Finasteride 5mg Film-Coated Tablets
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Finasteride 5 mg Film-coated Tablets
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Each tablet contains 5 mg of finasteride
Excipients: each tablet contains 90.95 mg of lactose monohydrate For a full list of excipients, see section 6.1
3 PHARMACEUTICAL FORM
Film-coated tablets
Film-coated, Blue, round biconvex tablets. Diameter 7mm. Marked “F5” on one side.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Finasteride is indicated for the treatment and control of benign prostatic hyperplasia (BPH) in patients with an enlarged prostate to:
- cause regression of the enlarged prostate, improve urinary flow and improve the symptoms associated with BPH
- reduce the incidence of acute urinary retention and the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.
4.2 Posology and method of administration
Route of administration: oral use
The recommended adult dose is one 5 mg tablet daily, taken orally with or without food.
Finasteride can be administered alone or in combination with the alpha-blocker doxazosin (see section 5.1 'Pharmacodynamic properties').
Although early improvement in symptoms may be seen, treatment for at least six months may be necessary to assess whether a beneficial response has been achieved. Thereafter, treatment should be continued long term.
No dosage adjustment is required in the elderly or in patients with varying degrees of renal insufficiency (creatinine clearances as low as 9 ml/min).
There are no data available in patients with hepatic insufficiency.
Finasteride is contra-indicated in children.
4.3 Contraindications
Finasteride is not indicated for use in women or children.
Finasteride is contraindicated in the following:
• Hypersensitivity to any component of this product:
• Pregnancy - Use in women when they are or may potentially be pregnant (see 4.6 Pregnancy and lactation, Exposure to finasteride -risk to male fetus).
4.4 Special warnings and precautions for use
General
To avoid obstructive complications it is important that patients with large residual urine and/or heavily decreased urinary flow are carefully controlled. The possibility of surgery should be an option.
Effects on prostate-specific antigen (PSA) and prostate cancer detection
No clinical benefit has yet been demonstrated in patients with prostate cancer treated with finasteride. Patients with BPH and elevated serum prostate specific antigen (PSA) were monitored in controlled clinical studies with serial PSAs and prostate biopsies. In these BPH studies, finasteride did not appear to alter the rate of prostate cancer detection and the overall incidence of prostate cancer was not significantly different in patients treated with finasteride or placebo.
Digital rectal examination, as well as other evaluations for prostate cancer, should be carried out on patients with BPH prior to initiating therapy with finasteride and periodically thereafter. Generally, when PSA assays are performed a baseline PSA>10 ng/ml (Hybritech) prompts further evaluation and consideration of biopsy; for PSA levels between 4 and 10 ng/ml, further evaluation is advisable. There is considerable overlap in PSA levels among men with and without prostate cancer. Therefore, in men with BPH, PSA values within the normal reference range do not rule out prostate cancer regardless of treatment with finasteride. A baseline PSA <4 ng/ml does not exclude prostate cancer.
Finasteride causes a decrease in serum PSA concentrations by approximately 50% in patients with BPH, even in the presence of prostate cancer. This decrease in serum PSA levels in patients with BPH treated with finasteride should be considered when evaluating PSA data and does not rule out concomitant prostate cancer. This decrease is predictable over the entire range of PSA values, although it may vary in individual patients. Analysis of PSA data from over 3000 patients in the 4-year, double-blind, placebo-controlled finasteride Long-Term Efficacy and Safety Study (PLESS) confirmed that in typical patients treated with finasteride for six months or more, PSA values should be doubled for comparison with normal ranges in untreated men. This adjustment preserves the sensitivity and specificity of the PSA assay and maintains its ability to detect prostate
cancer.
Any sustained increase in PSA levels of patients treated with finasteride should be carefully evaluated, including consideration of non-compliance to therapy with finasteride.
Percent free PSA (free to total PSA ratio) is not significantly decreased by finasteride. The ratio of free to total PSA remains constant even under the influence of finasteride. When percent free PSA is used as an aid in the detection of prostate cancer, no adjustment to its value is necessary.
