Finasteride 1mg is indicated for the treatment of the first stage of hair loss (androgenetic alopecia) in men. In men aged 18-41 years finasteride 1 mg stabilises the process of androgenetic alopecia. Efficacy in bi-temporal recession and hair loss in the end stage has not been established.

Posology

The recommended dosage is one 1mg tablet per day.

There is no evidence that a higher dose increases efficacy.

The efficacy and continuation of the treatment should continuously be assessed by the treating physician. Generally, finasteride 1 mg must be taken once daily for 3-6 months before evidence of stabilisation of hair loss can be expected. Continuous use is recommended for a sustained beneficial effect. If the treatment is stopped, the beneficial effect begins to disappear after 6 months, and has completely disappeared after 9-12 months.

Dosage in renal insufficiency

The dosage does not need to be adjusted in patients with renal insufficiency (see section 5.2).

Dosage in hepatic insufficiency

There are no data available in patients with hepatic insufficiency (see sections 4.4 and 5.2).

Paediatric population

There is no relevant use of finasteride 1mg in the paediatric population (see section 4.4).

Method of administration

For oral use.

Crushed or broken tablets of finasteride 1 mg should not be handled by women when they are or may potentially be pregnant because of the possibility of absorption of finasteride and subsequent potential risk to a male foetus (see section 4.6). Finasteride 1mg tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets are not broken or crushed.

The tablets should be swallowed whole and must not be divided or crushed (see section 6.6).

The tablets can be taken with or without food.

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

Finasteride should not be used in children/adolescents (see sections 4.2 and 4.4).

Contraindicated in women (see sections 4.6 and 5.1).

Should not be taken by men who are taking finasteride 5 mg or any other 5α -reductase inhibitor for benign prostatic hyperplasia or any other condition.

Evaluation of prostate-specific antigen

In clinical studies with finasteride 1 mg in men 18 - 41 years of age, the mean value of serum prostate-specific antigen (PSA) decreased from 0.7 ng/ml at baseline to 0.5 ng/ml at month 12. This decrease in serum PSA concentrations needs to be considered, if during treatment with Finasteride 1mg film-coated tablets, a patient requires a PSA assay. In this case it should be considered to double PSA value before making a comparison with the results from untreated men.

Patients who are planning to father a child should consider to stop treatment (see sections 4.6 Pregnancy (exposure to finasteride: risk to male foetus) and fertility, 5.1 and 5.3).

Hepatic impairment

The effect of hepatic insufficiency on the pharmacokinetics of finasteride has not been studied (see sections 4.2 and 5.2).

Breast cancer

Breast cancer has been reported in men taking Finasteride 1 mg in the post-marketing period (section 4.8).

Physicians should instruct their patients to promptly report any changes in their breast tissue such as lumps, pain, gynaecomastia or nipple discharge.

Mood alterations and depression

Mood alterations including depressed mood, depression and, less frequently, suicidal ideation have been reported in patients treated with finasteride 1 mg. Patients should be monitored for psychiatric symptoms and if these occur, treatment with finasteride should be discontinued and the patient advised to seek medical advice.

Paediatric population

Finasteride should not be used in children. There are no data demonstrating efficacy or safety of finasteride in children under the age of 18 (see section 4.2).

Excipients

This medicinal product contains lactose-monohydrate. Patients with rare hereditary problems of galactose intolerance, the total lactase deficiency or glucose-galactose malabsorption should not take this medicine.

This medicine contains less than 1 mmol sodium (23 mg) per one film-coated tablet, that is to say essentially 'sodium-free'.

No drug interactions of clinical importance have been identified. Finasteride is metabolised primarily via, but does not affect, the P450-3A4 system. Although the risk of finasteride to affect the pharmacokinetics of other drugs is estimated to be small, it is probable that inhibitors and inducers of cytochrome P450 3A4 will affect the plasma concentration of finasteride. However, based on established safety margins, any increase due to concomitant use of such inhibitors is unlikely to be of clinical significance. Compounds which have been tested in man have included antipyrine, digoxin, glibenclamide, propranolol, theophylline and warfarin and no interactions were found.

