 1.3 3.3
  Nervous
        Dizziness 8.1 17.7 7.4 23.2
        Libido Decreased 5.7 7.0 10.0 11.6
        Somnolence 1.5 3.7 1.7 3.1
  Respiratory
        Dyspnea 0.7 2.1 0.7 1.9
        Rhinitis 0.5 1.3 1.0 2.4
  Urogenital
        Abnormal Ejaculation 2.3 4.5 7.2 14.1
        Gynecomastia 0.7 1.1 2.2 1.5
        Impotence 12.2 14.4 18.5 22.6
        Sexual Function Abnormal 0.9 2.0 2.5 3.1
Long-Term Data

High-Grade Prostate Cancer

The PCPT trial was a 7-year randomized, double-blind, placebo-controlled trial that enrolled 18,882 men ≥55 years of age with a normal digital rectal examination and a PSA ≤3.0 ng/mL. Men received either Finasterid (finasteride 5 mg) or placebo daily. Patients were evaluated annually with PSA and digital rectal exams. Biopsies were performed for elevated PSA, an abnormal digital rectal exam, or the end of study. The incidence of Gleason score 8-10 prostate cancer was higher in men treated with Finasterid (1.8%) than in those treated with placebo (1.1%) . In a 4-year placebo-controlled clinical trial with another 5α-reductase inhibitor (dutasteride, AVODART), similar results for Gleason score 8-10 prostate cancer were observed (1% dutasteride vs 0.5% placebo).

No clinical benefit has been demonstrated in patients with prostate cancer treated with Finasterid.

Breast Cancer

During the 4- to 6-year placebo- and comparator-controlled MTOPS study that enrolled 3047 men, there were 4 cases of breast cancer in men treated with Finasterid but no cases in men not treated with Finasterid. During the 4-year, placebo-controlled PLESS study that enrolled 3040 men, there were 2 cases of breast cancer in placebo-treated men but no cases in men treated with Finasterid. During the 7-year placebo-controlled Prostate Cancer Prevention Trial (PCPT) that enrolled 18,882 men, there was 1 case of breast cancer in men treated with Finasterid, and 1 case of breast cancer in men treated with placebo. The relationship between long-term use of Finasterid and male breast neoplasia is currently unknown.

Sexual Function

There is no evidence of increased sexual adverse experiences with increased duration of treatment with Finasterid. New reports of drug-related sexual adverse experiences decreased with duration of therapy.

6.2 Postmarketing Experience

The following additional adverse events have been reported in postmarketing experience with Finasterid. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure:

  • hypersensitivity reactions, such as pruritus, urticaria, and angioedema (including swelling of the lips, tongue, throat, and face)
  • testicular pain
  • sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, decreased libido and ejaculation disorders (e.g. reduced ejaculate volume). These events were reported rarely in men taking Finasterid for the treatment of BPH. Most men were older and were taking concomitant medications and/or had co-morbid conditions. The independent role of Finasterid in these events is unknown.
  • male infertility and/or poor seminal quality were reported rarely in men taking Finasterid for the treatment of BPH. Normalization or improvement of poor seminal quality has been reported after discontinuation of Finasterid. The independent role of Finasterid in these events is unknown.
  • depression
  • male breast cancer.

The following additional adverse event related to sexual dysfunction that continued after discontinuation of treatment has been reported in postmarketing experience with Finasterid at lower doses used to treat male pattern baldness. Because the event is reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate its frequency or establish a causal relationship to drug exposure:

  • orgasm disorders
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7 DRUG INTERACTIONS

7.1 Cytochrome P450-Linked Drug Metabolizing Enzyme System

No drug interactions of clinical importance have been identified. Finasterid does not appear to affect the cytochrome P450-linked drug metabolizing enzyme system. Compounds that have been tested in man have included antipyrine, digoxin, propranolol, theophylline, and warfarin and no clinically meaningful interactions were found.

7.2 Other Concomitant Therapy

Although specific interaction studies were not performed, Finasterid was concomitantly used in clinical studies with acetaminophen, acetylsalicylic acid, α-blockers, angiotensin-converting enzyme (ACE) inhibitors, analgesics, anti-convulsants, beta-adrenergic blocking agents, diuretics, calcium channel blockers, cardiac nitrates, HMG-CoA reductase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, H2 antagonists and quinolone anti-infectives without evidence of clinically significant adverse interactions.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category X.