Drug/laboratory test interactions
Effect on levels of PSA
Serum PSA concentration is correlated with patient age and prostatic volume, and prostatic volume is correlated with patient age. When PSA laboratory determinations are evaluated, consideration should be given to the fact that PSA levels decrease in patients treated with finasteride. In most patients, a rapid decrease in PSA is seen within the first months of therapy, after which time PSA levels stabilize to a new baseline. The post-treatment baseline approximates half of the pre-treatment value. Therefore, in typical patients treated with finasteride for six months or more, PSA values should be doubled for comparison to normal ranges in untreated men. For clinical interpretation, see 4.4 Special warnings and precautions for use, Effects on PSA and prostate cancer detection.
Breast cancer in men
Breast cancer has been reported in men taking finasteride 5 mg during clinical trials and the post-marketing period. Physicians should instruct their patients to promptly report any changes in their breast tissue such as lumps, pain, gynaecomastia or nipple discharge.
Pediatric use
Finasteride is not indicated for use in children.
Safety and effectiveness in children have not been established.
Lactose
The tablet contains lactose monohydrate. Patients with any of the following genetic deficiencies should not take this drug: galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.
4.5 Interaction with other medicinal products and other forms of interaction
No clinically important drug interactions have been identified. Finasteride does not appear to significantly affect the cytochrome P450-linked drug metabolizing enzyme system.
Compounds which have been tested in man include propranol, digoxin, glibenclamide, warfarin, theophylline, and antipyrine and no clinically meaningful interactions were found.
Other concomitant therapy: Although specific interaction studies were not performed in clinical studies, finasteride was used concomitantly with ACE inhibitors, alpha-blockers, beta-blockers, calcium channel blockers, cardiac nitrates, diuretics, H2 antagonists, HMG-CoA reductase inhibitors, non-
steroidal anti-inflammatory drugs (NSAIDs) including aspirin and paracetamol, quinolones and benzodiazepines without evidence of clinically significant adverse interactions.
4.6 Pregnancy and lactation
Pregnancy. Finasteride is contraindicated for use in women when they are or may potentially be pregnant (See 4.3 Contraindications).
Because of the ability of Type II 5 a-reductase inhibitors to inhibit conversion of testosterone to dihydrotestosterone (DHT), these drugs, including finasteride, may cause abnormalities of the external genitalia of a male foetus when administered to a pregnant woman.
In animal developmental studies, dose-dependent development of hypospadias were observed in the male offspring of pregnant rats given finasteride at doses ranging from 100 micrograms/kg/day to 100 mg/kg/day, at an incidence of 3.6% to 100%. Additionally, pregnant rats produced male offspring with decreased prostatic and seminal vesicular weights, delayed preputial separation, transient nipple development and decreased anogenital distance, when given finasteride at doses below the recommended human dose. The critical period during which these effects can be induced has been defined in rats as days 16-17 of gestation.
The changes described above are expected pharmacological effects of Type II 5 a -reductase inhibitors. Many of the changes, such as hypospadias, observed in male rats exposed in utero to finasteride are similar to those reported in male infants with a genetic deficiency of Type II 5 a-reductase. It is for these reasons that finasteride is contra-indicated in women who are or may potentially be pregnant.
No effects were seen in female offspring exposed in utero to any dose of finasteride.
Exposure to finasteride - risk to male foetus
Women should not handle crushed or broken tablets of finasteride when they are or may potentially be pregnant because of the possibility of absorption of finasteride and the subsequent potential risk to a male foetus (see 'Pregnancy'). Finasteride tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets have not been broken or crushed.
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. Therefore, when the patient's sexual partner is or may potentially be pregnant, the patient should either avoid exposure of his partner to semen (e.g. by use of a condom) or discontinue finasteride.
Lactation'. Finasteride is not indicated for use in women. It is not known whether finasteride is excreted in human milk.
4.7 Effects on ability to drive and use machines
Not relevant.
4.8 Undesirable effects
The most frequent adverse reactions are impotence and decreased libido. These adverse reactions occur early in the course of therapy and resolve with continued treatment in the majority of patients.
