Finasteride (Propecia) versus ...

Finasteride (Propecia) vs. Minoxidil (Rogaine)

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.

Results of open, randomized, comparative study3 Finasteride Minoxidil 5% topical
Clinical cure rates (increased intensity of hair) 80% (32/40) 52% (13/25)
Side effects Mild, disappeared after treatment discontinuation
Loss of libido (6 patients), increase in other body hairs (1 patient) Scalp irritation(1 patient)

 

  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.

Finasteride (Propecia) vs. Dutasteride (Avodart)

Benign Prostatic Hyperplasia

Finasteride and dutasteride are 5-alpha-reductase inhibitors, used in the treatment of benign prostatic hyperplasia and male pattern hair loss. These drugs block the enzyme 5-alpha-reductase, thus preventing conversion of testosterone to more active androgen dihydrotestosterone.

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 medication 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 undergo 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 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.

Finasteride vs. Tamsulosin (Flomax)

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.

Finasteride (Propecia) vs. Terazosin (Hytrin)

Terazosin is a selective alpha-1 antagonist. Terazosin is indicated for the treatment of hypertension, and symptoms of benign prostatic hyperplasia.

Benign Prostatic Hyperplasia

Effectiveness of terazosin is superior to finasteride in the improvement of lower urinary symptoms associated with benign prostatic obstruction6. 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.

Results of study comparing efficacy of terazosin and finasteride in symptomatic benign prostatic hyperplasia5 Finasteride Terazosin
Treatment regimen 5 mg once daily 1 mg daily at for 3 days, 2 mg daily for the next 7 days, and thereafter 5 mg daily for 6 months
Improvement after 3 months
International Prostate Symptom Score 1.38 +/- 0.63 points reduction 3.93 +/- .74 points reduction
Qmax 0.55 +/- 0.78 ml/s increase 2.13 +/- .68 ml/s increase
Post-voided residual urine volume (PVR) 5.93 +/- 7.64 ml reduction (significant) 20.67 +/- 10.56 ml reduction (significant)
Prostate volume 0.17 +/- 5.6 ml reduction (non-significant) 0.57 +/- 1.54 ml reduction (not significant).
Improvement after 6 months significant statistical differences in all parameters including prostate volume 4.57 +/- 5.30 ml reduction similar statistical differences
Terazosin is effective for the treatment of mild to moderate cases of symptomatic Benign Prostatic Hyperplasia.
Finasteride is useful treatment for large prostate.

 

  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, hypotension, syncope 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
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Further reading

References
  • 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: May 18, 2017

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