Finasterid is contraindicated for use in women who are or may become pregnant. Finasterid is a Type II 5α-reductase inhibitor that prevents conversion of testosterone to 5α-dihydrotestosterone (DHT), a hormone necessary for normal development of male genitalia. In animal studies, Finasterid caused abnormal development of external genitalia in male fetuses. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the male fetus.

Abnormal male genital development is an expected consequence when conversion of testosterone to 5α-dihydrotestosterone (DHT) is inhibited by 5α-reductase inhibitors. These outcomes are similar to those reported in male infants with genetic 5α-reductase deficiency. Women could be exposed to Finasterid through contact with crushed or broken Finasterid tablets or semen from a male partner taking Finasterid. With regard to Finasterid exposure through the skin, Finasterid tablets are coated and will prevent skin contact with Finasterid during normal handling if the tablets have not been crushed or broken. Women who are pregnant or may become pregnant should not handle crushed or broken Finasterid tablets because of possible exposure of a male fetus. If a pregnant woman comes in contact with crushed or broken Finasterid tablets, the contact area should be washed immediately with soap and water. With regard to potential Finasterid exposure through semen, two studies have been conducted in men receiving Finasterid 5 mg/day that measured Finasterid concentrations in semen .

In an embryo-fetal development study, pregnant rats received Finasterid during the period of major organogenesis (gestation days 6 to 17). At maternal doses of oral Finasterid approximately 0.1 to 86 times the maximum recommended human dose (MRHD) of 5 mg/day (based on AUC at animal doses of 0.1 to 100 mg/kg/day) there was a dose-dependent increase in hypospadias that occurred in 3.6 to 100% of male offspring. Exposure multiples were estimated using data from nonpregnant rats. Days 16 to 17 of gestation is a critical period in male fetal rats for differentiation of the external genitalia. At oral maternal doses approximately 0.03 times the MRHD (based on AUC at animal dose of 0.03 mg/kg/day), male offspring had decreased prostatic and seminal vesicular weights, delayed preputial separation and transient nipple development. Decreased anogenital distance occurred in male offspring of pregnant rats that received approximately 0.003 times the MRHD (based on AUC at animal dose of 0.003 mg/kg/day). No abnormalities were observed in female offspring at any maternal dose of Finasterid.

No developmental abnormalities were observed in the offspring of untreated females mated with Finasterid treated male rats that received approximately 61 times the MRHD (based on AUC at animal dose of 80 mg/kg/day). Slightly decreased fertility was observed in male offspring after administration of about 3 times the MRHD (based on AUC at animal dose of 3 mg/kg/day) to female rats during late gestation and lactation. No effects on fertility were seen in female offspring under these conditions.

No evidence of male external genital malformations or other abnormalities were observed in rabbit fetuses exposed to Finasterid during the period of major organogenesis (gestation days 6-18) at maternal oral doses up to 100 mg/kg/day, (finasteride exposure levels were not measured in rabbits). However, this study may not have included the critical period for Finasterid effects on development of male external genitalia in the rabbit.

The fetal effects of maternal Finasterid exposure during the period of embryonic and fetal development were evaluated in the rhesus monkey (gestation days 20-100), in a species and development period more predictive of specific effects in humans than the studies in rats and rabbits. Intravenous administration of Finasterid to pregnant monkeys at doses as high as 800 ng/day (estimated maximal blood concentration of 1.86 ng/mL or about 143 times the highest estimated exposure of pregnant women to Finasterid from semen of men taking 5 mg/day) resulted in no abnormalities in male fetuses. In confirmation of the relevance of the rhesus model for human fetal development, oral administration of a dose of Finasterid (2 mg/kg/day or approximately 18,000 times the highest estimated blood levels of Finasterid from semen of men taking 5 mg/day) to pregnant monkeys resulted in external genital abnormalities in male fetuses. No other abnormalities were observed in male fetuses and no finasteride-related abnormalities were observed in female fetuses at any dose.

8.3 Nursing Mothers

Finasterid is not indicated for use in women.

It is not known whether Finasterid is excreted in human milk.