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 (>1/100 to <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.
|
System Organ Class |
Frequency: adverse reaction |
|
Investigations |
Common: decreased volume of ejaculate |
|
Cardiac disorders |
Unknown: palpitation |
|
Skin and subcutaneous tissue disorders |
Uncommon: rash Unknown: pruritus, urticaria |
|
Immune system disorders |
Unknown: hypersensitivity reactions including swelling of the lips and face |
|
Hepatobiliary disorders |
Unknown: increased hepatic enzymes |
|
Reproductive system and breast disorders |
Common: impotence Uncommon: ejaculation disorder, breast tenderness, breast enlargement Unknown: testicular pain |
|
Psychiatric disorders |
Common: decreased libido |
In addition, the following has been reported in clinical trials and postmarketing use: male breast cancer (see 4.4 Special warnings and precautions for use).
Medical Therapy of Prostate Symptoms (MTOPS)
The MTOPS study compared finasteride 5 mg/day (n=768), doxazosin 4 or 8 mg/day (n=756), combination therapy of finasteride 5 mg/day and doxazosin 4 or 8 mg/day (n=786), and placebo (n=737). In this study, the safety and tolerability profile of the combination therapy was generally consistent with the profiles of the individual components. The incidence of ejaculation disorder in patients receiving combination therapy was comparable to the sum of incidences of this adverse experience for the two monotherapies.
Other Long-Term Data
In a 7-year placebo-controlled trial that enrolled 18,882 healthy men, of whom 9060 had prostate needle biopsy data available for analysis, prostate cancer was detected in 803 (18.4%) men receiving finasteride and 1147 (24.4%) men receiving placebo. In the finasteride group, 280 (6.4%) men had prostate cancer with Gleason scores of 7-10 detected on needle biopsy vs. 237 (5.1%) men in the placebo group. Additional analyses suggest that the increase in the prevalence of high-grade prostate cancer observed in the finasteride group may be explained by a detection bias due to the effect of finasteride on prostate volume. Of the total cases of prostate cancer diagnosed in this study, approximately 98% were classified as intracapsular (clinical stage T1 or T2) at diagnosis. The clinical significance of the Gleason 7-10 data is unknown.
Laboratory Test Findings
When PSA laboratory determinations are evaluated, consideration should be given to the fact that PSA levels are decreased in patients treated with finasteride (see section 4.4Special warnings and precautions for use).
4.9 Overdose
No specific treatment of overdosage with finasteride is recommended. Patients have received single doses of finasteride up to 400 mg and multiple doses of finasteride up to 80 mg/day for up to three months without any adverse effects.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacodynamic group: Testosterone -5-alpha reductase inhibitors, ATC code: G04C B01
Finasteride is a competitive inhibitor of human 5 a -reductase, an intracellular enzyme which metabolises testosterone into the more potent androgen, dihydrotestosterone (DHT). In benign prostatic hyperplasia (BPH), enlargement of the prostate gland is dependent upon the conversion of testosterone to DHT within the prostate. Finasteride is highly effective in reducing circulating and intraprostatic DHT. Finasteride has no affinity for the androgen receptor.
In clinical studies of patients with moderate to severe symptoms of BPH, an enlarged prostate on digital rectal examination and low residual urinary volumes, finasteride reduced the incidence of acute retention of urine from 7/100 to 3/100 over four years and the need for surgery (TURP or prostatectomy) from 10/100 to 5/100. These reductions were associated with a 2-point improvement in QUASI-AUA symptom score (range 0-34), a sustained regression in prostate volume of approximately 20% and a sustained increase in urinary flow rate.