Due to lacking data for the concomitant use of finasteride and topical minoxidil in male pattern hair loss the combination is not recommended.

Interaction studies have only been performed in adults.

Pregnancy:

Finasteride is contraindicated in women due to the risk in pregnancy (see section 4.3). Because of the ability of finasteride to inhibit conversion of testosterone to dihydrotestosterone (DHT) Finasteride may cause abnormalities of the external genitalia of a male foetus when administered to a pregnant woman (see sections 5.3 and 6.6).

Exposure to finasteride: risk to male foetus

Women who are pregnant or may become pregnant should not handle finasteride tablets especially if crushed or broken because of the possibility of absorption of finasteride and the subsequent potential risk to a male foetus (see section 6.6).

Small amounts of finasteride have been recovered from the semen in subjects receiving finasteride 5 mg/day. It is not known whether a male foetus may be adversely affected if his mother is exposed to the semen of a patient being treated with finasteride. When the patient's sexual partner is or may potentially be pregnant, the patient is recommended to minimise exposure of his partner to semen (e. g. by using condoms).

Breast-feeding

Finasteride 1 mg are not indicated for use in women. It is not known whether finasteride is excreted in human breast milk.

Fertility

Long-term data on fertility in humans are lacking, and specific studies in subfertile men have not been conducted. The male patients who were planning to father a child were initially excluded from clinical trials.

Although, animal studies did not show relevant negative effects on fertility, spontaneous reports of infertility and/or poor seminal quality were received post- marketing. In some of these reports, patients had other risk factors that might have contributed to infertility. Normalisation or improvement of seminal quality has been reported after discontinuation of finasteride(See sections 4.4, 5.1 and 5.3).

Finasteride has no or negligible influence on the ability to drive and use machines.

The adverse reactions reported during clinical trials and/or post-marketing use are listed in the table below.

Frequency of adverse reactions is determined as follows:

Very common (≥ 1/10); common (≥ 1/100to <1/10); uncommon (≥ 1/1,000 to <1/100); rare (≥ 1/10,000 to < 1/1,000); very rare (<1/10,000); not known (cannot be estimated from the available data).

The frequency of adverse reactions reported during post-marketing use cannot be determined as they are derived from spontaneous reports.

* Incidences presented as difference from placebo in clinical studies at month 12.

† This adverse reaction was identified through post-marketing surveillance but the incidence in randomized controlled Phase III clinical trials (Protocols 087, 089, and 092) was not different between finasteride and placebo

** See Section 4.4.

Drug-related sexual undesirable effects were more common in the finasteride 1 mg-treated men than the placebo-treated men, with frequencies during the first 12 months of 3.8% vs 2.1%, respectively. The incidence of these effects decreased to 0.6% in finasterde 1 mg-treated men over the following four years. Approximately 1% of men in each treatment group discontinued due to drug related sexual adverse experiences in the first 12 months, and the incidence declined thereafter.

In addition, the following have been reported in post-marketing use: persistence of sexual dysfunction (decreased libido, erectile dysfunction after discontinuation of treatment with finasteride; male breast cancer (see section 4.4).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

In clinical studies, single doses of finasteride up to 400 mg and multiple doses of finasteride up to 80 mg/day for 3 months (n = 71) did not result in dose-related undesirable effects.

No specific treatment for an overdose of Finasteride 1 mg film-coated tablets is recommended.

Pharmacotherapeutic group: Other dermatologicals, ATC code: D11AX10

Mechanism of action

Finasteride is a 4-azasteroid, which inhibits human type II 5α -reductase (present in the hair follicles) with a more than 100-fold selectivity compared with human type I 5α -reductase, and blocks the peripheral conversion of testosterone to the androgenic dihydrotestosterone (DHT). In men with male pattern hair loss, the balding scalp contains miniaturised hair follicles and increased concentrations of DHT. Finasteride inhibits the process responsible for miniaturisation of the scalp hair follicles, which can lead to reversal of the balding process.