8.4 Pediatric Use

Finasterid is not indicated for use in pediatric patients.

Safety and effectiveness in pediatric patients have not been established.

8.5 Geriatric Use

Of the total number of subjects included in PLESS, 1480 and 105 subjects were 65 and over and 75 and over, respectively. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients. No dosage adjustment is necessary in the elderly .

8.6 Hepatic Impairment

Caution should be exercised in the administration of Finasterid in those patients with liver function abnormalities, as Finasterid is metabolized extensively in the liver .

8.7 Renal Impairment

No dosage adjustment is necessary in patients with renal impairment .

10 OVERDOSAGE

Patients have received single doses of Finasterid up to 400 mg and multiple doses of Finasterid up to 80 mg/day for three months without adverse effects. Until further experience is obtained, no specific treatment for an overdose with Finasterid can be recommended.

Significant lethality was observed in male and female mice at single oral doses of 1500 mg/m2 (500 mg/kg) and in female and male rats at single oral doses of 2360 mg/m2 (400 mg/kg) and 5900 mg/m2 (1000 mg/kg), respectively.

11 DESCRIPTION

Finasterid, a synthetic 4-azasteroid compound, is a specific inhibitor of steroid Type II 5α-reductase, an intracellular enzyme that converts the androgen testosterone into 5α-dihydrotestosterone (DHT).

Finasterid is 4-azaandrost-1-ene-17-carboxamide, N-(1,1-dimethylethyl)-3-oxo-,(5α,17ß)-. The empirical formula of Finasterid is C23H36N2O2 and its molecular weight is 372.55. Its structural formula is:

Results seen in earlier studies were comparable to those seen in PLESS. Although an early improvement in urinary symptoms was seen in some patients, a therapeutic trial of at least 6 months was generally necessary to assess whether a beneficial response in symptom relief had been achieved. The improvement in BPH symptoms was seen during the first year and maintained throughout an additional 5 years of open extension studies.

Effect on Acute Urinary Retention and the Need for Surgery

In PLESS, efficacy was also assessed by evaluating treatment failures. Treatment failure was prospectively defined as BPH-related urological events or clinical deterioration, lack of improvement and/or the need for alternative therapy. BPH-related urological events were defined as urological surgical intervention and acute urinary retention requiring catheterization. Complete event information was available for 92% of the patients. The following table (Table 5) summarizes the results.


Patients (%)patients with multiple events may be counted more than once for each type of event



Event Placebo

N=1503

Finasterid

N=1513

Relative

RiskHazard ratio based on log rank test

95% CI P

Value

All Treatment Failures  37.1 26.2 0.68 (0.57 to 0.79) <0.001
    Surgical

    Interventions for

    BPH

10.1 4.6 0.45 (0.32 to 0.63) <0.001
    Acute Urinary

    Retention

    Requiring

    Catheterization

6.6 2.8 0.43 (0.28 to 0.66) <0.001
    Two consecutive

    symptom scores

    ≥20

9.2 6.7
    Bladder Stone 0.4 0.5
    Incontinence 2.1 1.7
    Renal Failure 0.5 0.6
    UTI 5.7 4.9
    Discontinuation

    due to worsening

    of BPH, lack of

    improvement, or

    to receive other

    medical treatment

21.8 13.3

Compared with placebo, Finasterid was associated with a significantly lower risk for acute urinary retention or the need for BPH-related surgery [13.2% for placebo vs 6.6% for Finasterid; 51% reduction in risk, 95% CI: (34 to 63%)]. Compared with placebo, Finasterid was associated with a significantly lower risk for surgery [10.1% for placebo vs 4.6% for Finasterid; 55% reduction in risk, 95% CI: (37 to 68%)] and with a significantly lower risk of acute urinary retention [6.6% for placebo vs 2.8% for Finasterid; 57% reduction in risk, 95% CI: (34 to 72%)]; see Figures 2 and 3.

Effect on Maximum Urinary Flow Rate

In the patients in PLESS who remained on therapy for the duration of the study and had evaluable urinary flow data, Finasterid increased maximum urinary flow rate by 1.9 mL/sec compared with 0.2 mL/sec in the placebo group.

