Does is matter what brand Finasteride is?

[Raj Jayukdht]

I have have been prescribe finasteride tables (5mg) by my GP, the brand is called Actavis. Now my questions to this forum are:

 

Does it matter what brand it is?

How shall I start taking them, slowly introduce the tablets into my system ie take one 1.25mg for 1 week and week 2 take two 1.25mg and so.

Should I take 1.25mg everyday or just MWF

 

Proscar question:

I met Mr Wong (H&W) and he has advised me to take Proscar tablets MWF only 1.25mg BUT I thought proscar and finasteride are the same drug??

 

At the moment I have finasteride packet in my hands but I worried about side effects...so any advise on this forum would be greatly appreciated.

 

Also Im going to start regain form....how often should I put this on and is best in the crown only or frontal core aswell.

[TommyLucchese]

I'm no expert on this but I think 5mg is way too high.

 

Most take 1mg or 1.25mg (I think it's 1.25...something like that). Maybe the 5mg is cut into fifths?

 

There's lots of different names and brands for the same drug. Propecia, finasteride (the actual name of the drug), and proscar. There's also finpecia, and generic finasteride. Probably much more other types too. I take 1mg of propecia.

 

I'm guessing Dr. Wong says MWF because it's a slightly higher dose than the 1mg....but I don't know.

 

I've had it 3 years and get no sides. They are quite rare, it's worth giving it a go! From what I've read, I'd avoid taking 5mg tablets!

[Raj Jayukdht]

yes I agree tommy, the only way to find out about the side effects(if any), is to try the med.

 

How often should I put on the minoxidil form...once or twice aday (morning and evening)?

[TommyLucchese]

I think the foam is once, liquid is twice.

[Raphael84]

Foam and liquid, both the same, twice a day. Once in the morning, once at night! Regarding Finasteride, its an interesting one. As they are generics, they should be the same drug, but I think H&W (Jotronic) is/are a little more exact over which brand is used, whilst other Drs not so much! 5mg cut into either 4ths or 5ths. I personally find it pretty difficult to cut into 5ths, and whilst some take it every other day, others take 4 days consecutively and miss the 5th, I tend just to take 1/4 (1.25mg) daily. No sides after 8 years.

[Jotronic]

Jayukdht,

 

It was a pleasure to meet you last week. Original finasteride is Proscar 5mg and Propecia 1mg. They're the same stuff, just different dosages (and name, box, target market, etc). Anything else is generic. Most generics should be fine but we recommend the original because we had a few patients report that the generic was not as effective. Normally that would make no sense but we had too many report this issue to dismiss it.

 

There is a caveat with the generics issue. In some countries, such as India, Merck Pharmaceuticlas licensed out specific manufacturers to make the same medication. In India the same medication is known as Finpecia and I suspect that some other countries have similar licensing to make the same product under a different name.

[gillenator]

Drug manufacturers within the US are regulated by the FDA however the manufacturers outside the US may not be regulated in any form.

 

Not that the FDA is always doing their job in the oversight, it certainly is a plus in my opinion.

[Dr. Ricardo Mejia]

Have you tried cutting a 5 mg tablet? some of my patients have difficulty cutting it into quarters, and it depends on the manufacturer. I usually advise patients to take a 1/4 tablet a day. There is evidence that even smaller dosages are helpful and even if you alternate therapy. My patients have experienced good results with a quarter tablet a day.

[Raj Jayukdht]

I have not bought a pill cutter from a chemist and it seems easy to cut in 1/4. Dr Mejia Im just worried about the side effects and also that I will need to take it rest of my life. Hopefully as advised by my Mr Wong to take it MWF, that wont be too bad BUT I will have to see what works for me.

[Dr. Ricardo Mejia]

What I tell my patients is you only need to take it as long as you are concerned about your hair loss. Once you get to a point in your life where it does not matter you can always stop it. For some people, that day never comes. For others who seem to get into hair transplant early on in life, it comes after they get married and have kids and realize the hair is not as important as other factors in there life. This is the reason I caution young patients with a strong family history of balding to not rush into hair transplants and to start medical therapy to slow the process down. If you have side effects they are reversible once you stop them. I have never had a patient with permanent side effects.