Clinical efficacy and safety

Studies in men

The efficacy of finasteride has been demonstrated in three studies in 1879 men between 18 and 41 years old with mild to moderate, but not complete, hair loss on the crown and hair loss on the frontal/mid-area of the head. In these studies the hair growth was assessed on the basis of 4 different parameters, namely hair count, assessment of photographs of the head by a panel of expert dermatologists, assessment by the investigator and assessment by the patient himself.

In two studies in men with vertex hair loss, the treatment with finasteride was continued for 5 years; in this period, an improvement occurred compared with baseline and placebo, beginning after 3 to 6 months.

Although the improvement in hair growth compared to baseline in the men treated with finasteride was generally greatest after 2 years and then gradually decreased (the increase in hair count in a representative area of 5.1 cm² two years after the start of treatment was 88 hairs compared with 38 hairs 5 years after the start of treatment), the hair loss in the placebo group was progressively poorer in comparison to baseline (decrease of 50 hairs after 2 years and 239 hairs after five years). Thus, although the improvement in comparison to baseline did not continue further after 2 years in the men treated with finasteride, the difference between the treatment groups during the 5-year studies continued to increase. Treatment with Ffinasteride for 5 years resulted in stabilisation of the hair loss in 90 % of the men on the basis of photographic assessment and in 93 % on the basis of assessment by the investigator. In addition, increased hair growth was observed in 65 % of the men treated with Finasteride on the basis of hair count, in 48 % on the basis of photographic assessment, and in 77 % on the basis of assessment by the investigator. In contrast, in the placebo group a gradual hair loss over time was observed in 100 % of the men on the basis of hair count, in 75 % on the basis of photographic assessment, and in 38 % on the basis of assessment by the investigator. In addition, assessment by the patients themselves gave a significant increase in hair density, reduction in hair loss, and improvement in the appearance of the hair after 5 years of treatment with finasteride (see the table below).

Table 1: Percentage of patients with improvement, assessed on the basis of each of the 4 criteria

† Randomisation 1:1 finasteride: placebo

† † Randomisation 9:1 finasteride: placebo

In a study lasting 12 months in men with hair loss on the frontal/mid-area of the head, hair counts were performed in a representative area of 1 cm2 (approximately 1/5 of the area on which counts were performed in the vertex studies). The hair count, corrected for an area of 5.1 cm2, increased by 49 hairs (5 %) compared with baseline, and by 59 hairs (6 %) compared with placebo. This study also showed a significant improvement in self-assessment by the patient, in assessment by the investigator, and in the scores on the basis of photos of the head by a panel of expert dermatologists.

Two studies of 12 and 24 weeks showed that a dose of 5 times the recommended dosage (finasteride 5 mg/day) resulted in a median decrease in the volume of the ejaculate of about 0.5 ml (-25 %) compared with placebo. This decrease was reversible after the discontinuation of treatment. In a study lasting 48 weeks, finasteride 1 mg/day resulted in a median decrease in ejaculate volume of 0.3 ml (-11 %) compared with 0.2 ml (-8 %) for placebo. No effect on the number, motility and morphology of the spermatozoa was observed. There are no longer-term data available. It was not possible to carry out clinical trials that might directly reveal a possible negative effect on fertility. However, such effects are considered extremely unlikely (see also section 5.3).

Clinical efficacy in women:

No efficacy was demonstrated in post-menopausal women with androgenetic alopecia who were treated with finasteride 1 mg for 12 months.

Absorption:

The oral bioavailability of finasteride is approximately 80% and is not affected by food. The peak finasteride plasma concentration is reached approximately two hours after administration; the absorption is complete after six to eight hours.

Distribution

Protein binding is approximately 93%. The volume of distribution of finasteride is approximately 76 litres (44-96 l). At steady state following administration of 1 mg/day, the mean maximum finasteride plasma concentration was 9.2 ng/ml and was reached 1 to 2 hours after administration; the AUC (0-24 hours) was 53 ng x hours/ml.

Finasteride has been recovered in the cerebrospinal fluid (CSF), but the drug does not appear to concentrate preferentially there. A very small amount of finasteride has also been detected in the seminal fluid of subjects receiving the drug. From studies in rhesus monkeys it appears that this amount is not considered to constitute a risk for the growing male foetus (see sections 4.6 and 5.3).