There was a clear difference between treatment groups in maximum urinary flow rate in favor of Finasterid by month 4 (1.0 vs 0.3 mL/sec) which was maintained throughout the study. In the earlier 1-year studies, increase in maximum urinary flow rate was comparable to PLESS and was maintained through the first year and throughout an additional 5 years of open extension studies.

Effect on Prostate Volume

In PLESS, prostate volume was assessed yearly by magnetic resonance imaging (MRI) in a subset of patients. In patients treated with Finasterid who remained on therapy, prostate volume was reduced compared with both baseline and placebo throughout the 4-year study. Finasterid decreased prostate volume by 17.9% (from 55.9 cc at baseline to 45.8 cc at 4 years) compared with an increase of 14.1% (from 51.3 cc to 58.5 cc) in the placebo group (p<0.001).

Results seen in earlier studies were comparable to those seen in PLESS. Mean prostate volume at baseline ranged between 40-50 cc. The reduction in prostate volume was seen during the first year and maintained throughout an additional five years of open extension studies.

Prostate Volume as a Predictor of Therapeutic Response

A meta-analysis combining 1-year data from seven double-blind, placebo-controlled studies of similar design, including 4491 patients with symptomatic BPH, demonstrated that, in patients treated with Finasterid, the magnitude of symptom response and degree of improvement in maximum urinary flow rate were greater in patients with an enlarged prostate at baseline.

14.2 Combination with Alpha-Blocker Therapy

The Medical Therapy of Prostatic Symptoms (MTOPS) Trial was a double-blind, randomized, placebo-controlled, multicenter, 4- to 6-year study (average 5 years) in 3047 men with symptomatic BPH, who were randomized to receive Finasterid 5 mg/day (n=768), doxazosin 4 or 8 mg/day (n=756), the combination of Finasterid 5 mg/day and doxazosin 4 or 8 mg/day (n=786), or placebo (n=737). All participants underwent weekly titration of doxazosin (or its placebo) from 1 to 2 to 4 to 8 mg/day. Only those who tolerated the 4 or 8 mg dose level were kept on doxazosin (or its placebo) in the study. The participant's final tolerated dose (either 4 mg or 8 mg) was administered beginning at end-Week 4. The final doxazosin dose was administered once per day, at bedtime.

The mean patient age at randomization was 62.6 years (±7.3 years). Patients were Caucasian (82%), African American (9%), Hispanic (7%), Asian (1%) or Native American (<1%). The mean duration of BPH symptoms was 4.7 years (±4.6 years). Patients had moderate to severe BPH symptoms at baseline with a mean AUA symptom score of approximately 17 out of 35 points. Mean maximum urinary flow rate was 10.5 mL/sec (±2.6 mL/sec). The mean prostate volume as measured by transrectal ultrasound was 36.3 mL (±20.1 mL). Prostate volume was ≤20 mL in 16% of patients, ≥50 mL in 18% of patients and between 21 and 49 mL in 66% of patients.

The primary endpoint was a composite measure of the first occurrence of any of the following five outcomes: a ≥4 point confirmed increase from baseline in symptom score, acute urinary retention, BPH-related renal insufficiency (creatinine rise), recurrent urinary tract infections or urosepsis, or incontinence. Compared to placebo, treatment with Finasterid, doxazosin, or combination therapy resulted in a reduction in the risk of experiencing one of these five outcome events by 34% (p=0.002), 39% (p<0.001), and 67% (p<0.001), respectively. Combination therapy resulted in a significant reduction in the risk of the primary endpoint compared to treatment with Finasterid alone (49%; p≤0.001) or doxazosin alone (46%; p≤0.001).

Treatment Group
Placebo Doxazosin Finasterid Combination Total
N=737 N=756 N=768 N=786 N=3047
Event N (%) N (%) N (%) N (%) N (%)
AUA 4-point rise 100 (13.6) 59 (7.8) 74 (9.6) 41 (5.2) 274 (9.0)
Acute urinary retention 18 (2.4) 13 (1.7) 6 (0.8) 4 (0.5) 41 (1.3)
Incontinence 8 (1.1) 11 (1.5) 9 (1.2) 3 (0.4) 31 (1.0)
Recurrent UTI/urosepsis 2 (0.3) 2 (0.3) 0 (0.0) 1 (0.1) 5 (0.2)
Creatinine rise 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Total Events 128 (17.4) 85 (11.2) 89 (11.6) 49 (6.2) 351 (11.5)

The majority of the events (274 out of 351; 78%) was a confirmed ≥4 point increase in symptom score, referred to as symptom score progression. The risk of symptom score progression was reduced by 30% (p=0.016), 46% (p<0.001), and 64% (p<0.001) in patients treated with Finasterid, doxazosin, or the combination, respectively, compared to patients treated with placebo. Combination therapy significantly reduced the risk of symptom score progression compared to the effect of Finasterid alone (p<0.001) and compared to doxazosin alone (p=0.037).

