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Generic finasteride 1mg and Propecia

The UK patent for Propecia expired in 2014. 'Generic Propecia' or more accurately 'generic finasteride' became available from other pharmaceutical companies. A generic medicine is a medicine which is the same as a branded original, but is prescribed and supplied by its medical name, rather than its brand name.

Propecia is a brand name. The active ingredient of Propecia tablets is finasteride 1mg. Propecia tablets and finasteride 1mg tablets are medically the same. Dr Fox may supply any UK licensed generic version (Accord, Amarox, Bristol, Mylan, Milpharm/Aurobindo, Relonchem). Dr Fox pharmacy can often supply a preferred generic brand on request.

How long does it take to work?

Clinical studies show improved hair growth is usually noticeable after 4-6 months of taking finasteride 1mg daily. Maximum benefit is seen at 1-2 years. At 2 years 66% of men had improved hair growth counts compared to 7% of those taking no drug.

The studies were conducted on men aged 18 to 41 years of age with mild to moderate hair loss, but not complete hair loss.

How does finasteride work?

Hair grows in hair follicles normally for about three years. The hair then falls out and a new hair grows from the follicle. For men affected by male pattern hair loss, as they age, hair follicles gradually become smaller. New hair becomes thinner and falls out more quickly, eventually not growing enough to break the surface of the scalp (balding).

Male hormones cause these changes. Hair follicles convert the male hormone testosterone into another hormone called dihydrotestosterone (DHT). Hair follicles become more sensitive to dihydrotestosterone and this causes the hair follicles to shrink.

Finasteride 1mg blocks testosterone conversion to DHT which results in hair regrowth and improved hair thickness in most men.

Who benefits

Men at any stage of male pattern hair loss are likely to benefit. Finasteride 1mg is most effective for hair loss over the top of the scalp (vertex). It has NOT been proven to reverse receding frontal hairline, hair loss which is ONLY in the temple regions, nor restore hair to entirely bald areas.

When not to take finasteride

You should not take finasteride if:

• Under 18 or assigned female at birth.
• Already taking another 5AR medication such as dutasteride or finasteride 5mg for another condition e.g. prostate cancer or enlarged prostate gland.
• You have a known allergy to finasteride.

You may be able to take finasteride for hair loss but Dr Fox does not supply if you have:

• Previously suffered with sexual problems when taking finasteride or a similar 5AR medication such as dutasteride.
• Prostate cancer or have had it in the past.
• Male breast enlargement (gynaecomastia) or have had it in the past.
• A history of liver disease as the metabolism of finasteride is likely to be affected.

Cautions

• If hair loss has been rapid and recent (less than a year), or where there are symptoms of serious illness - such as unexplained weight loss, fevers, persistent diarrhoea, or excessive fatigue, or there is also loss of eyebrows or eyelashes - your GP should be consulted.
• If hair loss is patchy or irregular, or comes out in clumps, or there is scalp inflammation, papules or pustules, you should consult your GP or a dermatologist.
• Blood tests carried out to detect prostate cancer (PSA) can give misleading results when finasteride 1mg is being taken. Tell your doctor that you are taking Propecia/finasteride, if you are having a PSA test.
• If you are also having difficulty passing urine either starting the flow or with very slow flow, please consult your GP as this may be caused by your prostate gland.
• If treatment is stopped, the beneficial effects begin to reverse by 6 months and return to baseline by 9-12 months.
• Pregnant women should not come into contact with Propecia/finasteride 1mg tablets. It may affect the baby's sex organ development. For this reason tablets are film coated and women should not handle crushed or broken tablets.

Possible side effects of finasteride

Propecia/finasteride side effects are usually mild.

Reduced libido and erectile dysfunction are possible.

There are some case reports of diminished libido or erectile dysfunction persisting after stopping Propecia/finasteride. However sexual problems usually settle once finasteride has washed out of the system.

In 2017 the NHS reviewed a new study and concluded that If sexual problems do occur, the drug can be stopped and the problem will resolve in nearly all cases. Extremely rarely, patients report symptoms linked to post-finasteride syndrome. An editorial in the British Medical Journal in 2019 supported this position, but suggested a need for further research.

Important: if you develop any lumps or experience pain in your breast area, or discharge from your nipples, please consult your GP. There have been rare reports of breast cancer in men who have taken finasteride.

Some men have reported episodes of depressive illness in association with the use of Propecia/finasteride 1mg for male pattern hair loss. There are also some reports of men developing suicidal thoughts. If low mood, depression, or suicidal thoughts develop, stop treatment and consult your GP straight away.

See the finasteride patient leaflet for a full list of side effects. Side effects can be reported directly via the MHRA Yellow Card Scheme website or their app which can be downloaded from Google Play or Apple's App Store.

Alternative hair loss treatments

Regaine Extra Strength/minoxidil 5% foam or lotion applied to the scalp twice daily is the only other proven effective hair loss treatment. Regaine and finasteride 1mg can be used at the same time.

Dutasteride 0.5mg (brand name Avodart) is another 5AR inhibitor which works in the same way as finasteride to prevent male pattern baldness. In theory dutasteride is more potent than finasteride, and is therefore a more effective treatment. However dutasteride does not have a licence to be used to prevent hair loss and so it's prescription is off label. Dr Fox only supplies finasteride which does have a licence for the treatment of men with male pattern hair loss.

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