I know it's been discussed before but I can't remember the consensus. I would prefer to take 1mg propecia tablet every other day. I have been taking it every day for approx 18 months now. The main reason for EOD being concern over sides(psychological or not) and the fact that I don't like taking any drug unless absolutely necessary. I will continue with 5% minox 2xday. Does anyone know if the drug still has a benefit if taken eod and what the percentage of effect might be?
Thanks.

Not sure if there is a truly crystallized consencus, insofar as there is a % of effect disparity between EOD and ED.....that said, quite a few (reputable) docs greenlight taking it EOD and many people take fin EOD and have done well w/ it.

The consensus I came to was that ED is optimal, but EOD is still effective and certaintly the optimal route to go if "side-effects" come into play.

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EOD is just fine, finasteride has a nearly straight line dose curve.

per indiciation it is to be taken once a day. The half life and bio-availabilty of the drug is good for a 24hr dose. Peak Plasma levels are best with daily dosing.
That said, there should be benefit with eod dosing, but serum levels will not be steady state-- but might work with some people.

SMOOTHY
Dr. Shapiro
Propecia/Rogain xtra
MSM/Saw Palmetto/Zinc
Zrii 3 oz daily

Hi guys. I do have an opinion on this topic. Propecia is approved by the US FDA for once a day use. This does not mean it is the best dosage, only the one that was studied and approved. The average serum "half-life" of finasteride 1mg is about 5 hours in young men and 8 hours in older men. This does not mean that half of the medicine is out of your body in that time period though. The finasteride molecule is distributed throughout the body where it binds to the type II 5-alpha-reductase enzyme, thereby inhibiting conversion of testosterone to dihydrotesterone. Serum DHT is reduced about 65%, and less DHT means less balding. But several studies show that a single dose of finasteride suppresses serum DHT for 7 days or more (Eur J Drug Metab Pharmacokinet. 1991 Jan-Mar;16(1):15-21, J Clin Endocrinol Metab. 1990 Apr;70(4):1136-41, Prostate. 1989;14(1):45-53). So the finasteride is leaving the bloodstream, entering the tissue throughout the body, and binding to the typeII 5AR enzyme, resulting in long lasting DHT suppression.

I do not "recommend" my patients take finasteride daily, every other day, twice weekly, etc. Rather I feel it is my duty as their doctor to advise them of the known facts about this medication. Most of my patients choose to take it on a Mon-Wed-Fri schedule, which is rational from my point of view. Many of my younger patients take it daily 'just to be sure' while my older patients are happy to take it two or three times a week. There are no clinical studies showing that less than daily dosing is as effective at treating hair loss as daily dosing and for obvious financial reasons, the pharmaceutical company making finasteride has no incentive to fund such a study.

I hope this information is helpful. It is up to each patient to make an informed decision about which dosage is right for them.

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Dr. Cooley is a member of the Coalition of Independent Hair Restoration Physicians

Dr. Cooley--
I had a nightmare of a time with sides from the drug years ago. I've been frightened to try it again ever since. Have you had any success with reducing sides by using intermittent dosing?

Thanks.

Sorry to hear about the side effects. We have had some patients who find that less frequent dosing still helps their hair but does not cause side effects. It seems that each person has a unique set point when it comes to side effects. Some do fine at 3 times a week, others at 2, while some of our older patients can only take it once a week. If our patients can't tolerate finasteride at all, we really push the topicals: minoxidil, ketoconazole, zinc pyrithione shampoo, etc. It can be a tough situation for some patients. Good luck.

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Dr. Cooley is a member of the Coalition of Independent Hair Restoration Physicians

Thank you for answering Dr. Cooley. I was one of the lucky ones who grew a lot of hair on Propecia 1mg/day, and one of the unlucky ones to have very definite sides.

I have been on Minoxidil for years, but it doesn't seem to be doing the trick on its own. I am very tempted to try one propecia, or even two a week.

Ceasar
I am copying my post elsewhere here, regarding the use of topical ketoconazole in men who can't tolerate finasteride. You might discuss this with your physician. Good luck.


Posted September 28, 2008 07:54 PM Hide Post
For men, we recommend finasteride as firstline therapy. If men can be committed to daily topical treatment, then 5% minoxidil can be effective, especially when combined with finasteride.

There is growing evidence that ketoconazole is helpful too (go to PubMed and check out:

Topical application of ketoconazole stimulates hair growth in C3H/HeN mice.
J Dermatol. 2005 Apr;32(4):243-7.

J Dermatol. 2002 Aug;29(8):489-98.
Comparative efficacy of various treatment regimens for androgenetic alopecia in men.

Med Hypotheses. 2004;62(1):112-
Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men.

There is some weaker evidence that zinc pyrithione might be helpful too (see Br J Dermatol. 2003 Aug;149(2):354-62.
The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial).

For men who cannot tolerate oral finasteride because of side effects, we recommend topical 2% ketoconazole foam, which is available in the US as "Extina foam". I believe that any leave on product like Extina will work better than a shampoo that is washed off the scalp within minutes.

Just my opinion. Hope this helps.

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Dr. Cooley is a member of the Coalition of Independent Hair Restoration Physicians

Dr. Cooley,

Thanks for contributing your expertise on this thread.

That's interesting news about topical ketoconazole and only reinforces my research and what I typically recommend to hair loss sufferers.

How do you feel about using Extina the topical foam verses ketoconazole based shampoos such as Nizoral (1 or 2%) and Revita (1%)?

Best wishes,

Bill

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