Treatment with Finasterid, doxazosin or the combination of Finasterid with doxazosin, reduced the mean symptom score from baseline at year 4. Table 7 provides the mean change from baseline for AUA symptom score by treatment group for patients who remained on therapy for four years.

Placebo

N=534

Doxazosin

N=582

Finasterid

N=565

Combination

N=598

Baseline Mean (SD) 16.8 (6.0) 17.0 (5.9) 17.1 (6.0) 16.8 (5.8)
Mean Change

AUA Symptom Score (SD)

-4.9 (5.8) -6.6 (6.1) -5.6 (5.9) -7.4 (6.3)
Comparison to

Placebo (95% CI)

-1.8

(-2.5, -1.1)

-0.7

(-1.4, 0.0)

-2.5

(-3.2, -1.8)

Comparison to

Doxazosin alone (95% CI)

-0.7

(-1.4, 0.0)

Comparison to

Finasterid alone (95% CI)

-1.8

(-2.5, -1.1)


The results of MTOPS are consistent with the findings of the 4-year, placebo-controlled study PLESS in that treatment with Finasterid reduces the risk of acute urinary retention and the need for BPH-related surgery. In MTOPS, the risk of developing acute urinary retention was reduced by 67% in patients treated with Finasterid compared to patients treated with placebo (0.8% for Finasterid and 2.4% for placebo). Also, the risk of requiring BPH-related invasive therapy was reduced by 64% in patients treated with Finasterid compared to patients treated with placebo (2.0% for Finasterid and 5.4% for placebo).

14.3 Summary of Clinical Studies

The data from these studies, showing improvement in BPH-related symptoms, reduction in treatment failure (BPH-related urological events), increased maximum urinary flow rates, and decreasing prostate volume, suggest that Finasterid arrests the disease process of BPH in men with an enlarged prostate.

Image of Figure 1 Image of Figure 2 Image of Figure 3 Image of Figure 4 Image of Figure 5

16 HOW SUPPLIED/STORAGE AND HANDLING

No. 3094 - Finasterid tablets 5 mg are blue, modified apple-shaped, film-coated tablets, with the code MSD 72 on one side and Finasterid on the other. They are supplied as follows:

NDC 0006-0072-31 unit of use bottles of 30

NDC 0006-0072-58 unit of use bottles of 100.

Storage and Handling

Store at room temperatures below 30°C (86°F). Protect from light and keep container tightly closed.

Women should not handle crushed or broken Finasterid tablets when they are pregnant or may potentially be pregnant because of the possibility of absorption of Finasterid and the subsequent potential risk to a male fetus .

17 PATIENT COUNSELING INFORMATION

17.1 Increased Risk of High-Grade Prostate Cancer

Patients should be informed that there was an increase in high-grade prostate cancer in men treated with 5α-reductase inhibitors indicated for BPH treatment, including Finasterid, compared to those treated with placebo in studies looking at the use of these drugs to prevent prostate cancer .

17.2 Exposure of Women - Risk to Male Fetus

Physicians should inform patients that women who are pregnant or may potentially be pregnant should not handle crushed or broken Finasterid tablets because of the possibility of absorption of Finasterid and the subsequent potential risk to the male fetus. Finasterid tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets have not been broken or crushed. If a woman who is pregnant or may potentially be pregnant comes in contact with crushed or broken Finasterid tablets, the contact area should be washed immediately with soap and water .

17.3 Additional Instructions

Physicians should inform patients that the volume of ejaculate may be decreased in some patients during treatment with Finasterid. This decrease does not appear to interfere with normal sexual function. However, impotence and decreased libido may occur in patients treated with Finasterid .