[Raj Jayukdht]

Thanks Dr Mejia for all your advice.

[Raj Jayukdht]

my next question to this forum is, as I will need to cut the tablets up into 1/4's, is best to cut one 5mg tablet at a time or can I cut few tablets up and put the 1/4's together in a medication box.

[Jotronic]

You can cut a few at a time if you like and keep them in the pill cutter box. Personally, I only cut one at a time but that's just me.

[Raj Jayukdht]

Do you take it everyday, Mr Wong suggested MWF

[Jotronic]

I do take it everyday now. I took it MWF for the first year or two, maybe three, but with the small gains I received from it and the excellent surgical results from my first two procedures I got a big greedy and wanted to do more to improve my outcome so I went to every day. No problems since.

[Dr. Ricardo Mejia]

I usualy tell my patients to cut them all in 1/4 and put them back in the bottle . It s more efficient this way

[gillenator]

my next question to this forum is, as I will need to cut the tablets up into 1/4's, is best to cut one 5mg tablet at a time or can I cut few tablets up and put the 1/4's together in a medication box.

 

If you are in the family planning years and there are any chances that any females might be exposed to the active ingredient, we must be very careful. Once the 5 mg Proscar tablet is "cut", the active ingredient finasteride is released and can potentially be exposed to women who may incidentally touch the drug.

 

The concern would be for females who may be planning for child conception and the potential risk then is very apparent to them. This is one of the benefits of taking Proepcia which is manufactured at 1mg per tablet and has the protective coating on the tablet.

 

If this applies to you, and you still wish to cut Proscar, then you want to take the extra measures of putting the cut pieces in a sealed bottle with a child proof cap and out of sight and reach.

 

Something to consider.

[Dr. Ricardo Mejia]

it is certainly easier to take a 1 milligram tablets of propecia. I have asked for the data on systemic absorption of touching a cut finasteride tablet. I have not gotten any replies or studies. It is a theoretical risk and promoted due to uncertainty and cya. Finasteride is a large mecule and our epidermal skin barrier prevents absorption. While it is advocated not to touch, it is an extremely low low risk

[gillenator]

Dr. Mejia, thank you for your contributions to this thread. You may not recall, but we met face-to-face in Orlando ten years ago in Dr. Leavitt's office.

 

So then in your opinion it is safe for females to handle the cut pieces? No apparent risk to the potential male fetus? All of the prostrate drugs, which as you know Proscar and Avodart (dutasteride) are, have a clear warning to women handling the drug.

 

Would you feel that is the consensous opinion of your fellow colleages?

[Dr. Ricardo Mejia]

I have not seen any convincing data to support the claims. As a scientist and dermatologist understanding the structure and function of skin, it is highly unlikely there will be a problem. I personally would not have an issue if my pregnant wife cut a tablet and fed me a pill. I personally would feel very comfortable. I would welcome any studies that perhaps I am not aware of to the contrary which demonstrate the absorption of finasteride simply by touching it.

 

On the other hand, since you have been around the block a long time, you also realize pharmaceutical companies and doctors must practice defensive medicine to protect against malpractice claims. We know that taking finasteride systemically in a women can cause problems with a male featus. Consequently, similar labeling requiirements must be imposed cautioning women against handling the medication, otherwise any women

With a birth defect suddenly has grounds to sue a manufacturer or doctor claiming they handled the pill. if it was so easily absorbed, current studies with Transcutol P 1% in combination with water, propylene glycol and 2-propanol in rats would not be undertaken. They need special solvents In an effort to help deliver finasteride topically.

 

Generally, most physicians including myself follow the party lines as recommended by the manufacturer primarily from a medico legal issue. If the finances of an individual or of significant concern, cutting a 5 mg tablet which in some cases is covered by insurance for a minimal copayment is much cheaper than Propecia, then it is a suitable alternative. If there is concern or uncertainty about topical absorption, then do not let pregnant women handle the medication. That is what I also tell my patients, even though I know it is an extreme low risk.

