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Androgenetic alopecia (hair loss)

Both medications finasteride and topical minoxidil are effective and safe in the treatment of mild to severe hair loss. However, finasteride treatment is more effective.

In an open, randomized, comparative study3 the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Side effects were all mild, and there was no need to stop the treatment. In the group given finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs. Irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped.

	Finasteride (Propecia)	Minoxidil (Rogaine)
Mechanism of action	5 alpha-reductase inhibitor. Promotes hair growth and prevents further hair loss by reducing circulating dihydrotestosterone levels	Not known. The mechanism of minoxidil is uncertain, although it may work by increasing the cutaneous blood flow to the scalp.
Route	Oral	Topical
Usual dosage	1 mg per day	2% solution or 5% solution applied twice daily to the affected area
Increased hair growth (% of patients) at 1 year	48	</=50
Increased hair growth (% of patients) at 2 years	66	Not observed
No further hair loss (% of patients)	83 (at 2 years)	Not observed
Most frequent adverse effects	Sexual dysfunction (approximately 4%)	Local skin reactions (approximately 7%)
Women	Not indicated	Yes
Men	Yes	Yes
Duration of bebeficial effect	Beneficial effects are temporary. When the drug is discontinued, hair regrowth is lost within approximately 1 year.	Beneficial effects are temporary. When the drug is discontinued, hair regrowth is lost within 6 months.

Benign Prostatic Hyperplasia

The prostate gland contains an enzyme called 5 alpha-reductase that converts testosterone to another androgen called dihydrotestosterone. Finasteride (Proscar) and dutasteride (Avodart), known as a 5-alpha-reductase inhibitors, block this enzyme and thus reduce dihydrotestosterone in the prostate.

Finasteride selectively inhibits the Type 2 isoenzyme, whereas dutasteride inhibits both Type 1 and Type 2 isoenzymes of 5 alpha-reductase.

Dutasteride achieves a more rapid suppression of dihydrotestosterone (DHT) than finasteride. Whereas 5-mg finasteride decreases serum DHT by about 70%, dutasteride can decrease serum DHT by more than 90%.

Dutasteride has longer half-life. It takes 5 weeks before half of the medication is cleared, while it only takes 6 to 15 hours for finasteride. This means, the effects, good or bad, stay in your system longer.

Patients treated with dutasteride (Avodart) are less likely to experience acute urinary retention and less likely to experience prostate-related surgeries than patients treated with finasteride (Proscar)1-2.

Dutasteride and finasteride appear to have a similar safety profile.

In large retrospective descriptive and comparative analysis1 after 5 months of 5-alpha reductase inhibitor therapy, the rate of acute urinary retention during months 5 to 12 was found to be significantly lower in the dutasteride group compared with the finasteride group (5.3% vs 8.3%). Dutasteride-treated patients were 49.1% less likely to experience acute urinary retention than patients treated with finasteride. Patients treated with dutasteride were also less likely to undergo prostate-related surgery, with 1.4% of dutasteride treated patients and 3.4% of patients receiving finasteride undergoing surgery.

Benign Prostatic Hyperplasia

Finasteride (Propecia) is a 5-Alpha-Reductase Inhibitor, Tamsulosin (Flomax) is a selective alpha-blocker. These two medications work in different ways.

Finasteride is not as effective as alpha-blockers in improving BPH and urinary tract symptoms. Tamsulosin improves urinary symptoms and flow more quickly than finasteride4.

Tamsulosin (Flomax) does not appear to cause impotence or reduce sexual drive as finasteride does.

Benign Prostatic Hyperplasia

Effectiveness of terazosin is superior to finasteride in the improvment of urinary symptoms and flow measures associated with BPO6. On the other hand, finasteride may be useful in large prostate when given for at least 6 months5. Finasteride produces significant prostate gland size reduction.

