Proscar (Finasteride) is a 5-alpha reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT), a hormone responsible for prostate growth. By reducing DHT levels, Proscar gradually shrinks the enlarged prostate gland in men with benign prostatic hyperplasia (BPH), alleviating urinary symptoms like weak stream, frequent urination, and incomplete bladder emptying.

Unlike short-term treatments, Proscar requires 3–6 months of continuous use to achieve full therapeutic effects. It is not approved for women or children and should never be handled by pregnant women due to the risk of fetal harm from crushed or broken tablets. While finasteride is also used for male pattern hair loss at a lower dose (1 mg, sold as Propecia®), Proscar’s 5 mg formulation is specifically indicated for BPH management.

Key Considerations:

• Regular monitoring of prostate-specific antigen (PSA) levels is required, as Proscar lowers PSA by approximately 50%.
• Discontinuing treatment may reverse benefits within 12 months.
• Rare but serious side effects include sexual dysfunction (e.g., decreased libido, erectile dysfunction) and depression.

How to Take:

Take Proscar once daily, with or without food. Swallow the tablet whole with water—do not crush, split, or chew it, as crushed particles can harm a developing fetus if handled by pregnant women.

Dosage Adjustments:

• Kidney/liver impairment: No dose adjustment is typically needed for mild-to-moderate impairment. For severe kidney/liver dysfunction, consult your doctor.
• Elderly patients: No specific adjustment required, but monitor closely for side effects.

Missed Dose:

If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Never take two doses in one day.

Storage:

Store tablets in the original container at room temperature (20–25°C). Protect from moisture, heat, and direct light. Keep out of reach of children and pregnant women.

Important Notes:

• Do not donate blood while taking Proscar or for 1 month after stopping to prevent fetal exposure.
• PSA testing: Proscar lowers PSA levels by ~50%. Inform your doctor you are taking this medication before prostate cancer screening.
• Pregnancy precautions: Pregnant women should avoid handling crushed or broken tablets due to risk of fetal harm.
• Treatment duration: Use continuously for 3–6 months to see symptom improvement. Do not stop abruptly without medical advice.
• Follow-up: Regular check-ups are required to monitor prostate health and side effects.

Common Side Effects

The most frequently reported side effects include decreased sexual desire, difficulty achieving or maintaining an erection (erectile dysfunction), and reduced semen volume during ejaculation. Some men may experience dizziness, mild allergic reactions (e.g., rash, itching), or swelling in the hands/feet. These effects often diminish with continued use but should be discussed with your doctor if persistent.

Less Common Effects

A small percentage of users report breast enlargement or tenderness (gynecomastia), testicular pain, or mood changes such as depressive symptoms, anxiety, or brain fog. Mild digestive issues like diarrhea or abdominal discomfort may also occur, particularly during the first few weeks of treatment.

Serious Side Effects

Stop Proscar immediately and seek medical help if you develop signs of a severe allergic reaction (swelling of the face/lips, difficulty breathing), suicidal thoughts, or symptoms of male breast cancer (e.g., lumps, nipple discharge). Although rare, finasteride has been linked to persistent sexual dysfunction (low libido, erectile issues) that continues even after stopping the medication.

Managing Side Effects

For mild reactions like dizziness, avoid driving or operating machinery until symptoms resolve. Sexual side effects may improve with dose adjustments or alternative therapies, so inform your doctor promptly. Breast changes require clinical evaluation to rule out malignancy. Do not discontinue Proscar abruptly without medical guidance, as this can reverse BPH symptom relief.

Important Considerations

• PSA Monitoring: Proscar lowers PSA levels by approximately 50%. Always inform lab technicians you are taking finasteride to ensure accurate prostate cancer screening.
• Pregnancy Risks: Pregnant women must avoid handling crushed tablets due to the risk of fetal abnormalities.
• Long-Term Use: Regular follow-ups are crucial to assess prostate health and manage chronic side effects.

Primary Medical Use

Proscar is prescribed to treat benign prostatic hyperplasia (BPH) in adult men. It alleviates urinary symptoms caused by an enlarged prostate, such as:

• Weak or interrupted urine stream
• Frequent urination (especially at night)
• Difficulty starting or maintaining urination
• Feeling of incomplete bladder emptying

By inhibiting the conversion of testosterone to dihydrotestosterone (DHT), Proscar reduces prostate size over time, improving urinary flow and reducing complications like urinary retention.