Physicians should instruct their patients to promptly report any changes in their breasts such as lumps, pain or nipple discharge. Breast changes including breast enlargement, tenderness and neoplasm have been reported .

Physicians should instruct their patients to read the patient package insert before starting therapy with Finasterid and to reread it each time the prescription is renewed so that they are aware of current information for patients regarding Finasterid.

Dist. by: Merck Sharp & Dohme Corp., a subsidiary of

MERCK & CO., INC., Whitehouse Station, NJ 08889, USA

For patent information: www.merck.com/product/patent/home.html

Copyright © 1992, 1995, 1998, 2011 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

All rights reserved.

uspi-mk0906-5t-1309r011

Finasterid® (finasteride) Tablets

Patient Information about

Finasterid® (Prahs-car)

Generic name: Finasterid

(fin-AS-tur-eyed)

Finasterid is for use by men only.

Please read this leaflet before you start taking Finasterid. Also, read it each time you renew your prescription, just in case anything has changed. Remember, this leaflet does not take the place of careful discussions with your doctor. You and your doctor should discuss Finasterid when you start taking your medication and at regular checkups.

What is Finasterid?

Finasterid is a medication used to treat symptoms of benign prostatic hyperplasia (BPH) in men with an enlarged prostate. Finasterid may also be used to reduce the risk of a sudden inability to pass urine and the need for surgery related to BPH in men with an enlarged prostate.

Finasterid may be prescribed along with another medicine, an alpha-blocker called doxazosin, to help you better manage your BPH symptoms.

Who should NOT take Finasterid?

Finasterid is for use by MEN only.

Do Not Take Finasterid if you are:

  • a woman who is pregnant or may potentially be pregnant. Finasterid may harm your unborn baby. Do not touch or handle crushed or broken Finasterid tablets (see "A warning about Finasterid and pregnancy" ).
  • allergic to Finasterid or any of the ingredients in Finasterid. See the end of this leaflet for a complete list of ingredients in Finasterid.

A warning about Finasterid and pregnancy:

Women who are or may potentially be pregnant must not use Finasterid. They should also not handle crushed or broken tablets of Finasterid. Finasterid tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets are not broken or crushed.

If a woman who is pregnant with a male baby absorbs the active ingredient in Finasterid after oral use or through the skin, it may cause the male baby to be born with abnormalities of the sex organs. If a woman who is pregnant comes into contact with the active ingredient in Finasterid, a doctor should be consulted.

How should I take Finasterid?

Follow your doctor's instruction.

  • Take one tablet by mouth each day. To avoid forgetting to take Finasterid, you can take it at the same time every day.
  • If you forget to take Finasterid, do not take an extra tablet. Just take the next tablet as usual.
  • You may take Finasterid with or without food.
  • Do not share Finasterid with anyone else; it was prescribed only for you.

What are the possible side effects of Finasterid?

Finasterid may increase the chance of a more serious form of prostate cancer.

The most common side effects of Finasterid include:

  • trouble getting or keeping an erection (impotence)
  • decrease in sex drive
  • decreased volume of ejaculate
  • ejaculation disorders
  • enlarged or painful breast. You should promptly report to your doctor any changes in your breasts such as lumps, pain or nipple discharge.

The following have been reported in general use with Finasterid and/or Finasterid at lower doses:

  • allergic reactions, including rash, itching, hives, and swelling of the lips, tongue, throat, and face
  • rarely, some men may have testicular pain
  • trouble getting or keeping an erection that continued after stopping the medication
  • problems with ejaculation that continued after stopping the medication
  • male infertility and/or poor quality of semen. Improvement in the quality of semen has been reported after stopping the medication.
  • depression
  • decrease in sex drive that continued after stopping the medication
  • in rare cases, male breast cancer has been reported.

You should discuss side effects with your doctor before taking Finasterid and anytime you think you are having a side effect. These are not all the possible side effects with Finasterid. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at: 1-800-FDA-1088.

