From the Guidelines
Finasteride can be stopped abruptly without a weaning period. Unlike some medications that require gradual dose reduction, finasteride does not cause withdrawal symptoms when discontinued suddenly. This applies to both the 1mg dose used for male pattern baldness and the 5mg dose used for benign prostatic hyperplasia (BPH). The reason finasteride can be stopped immediately is related to how it works - it inhibits the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT), but doesn't affect hormone receptors or neurotransmitters that typically require tapering.
According to the study by Guess et al 1, finasteride's effect on serum PSA levels in men with BPH and/or prostate cancer shows considerable variability, but there is no indication that stopping the medication abruptly would lead to adverse effects. In fact, the study suggests that the effects of finasteride on PSA levels continue to decrease over time, with the majority of decreases occurring within the first year of treatment.
Some key points to consider when stopping finasteride include:
- DHT levels will return to baseline within about 2 weeks after discontinuation
- Benefits for hair loss or prostate symptoms will gradually reverse
- For hair loss specifically, any regrown hair will likely be lost within 6-12 months after discontinuation
- Side effects typically resolve within weeks of discontinuation, though in rare cases some individuals report persistent symptoms
It's essential to note that the decision to stop finasteride should be made in consultation with a healthcare provider, as they can assess individual circumstances and provide guidance on the best course of action. However, from a medical standpoint, there is no requirement to taper off finasteride, and it can be discontinued abruptly without concern for withdrawal symptoms or other adverse effects 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.
Discontinuation of finasteride can be done abruptly, as the drug label does not indicate a need for tapering. The levels of DHT return to pretreatment levels in approximately 2 weeks after discontinuation of therapy, and prostate volume returns to close to baseline value after approximately three months of discontinuation of therapy 2.
From the Research
Discontinuation of Finasteride
- There is no direct evidence in the provided studies that suggests finasteride requires tapering off or can be discontinued abruptly 3, 4, 5, 6, 7.
- However, a study on the discontinuation of medication in general suggests that not all drugs can be stopped abruptly, as this can result in a rebound-effect or withdrawal symptoms, especially for drugs that act on the central nervous system 6.
- Finasteride is a 5-alpha-reductase inhibitor that can pass the blood-brain barrier and block many other neurosteroids in the brain, which may lead to changes in neurochemistry and impaired neurogenesis 3.
- The US Food and Drug Administration has added suicidal ideation to the list of adverse effects for finasteride, and urologists are recommended to perform a mental health screen and provide appropriate resources to patients commencing treatment 5.
- It is recommended to discontinue finasteride in patients with new onset of depression or suicidal symptoms, and close liaison with the patient's general practitioner is vital for management of depressive or suicidal symptoms 5.
Potential Risks of Abrupt Discontinuation
- The provided studies do not specifically address the risks of abrupt discontinuation of finasteride, but they do highlight the potential for persistent side effects after stopping the drug, including sexual, neurological, psychiatric, endocrinological, metabolic, and ophthalmological dysfunctions 3, 5.
- A study on the treatment of alopecia with finasteride notes that the most common adverse events include reduced libido, decreased ejaculate volume, and gynaecomastia, but does not discuss the risks of abrupt discontinuation 7.
- Another study on finasteride notes that the frequency of adverse drug events is low, with the most common side effects being impotence, decreased libido, and decreased volume of ejaculate, but does not address the risks of abrupt discontinuation 4.