Key Usage Notes

• Long-term treatment: Requires 3–6 months of continuous use to achieve full therapeutic benefits. Improvement in symptoms is gradual and sustained with ongoing therapy.
• Not for acute relief: Does not provide immediate symptom relief; intended for chronic management.
• PSA adjustment: Proscar lowers PSA levels by ~50%. Baseline PSA testing is required before starting treatment, and results must be interpreted with this reduction in mind during cancer screening.

Important Considerations

• Approved for BPH only: The 5 mg dose is specifically for prostate enlargement. A lower dose (1 mg, sold as Propecia®) is used for male pattern hair loss, but Proscar is not interchangeable with hair loss treatments.
• Not for cancer prevention: While Proscar reduces prostate size, it is not approved to prevent or treat prostate cancer.
• Patient eligibility: Suitable only for men with confirmed BPH. Not prescribed for women, children, or men with urinary symptoms unrelated to prostate enlargement.

Limitations

• Does not cure BPH – symptoms may return if treatment is discontinued.
• Not effective for urinary issues caused by infections, bladder dysfunction, or neurological disorders.
• Contraindicated in individuals allergic to finasteride or with severe liver impairment.

Sexual Health Risks

Proscar may cause persistent sexual dysfunction, including erectile dysfunction, reduced libido, or ejaculation disorders, even after discontinuation. While rare, these effects can be long-lasting and require medical evaluation.

Prostate Cancer Screening Challenges

The medication reduces prostate-specific antigen (PSA) levels by ~50%, potentially masking early signs of prostate cancer. Patients must inform healthcare providers about Proscar use before PSA testing, and results should be adjusted accordingly.

Pregnancy and Fetal Risks

Proscar is teratogenic and can cause severe birth defects in male fetuses if pregnant women are exposed to crushed tablets. Partners of men taking Proscar should avoid handling broken pills during pregnancy or suspected pregnancy.

Mental Health Considerations

Rare cases of depression, anxiety, or suicidal thoughts have been reported. Patients with a history of mental health conditions should be monitored closely, and treatment should be reassessed if mood changes occur.

Cancer-Related Risks

• Prostate Cancer: While Proscar lowers overall prostate cancer risk, it may increase the likelihood of high-grade tumors. Regular prostate exams are essential.
• Male Breast Cancer: Rare instances of breast cancer have been reported. Promptly report breast lumps, pain, or nipple discharge.

Handling and Exposure Precautions

Pregnant women must avoid contact with Proscar tablets. Men should store the medication securely and wash hands after handling to prevent accidental exposure.

Blood Donation Restrictions

Avoid donating blood during treatment and for 1 month after discontinuation to prevent fetal exposure through transfusions.

Off-Label Use Dangers

Proscar’s 5 mg dose is not approved for hair loss (unlike 1 mg finasteride). Using it off-label increases side effect risks without proven benefits.

Treatment Discontinuation Effects

Stopping Proscar may reverse BPH symptom relief within 12 months. Do not discontinue abruptly without medical guidance to avoid recurrence of urinary issues.

Teratogenic Effects

Proscar is contraindicated in pregnancy due to the risk of severe birth defects in male fetuses, particularly genital abnormalities. Crushed or broken tablets can be absorbed through the skin, so pregnant women must avoid any contact with the medication. Men taking Proscar should store tablets securely and avoid donating blood during and for 1 month after treatment to prevent fetal exposure.

Prostate Cancer Screening

Proscar reduces prostate-specific antigen (PSA) levels by approximately 50%, which can mask early signs of prostate cancer. Healthcare providers must adjust PSA values during screening to account for this reduction. Discontinue Proscar for at least 6 months before accurate PSA testing if treatment is stopped.

Persistent Sexual Dysfunction

Rare cases of persistent erectile dysfunction, reduced libido, or ejaculatory disorders have been reported, continuing even after discontinuation. Patients should discuss these risks with their doctor before starting treatment, especially if they have a history of sexual health issues.

High-Grade Prostate Cancer Risk

While Proscar lowers overall prostate cancer risk, it may increase the likelihood of high-grade (aggressive) tumors. Regular prostate exams, including digital rectal exams (DRE) and adjusted PSA monitoring, are critical for early detection.

Mental Health Risks

Finasteride may exacerbate or trigger depression, anxiety, or suicidal ideation. Patients with a history of mental health disorders should be closely monitored. Discontinue use immediately if mood changes occur and seek medical help.