What you need to know while taking Finasterid:

  • You should see your doctor regularly while taking Finasterid. Follow your doctor's advice about when to have these checkups.
  • Checking for prostate cancer. Your doctor has prescribed Finasterid for BPH and not for treatment of prostate cancer - but a man can have BPH and prostate cancer at the same time. Your doctor may continue checking for prostate cancer while you take Finasterid.
  • About Prostate-Specific Antigen (PSA). Your doctor may have done a blood test called PSA for the screening of prostate cancer. Because Finasterid decreases PSA levels, you should tell your doctor(s) that you are taking Finasterid. Changes in PSA levels will need to be evaluated by your doctor(s). Any increase in follow-up PSA levels from their lowest point may signal the presence of prostate cancer and should be evaluated, even if the test results are still within the normal range. You should also tell your doctor if you have not been taking Finasterid as prescribed because this may affect the PSA test results. For more information, talk to your doctor.

How should I store Finasterid?

  • Store Finasterid tablets in a dry place at room temperature.
  • Keep Finasterid in the original container and keep the container closed.

    Finasterid tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets are not broken or crushed.


Keep Finasterid and all medications out of the reach of children.

Do not give your Finasterid tablets to anyone else. It has been prescribed only for you.

For more information call 1-800-622-4477.

What are the ingredients in Finasterid?

Active ingredients: Finasterid

Inactive ingredients: hydrous lactose, microcrystalline cellulose, pregelatinized starch, sodium starch glycolate, hydroxypropyl cellulose LF, hydroxypropyl methylcellulose, titanium dioxide, magnesium stearate, talc, docusate sodium, FD&C Blue 2 aluminum lake and yellow iron oxide.

What is BPH?

BPH is an enlargement of the prostate gland. The prostate is located below the bladder. As the prostate enlarges, it may slowly restrict the flow of urine. This can lead to symptoms such as:

  • a weak or interrupted urinary stream
  • a feeling that you cannot empty your bladder completely
  • a feeling of delay or hesitation when you start to urinate
  • a need to urinate often, especially at night
  • a feeling that you must urinate right away.

In some men, BPH can lead to serious problems, including urinary tract infections, a sudden inability to pass urine (acute urinary retention), as well as the need for surgery.

What Finasterid does:

Finasterid lowers levels of a hormone called DHT (dihydrotestosterone), which is a cause of prostate growth. Lowering DHT leads to shrinkage of the enlarged prostate gland in most men. This can lead to gradual improvement in urine flow and symptoms over the next several months. Finasterid will help reduce the risk of developing a sudden inability to pass urine and the need for surgery related to an enlarged prostate. However, since each case of BPH is different, you should know that:

  • Even though the prostate shrinks, you may NOT notice an improvement in urine flow or symptoms.
  • You may need to take Finasterid for six (6) months or more to see whether it improves your symptoms.
  • Therapy with Finasterid may reduce your risk for a sudden inability to pass urine and the need for surgery for an enlarged prostate.

Dist. by: Merck Sharp & Dohme Corp., a subsidiary of

MERCK & CO., INC., Whitehouse Station, NJ 08889, USA

For patent information: www.merck.com/product/patent/home.html

Copyright © 1992, 1995, 1998, 2011 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

All rights reserved.

Revised: 09/2013

usppi-mk0906-5t-1309r011

PRINCIPAL DISPLAY PANEL - 5 mg Bottle Label

NDC 0006-0072-31

Finasterid®

(finasteride) Tablets

5 mg

WARNING: Finasterid® (finasteride) should

not be used by women or children.

Women who are or may potentially be

pregnant must not use Finasterid. They

should also not handle crushed or broken

tablets of Finasterid.

Rx only

30 Tablets

Finasterid pharmaceutical active ingredients containing related brand and generic drugs:

infoActive ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.


Finasterid available forms, composition, doses:

infoForm of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.


Finasterid destination | category:

infoDestination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.


Finasterid Anatomical Therapeutic Chemical codes:

infoA medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.


Finasterid pharmaceutical companies:

infoPharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.


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References

  1. Dailymed."PROSCAR (FINASTERIDE) TABLET, FILM COATED [MERCK SHARP & DOHME CORP.]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  2. Dailymed."FINASTERIDE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  3. "finasteride". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Finasterid?

Depending on the reaction of the Finasterid after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Finasterid not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Finasterid addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

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Review

sDrugs.com conducted a study on Finasterid, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Finasterid consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

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The information was verified by Dr. Arunabha Ray, MD Pharmacology

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