What is the recommended approach for discontinuing finasteride (Propecia) in patients with Benign Prostatic Hyperplasia (BPH) or androgenetic alopecia?

From the Guidelines

Finasteride (Propecia) can typically be discontinued abruptly without a tapering schedule in patients with BPH or androgenetic alopecia. Simply stopping the medication is generally considered safe and appropriate, as there is no evidence to suggest that tapering is necessary to prevent adverse effects 1. For patients with BPH, symptoms may gradually return within 6-12 months after discontinuation as DHT levels increase again. Similarly, for those using finasteride for hair loss, the beneficial effects will likely reverse within 6-12 months, with hair loss resuming at pre-treatment rates. Patients should be informed about this expected return of symptoms to set appropriate expectations. The medication has a relatively short half-life (approximately 5-6 hours), but its effects on DHT suppression can persist for several days after discontinuation. No withdrawal symptoms are typically associated with stopping finasteride, as it doesn't cause physical dependence 1. However, some patients may benefit from follow-up evaluation after discontinuation to assess symptom recurrence and discuss alternative treatment options if needed. Key points to consider when discontinuing finasteride include:

• The lack of need for a tapering schedule
• The potential for return of symptoms within 6-12 months
• The importance of patient education and follow-up evaluation
• The absence of withdrawal symptoms or physical dependence. It's also important to note that finasteride reduces the risk of acute urinary retention and the need for BPH-related surgery, and its effects on reducing prostate size and improving symptoms are well established 1.

From the FDA Drug Label

In healthy male volunteers treated with finasteride tablets for 14 days, discontinuation of therapy resulted in a return of DHT levels to pretreatment levels in approximately 2 weeks. In patients treated for three months, prostate volume, which declined by approximately 20%, returned to close to baseline value after approximately three months of discontinuation of therapy.

No tapering is recommended when discontinuing finasteride, as the drug's effects on DHT levels and prostate volume return to baseline within a few weeks to months after stopping treatment 2.

From the Research

Discontinuing Finasteride

When considering discontinuing finasteride, particularly in patients with Benign Prostatic Hyperplasia (BPH) or androgenetic alopecia, several factors must be taken into account. The decision to taper off finasteride should be based on the individual patient's response to the medication, potential side effects, and the underlying condition being treated.

Potential Side Effects and Post-Finasteride Syndrome

• Finasteride has been associated with various side effects, including sexual dysfunction, neurological, physical, and mental symptoms, which may persist even after discontinuation of the medication 3.
• Post-finasteride syndrome (PFS) is a condition characterized by a constellation of serious adverse side effects that develop and persist in patients during and/or after discontinuing finasteride treatment 3.
• The risk of erectile dysfunction (ED) has been reported in patients taking finasteride, particularly those with BPH, although the relationship between finasteride and ED is not fully understood 4.

Tapering Off Finasteride

• There is no established protocol for tapering off finasteride, and the decision to discontinue the medication should be made on a case-by-case basis.
• Patients who experience side effects or concerns about post-finasteride syndrome should discuss their options with their healthcare provider.
• The loss of hair following withdrawal of finasteride has been reported, highlighting the importance of considering the potential consequences of discontinuing treatment 5.

Recommendations for Discontinuation

• Healthcare providers should discuss the potential risks and benefits of finasteride treatment with their patients, including the possibility of persistent side effects and post-finasteride syndrome 3, 6.
• Patients should be closely monitored for side effects and changes in their condition during and after treatment with finasteride.
• Further research is needed to fully understand the effects of finasteride and to develop effective treatments for post-finasteride syndrome 3, 6.