Hypersensitivity Reactions

Severe allergic reactions, including angioedema (swelling of the face, lips, or tongue) and difficulty breathing, require immediate discontinuation and emergency care.

Breast Cancer and Gynecomastia

Proscar may cause breast enlargement (gynecomastia) or tenderness. Rare cases of male breast cancer have been reported. Report breast lumps, pain, or nipple discharge promptly for evaluation.

Drug Interactions

Avoid concurrent use with other 5-alpha reductase inhibitors (e.g., dutasteride) due to compounded side effects. Use caution with CYP3A4 inhibitors (e.g., ketoconazole), which may increase finasteride levels.

Handling and Disposal

Dispose of unused tablets through pharmacy take-back programs. If unavailable, mix with an unpalatable substance (e.g., coffee grounds) in a sealed container before disposal. Never flush tablets.

Critical Reminder

Proscar is approved only for men with confirmed BPH. It is not for use in women, children, or individuals without a prostate. Always disclose your full medical history and medications to your prescriber.

Standard Adult Dosage:

The recommended dose for benign prostatic hyperplasia (BPH) is 5 mg taken orally once daily, with or without food. Swallow the tablet whole with water—do not crush, split, or chew it. Continuous use for at least 3–6 months is required to achieve significant improvement in urinary symptoms.

Special Populations:

• Elderly Patients (≥65 years): No dose adjustment is typically needed unless significant liver or kidney impairment exists.
• Renal Impairment: No adjustment required for mild-to-moderate impairment. Use with caution in severe renal dysfunction (CrCl <10 mL/min).
• Hepatic Impairment: Use cautiously in severe liver disease (Child-Pugh C); monitor for adverse effects.

Missed Dose:

If a dose is missed, take it as soon as remembered. If it is close to the next scheduled dose, skip the missed dose. Never double the dose to compensate.

Important Notes:

• Not for acute relief: Proscar works gradually and does not provide immediate symptom improvement.
• Long-term use: Benefits reverse within 12 months of discontinuation. Do not stop without consulting your doctor.
• PSA monitoring: Baseline PSA testing is required before starting treatment. Results must be interpreted with the understanding that Proscar lowers PSA by ~50%.

Drug Interactions:

Avoid combining Proscar with other 5-alpha reductase inhibitors (e.g., dutasteride) or CYP3A4 inhibitors (e.g., ketoconazole), as these may increase finasteride levels. Always inform your doctor of all medications, including supplements.

Overdose Management:

Overdose is rare but may cause dizziness, nausea, or hypotension. If suspected, seek immediate medical attention. There is no specific antidote; treatment is supportive.

Storage:

Store tablets in the original container at room temperature (20–25°C). Protect from moisture, heat, and light. Keep out of reach of children and pregnant women.

Critical Reminder:

Proscar’s 5 mg dose is not interchangeable with the 1 mg finasteride formulation (Propecia®) used for hair loss. Using Proscar for unapproved purposes increases risks without benefits.

Other 5-Alpha Reductase Inhibitors:

Combining Proscar with medications like dutasteride increases the risk of side effects such as sexual dysfunction and hormonal imbalances. This combination offers no therapeutic benefit and should be avoided.

CYP3A4 Inhibitors:

Drugs like ketoconazole or erythromycin may increase finasteride levels in the body, potentially amplifying side effects such as dizziness or breast tenderness.

Blood Thinners:

While Proscar does not directly interact with anticoagulants like warfarin, patients on blood thinners should inform their doctor to monitor for compounded risks during procedures.

Herbal Supplements:

Supplements such as saw palmetto, often used for prostate health, may enhance finasteride’s effects or side effects. Discuss all supplements with your healthcare provider.

Alcohol:

Excessive alcohol consumption may worsen side effects like dizziness or fatigue. Moderate intake is advised to minimize these risks.

PSA-Altering Medications:

Drugs like testosterone therapy or corticosteroids can affect PSA levels. Proscar lowers PSA by ~50%, so adjustments are needed during cancer screening.

Precautions:

• Always provide your healthcare provider with a complete list of all medications, supplements, and herbal products you are taking.
• Regular monitoring of PSA levels and prostate health is essential.
• Inform your doctor if you have liver or kidney disease, as these conditions may affect drug processing.
• Avoid starting new medications or supplements without consulting your doctor while using Proscar.