The study5 was designed to find out and compare the efficacy of terazosin and finasteride in symptomatic BPH. Terazosin group received 1 mg daily at bedtime for 3 days, 2 mg at bedtime for 7 days, thereafter 5 mg at bedtime daily for 6 months. Finasteride group received 5 mg once daily. In terazosin treated patients, improvement after 3 months were as follows, International Prostate Symptom Score 3.93 +/- .74 points reduction, Qmax 2.13 +/- .68 ml/s increase, post-voided residual urine volume (PVR) 20.67 +/- 10.56 ml reduction (significant) and prostate volume 0.57 +/- 1.54 ml reduction (not significant). Similar statistical differences were observed at 6 months follow up. In finasteride treated patients, improvements after 3 months were as follows, International Prostate Symptom Score 1.38 +/- 0.63 points reduction, Qmax 0.55 +/- 0.78 ml/s increase, post-voided residual urine volume 5.93 +/- 7.64 ml reduction (significant) and prostate volume 0.17 +/- 5.6 ml reduction (non-significant). At 6 month follow up statistical differences were significant in all parameters including prostate volume 4.57 +/- 5.30 ml reduction. In comparison, statistically significant superiority of terazosin over finasteride was found in improving IPSS, Qmax and PVR in both follow up visits. But terazosin had nonsignificant effect in reducing prostate volume; in contrast, finasteride had significant effect in second visit.

	Finasteride (Propecia)	Dutasteride (Avodart)	Tamsulosin (Flomax)	Terazosin (Hytrin)	Doxazosin Mesylate (Cardura)
Half-life	6-8 h	5 weeks	14-15 h	12 h	22 h
Short-term efficacy	Yes	Yes	Yes	Yes	Yes
Long-term efficacy	Yes	Yes	Yes	Yes	Yes
Side effects	Impotence, decreased libido, effects on PSA levels	Decreased libido, abnormal ejaculation, impotence, breast tenderness	Headache, abnormal ejaculation, rhinitis, dizziness	Dizziness, headache, fatigue	Dizziness, headache, fatigue Headache, abnormal
Titration	Not required	Not required	Not required	Required	Required
Increase in mean peak urinary flow rate	~1.9 mL/s	0.7-1.1 mL/s	0.5-1.8 mL/s	2.6-3.0 mL/s	2.3-3.3 mL/s
Chance for symptom improvement	54% to 78%		59% to 86%
Degree of symptom improvement	51%		31%
Source: Approved Medical Therapies for BPH MedScape

• Finasteride (Propecia) Medical Facts

• 1. Issa MM, Runken MC, Grogg AL, Shah MB. A large retrospective analysis of acute urinary retention and prostate-related surgery in BPH patients treated with 5-alpha reductase inhibitors: dutasteride versus finasteride. Am J Manag Care. 2007 Feb;13 Suppl 1:S10-6. PubMed
• 2. Fenter TC, Davis EA, Shah MB, Lin PJ. Dutasteride vs finasteride: assessment of differences in acute urinary retention rates and surgical risk outcomes in an elderly population aged > or =65 years. Am J Manag Care. 2008 May;14(5 Suppl 2):S154-9.
• 3. Arca E, Acikgoz G, Tas,tan HB, Kose O, Kurumlu Z. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology. 2004;209(2):117-25. PubMed
• 4. Rigatti P, Brausi M, Scarpa RM, Porru D, Schumacher H, Rizzi CA; MICTUS Study Group. A comparison of the efficacy and tolerability of tamsulosin and finasteride in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2003;6(4):315-23. PubMed
• 5. Anwarul Islam AK, Kashem MA, Shameem IA, Kibria SA. Efficacy of terazosin and finasteride in symptomatic benign prostatic hyperplasia: A comparative study. Bangladesh Med Res Counc Bull. 2005 Aug;31(2):54-61
• 6. Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G, Haakenson C, Machi M, Narayan P, Padley RJ. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. The New England Journal of Medicine. 1996 Aug 22;335(8):533-9.

Published: November 03, 2008
Last updated: January 09, 2010