Medical therapy of prostatic symptoms
The Medical Therapy of Prostatic Symptoms (MTOPS) Trial was a 4- to 6-year study in 3047 men with symptomatic BPH who were randomized to receive finasteride 5 mg/day, doxazosin 4 or 8 mg/day , the combination of finasteride 5 mg/day and doxazosin 4 or 8 mg/day*, or placebo. The primary endpoint was time to clinical progression of BPH, defined as a ^4 point confirmed increase from baseline in symptom score, acute urinary retention, BPH-related renal insufficiency, recurrent urinary tract infections or urosepsis, or incontinence. Compared to placebo, treatment with finasteride, doxazosin, or combination therapy resulted in a significant reduction in the risk of clinical progression of BPH by 34(p=0.002), 39 (p<0.001), and 67% (p<0.001), respectively. The majority of the events (274 out of 351) that constituted BPH progression were confirmed M point increases in symptom score; the risk of symptom score progression was reduced by 30 (95% CI 6 to 48%), 46 (95%
CI 25 to 60%), and 64% (95% CI 48 to 75%) in the finasteride, doxazosin, and combination groups, respectively, compared to placebo. Acute urinary retention accounted for 41 of the 351 events of BPH progression; the risk of developing acute urinary retention was reduced by 67 (p=0.011), 31 (p=0.296), and 79% (p=0.001) in the finasteride, doxazosin, and combination groups, respectively, compared to placebo. Only the finasteride and combination therapy groups were significantly different from placebo.
* Titrated from 1 mg to 4 or 8 mg as tolerated over a 3-week period
5.2 Pharmacokinetic properties
After an oral dose of 14C-finasteride in man, 39% of the dose was excreted in the urine in the form of metabolites (virtually no unchanged drug was excreted in the urine), and 57% of total dose was excreted in the faeces. Two metabolites have been identified which possess only a small fraction of the Type II 5 a -reductase activity of finasteride.
The oral bioavailability of finasteride is approximately 80%, relative to an intravenous reference dose, and is unaffected by food. Maximum plasma concentrations are reached approximately two hours after dosing and the absorption is complete within 6-8 hours. Protein binding is approximately 93%. Plasma clearance and the volume of distribution are approximately 165 ml/min and 76 l, respectively.
In the elderly, the elimination rate of finasteride is somewhat decreased. Halflife is prolonged from a mean half-life of approximately six hours in men aged 18-60 years to eight hours in men aged more than 70 years. This is of no clinical significance and does not warrant a reduction in dosage.
In patients with chronic renal impairment, whose creatinine clearance ranged from 9-55 ml/min, the disposition of a single dose of 14C-finasteride was not different from that in healthy volunteers. Protein binding also did not differ in patients with renal impairment. A portion of the metabolites which is normally excreted renally was excreted in the faeces. It therefore appears that faecal excretion increases commensurate to the decrease in urinary excretion of metabolites. Dosage adjustment in non-dialysed patients with renal impairment is not necessary.
There are no data available in patients with hepatic insufficiency.
Finasteride has been found to cross the blood-brain barrier. Small amounts of finasteride have been recovered in the seminal fluid of treated patients.
5.3 Preclinical safety data
There are no preclinical data of relevance to the prescriber which are additional to those already in other sections of the SPC.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Lactose monohydrate Cellulose microcrystalline Pregelatinised starch Lauroyl macrogolglycerides Sodium starch glycolate (type A)
Magnesium stearate Film coat:
Hypromellose 6 cps.
Titanium dioxide (E171)
Indigocarmine-lake (E 132)
Macrogol 6000
6.2 Incompatibilities
Not Applicable
6.3 Shelf life
36 months
6.4 Special precautions for storage
There are no special storage instructions
6.5 Nature and contents of container
1. Al/PVC Blister, pack sizes; 12, 28, 30 and 56 Tablets
2. Al/Al Blister, pack sizes; 12, 28, 30 and 56 Tablets Not all pack sizes may be marketed
6.6 Special precautions for disposal
Women should not handle crushed or broken finasteride tablets when they are or may potentially be pregnant (see 'Contra-indications, 'Pregnancy and lactation', Exposure to finasteride - risk to male foetus).
7 MARKETING AUTHORISATION HOLDER
Strandhaven Ltd t/a Somex Pharma 600 High Road,
Seven Kings,
Ilford, Essex,
IG3 8BS UK
8 MARKETING AUTHORISATION NUMBER(S)
PL 15764/0036
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
02/09/2009
10 DATE OF REVISION OF THE TEXT
19/08/2010