Biotransformation

Finasteride is metabolised primarily via the cytochrome P450 3A4 system, but has no effect here. Following an oral dose of 14C-finasteride in man, two metabolites of the drug were identified that represent only a small fraction of the inhibitory activity of finasteride on 5α -reductase.

Elimination

Following an oral dose of 14C-finasteride in man, approximately 39% (32-46 %) of the dose was excreted in the urine in the form of metabolites. Virtually no unchanged drug was excreted in the urine and 57 % (51-64 %) of the total dose was excreted in the faeces.

Plasma clearance is approximately 165 ml/min (70-279 ml/min).

The elimination rate of finasteride decreases somewhat with age. The mean terminal half-life is approximately 5-6 hours (3-14 hours), and in men more than 70 years of age 8 hours (6-15 hours). These findings are of no clinical significance and therefore a reduction in dosage in the elderly is not necessary.

Hepatic insufficiency:

The effect of hepatic insufficiency on the pharmacokinetics of finasteride has not been studied.

Renal insufficiency:

In patients with a chronic disturbance of renal function with creatinine clearance between 9 55 ml/min the area under the curve, the peak plasma concentrations, the half-life and the protein-binding of unchanged finasteride after a single dose of 14C-finasteride were virtually identical to the values in healthy volunteers.

Mutagenicity/carcinogenicity

In genotoxicity and carcinogenicity studies no dangers for humans were revealed.

Negative effect on reproduction, including fertility

The effect on embryonal and foetal development has been studied in rats, rabbits and rhesus monkeys. In rats that were treated with 5-5000x the clinical dose, a dose-dependent occurrence of hypospadia in male foetuses was observed. In rhesus monkeys, treatment with oral doses of 2 mg/kg/day also resulted in abnormalities of the external genitalia. After intravenous doses of up to 800 ng/day in rhesus monkeys no effects on the male foetuses were observed. This represents at least 750 times the highest estimated exposure of pregnant women to finasteride from the semen of men who take 1 mg/day (see section 5.2). In the study in rabbits the foetuses were not exposed to finasteride during the critical period for the development of the genitalia.

In rabbits, after treatment with 80 mg/kg/day, a dose which in other studies was shown to have a clear weight-lowering effect on the gonads, no effect on ejaculate volume, sperm count or fertility was observed. In rats that were treated for 6 and 12 weeks with 80 mg/kg/day (about 500 times the clinical dose), no effect on fertility was observed. After treatment for 24-30 weeks some reduction in fertility and a clear decrease in weight of the prostate and the seminal vesicles was observed. All these changes appeared to be reversible within 6 weeks. The reduced fertility appeared to be the results of disturbed semen plug formation, an effect that is not relevant for humans. The development of the newborns and their ability to reproduce at sexually mature age were normal. After insemination of female rats with spermatozoa from the epididymis of rats that had been treated for 36 weeks with 80 mg/kg/day, no effect on the various fertility parameters was observed.

Tablet core:

Lactose monohydrate

Cellulose, microcrystalline (E460)

Maize starch, pregelatinised

Sodium starch glycolate

Docusate sodium

Magnesium stearate (E470b)

Povidone K30

Film-coating:

Titanium dioxide (E171)

Yellow and red iron oxide (E172).

Talc (E533b)

Hypromellose (E464)

Hydroxypropylcellulose (E463)

Not applicable.

3 years

Store in the original package in order to protect from light.

PVC/Aluminium blisters packs of 7, 14, 28, 30, 60, 84, 90, 98 tablets.

Not all pack sizes may be marketed.

Finasteride tablets are coated, as a result of which contact with the active ingredient during normal handling is prevented provided that the tablets are not broken or crushed.

Crushed or broken finasteride tablets should not be handled by women who are or may be pregnant on account of the possible absorption of finasteride and the resultant potential danger for the male foetus (see section 4.6).

Any unused product or waste material should be disposed of in accordance with local requirements.