[TruthOnly]

There are several things to consider in taking Propecia (finasteride). First off, brand name and generic do not matter. Brand name proscar 5mg is never dispensed as it is available generically. Propecia 1mg is currently brand name only so it must be dispensed this way until it's patent expires (next 2 years). In any case, they are all the identical chemical, just in different potencies. Steer clear from names like finpecia etc. from out of the country as their potency and content is not verified. Luckily in the USA we have the FDA.

 

Secondly, your weight and muscle mass is an important indicator of the appropriate dose you should take. Why? Because finasteride is highly lipophilic (fat soluble) and distributes widely into the tissues. A person who is obese is going to lose a lot more drug while it is traveling through the bloodstream into the tissues. A thin muscular person will retain the drug in the bloodstream and it will be more likely to get to the site of action, hence will require a lower dose. The dose that was FDA approved for ALL people is 1 mg daily. Why 1 mg? Because this is the dose that is effective in most everyone. Keep in mind we live in on average an obese population, so this dose is too high for many averaged size people. Clinical studies have shown that as little as 0.2mg daily were effective in blocking conversion of testosterone into DHT and stoping hair follicle death.

 

Next, lets talk about the half life. On average it is about 6 hours, about half of the drug is excreted from your system in 6 hours. Typically, a drug will be completely excreted in about 4-6 half lives, so in finasterides case about 24 hours. However, looking at our data, a dose of 0.2mg was effective in some people. For simplification, lets say the entire 0.2mg gets into your bloodstream upon taking 0.2 mg orally (it doesn't as the bioavailability is much less than 100% but its an arbitrary number). Therefore, 6 hours after taking the dose (or longer due to time it takes for absorption), you will have a blood level of 0.1mg. After 24 hours it would be 0.025 mg left over. This was the lowest point that the drug has shown effectiveness (AKA trough level). So technically a dosing schedule that would work in a lot of people is 0.2mg daily. For more simplification lets call it 0.25mg daily. Theoretically, 0.5 mg every other day would give you the same trough and would be acceptable.

 

Now here's the tricky part. Although the above listed doses would give you similar trough levels, the peaks would be much different. Taking the higher 0.5 mg every other day, your peak blood levels would be higher than taking the drug more frequently, in our example 0.25 mg every day. What risk does this cause? Higher peak levels are associated with greater side effects. Therefore it would be better to be on a daily regimen than every other day, however with the formulations that are available it would bed difficult to cut the pieces this small and have an accurate dose.

 

Personally, I titrated the dose to the lowest effective dose for me. I take 0.25 mg every day. However for me it was easy as I compounded the drug into capsules. This dose works great for me as I have a low BMI and low body fat composition, and I have minimal risk for side effects.

 

The reason I want the lowest effective dose and not the safe dose (1 mg daily FDA approved) is because finasteride is a chemical that changes hormone levels in your body and is potentially dangerous. When testosterone blocked from conversion to DHT, high circulating levels have no choice but to be converted into Estrogen by the enzyme aromatase. And in reality you do need some DHT for your body to carry out normal functioning. I would not recommend its use in patients less than 18 years old as it has the potential to interfere with normal development.

 

That being said, it is currently all we have to prevent one important aspect of hairloss, so we need to consider the risks and benefits carefully.

[Raj Jayukdht]

Thanks Truthonly

 

You mentioned that you take 0.25 dose, is that from a 5mg or 1mg tablet. If its 5mg tablet, how the hell do you get it cut to 0.25mg does?

[gillenator]

Thank you four your comprehensive reply Dr. Mejia.

 

And yes, you bet that I am aware that all drug manufacturers use these remedial warnings and disclaimers primarily for the defense of any future potential legal claims and actions. I am always intrigued by the disclaimers and warnings at the tail end of their media advertisements.

 

On the other side, certainly there are some medications that need to disclose some of the warnings that are legitimate to patient safety.

 

It's nice to know that you have researched this yourself in the interest of your patients.

[TruthOnly]

I compound the drug by levigating the 5mg tabs in a mortar and pestle, and use pharmaceutical calculations, a digital scale, a capsule machine, empty vegetable capsules, and calcium bicarbonate as a diluent, resulting in a 0.25 mg capsule.