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drug adverse effects of 5-alpha reductase inhibitors

Adverse effects: - fetal abnormalities in male fetus a) absorbed through skin b) may be passed to pregnant woman through blood transfusion - impotence < 5% (transient) - sexual dysfunction may persist after discontinuation [6] - gynecomastia < 1% - increased risk of high-grade prostate cancer - no increased risk of high-grade prostate cancer [3,6] - delayed diagnosis & increased mortality from prostate cancer [8] - erectile dysfunction - no increased risk of erectile dysfunction [4] - common [9] - depression [5] - increased risk for type 2 diabetes (RR= 1.3 vs tamsulosin) [7]

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DRUGS: 5-alpha reductase inhibitor FORM: drug adverse effects 5 alpha reductase inhibitor

References

  1. FDA MedWatch: 6/9/2011 5-alpha reductase inhibitors (5-ARIs): Label Change - Increased Risk of Prostate Cancer http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm258529.htm
  2. Prescriber's Letter 18(8): 2011 COMMENTARY: Possible Increased Risk of Aggressive Prostate Cancer with Finasteride and Dutasteride GUIDELINES: Use of 5-alpha Reductase Inhibitors for Prostate Cancer Chemoprevention (2008) Detail-Document#: 270810 (subscription needed) http://www.prescribersletter.com
  3. Robinson D et al Use of 5alpha-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study. BMJ 2013;346:f3406 PMID: 23778271 http://www.bmj.com/content/346/bmj.f3406?etoc=
  4. Hagberg KW, Divan HA, Persson R, Nickel JC, Jick SS. Risk of erectile dysfunction associated with use of 5-alpha reductase inhibitors for benign prostatic hyperplasia or alopecia: population based studies using the Clinical Practice Research Datalink. BMJ 2016;354:i4823 PMID: 27659058 Free Article http://www.bmj.com/content/354/bmj.i4823
  5. Welk B, McArthur E, Ordon M et al Association of Suicidality and Depression With 5alpha-Reductase Inhibitors. JAMA Intern Med. Published online March 20, 2017 PMID: 28319231 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2610105
  6. Unger JM, Hershman DL, Till C et al. Using Medicare claims to examine long-term prostate cancer risk of finasteride in the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2018 Nov; 110:1208-1215. PMID: 29534197 - Wallerstedt A, Strom P, Gronberg H, Nordstrom T, Eklund M. Risk of prostate cancer in men treated with 5alpha-reductase inhibitors - A large population-based prospective study. J Natl Cancer Inst 2018 Nov; 110:1216-1221 PMID: 29548030
  7. Wei L, Lai EC, Kao-Yang YH et al Incidence of type 2 diabetes mellitus in men receiving steroid 5alpha-reductase inhibitors: population based cohort study. BMJ 2019;365:l1204 PMID: 30971393 Free Article https://www.bmj.com/content/365/bmj.l1204 - Andrew R, Wei L, Walker B, MacDonald D Reducing the risk of type 2 diabetes in men with benign prostatic hyperplasia - old steroids, new tricks. thebmjopinion. April 10, 2019 https://blogs.bmj.com/bmj/2019/04/10/reducing-the-risk-of-type-2-diabetes-in-men-with-benign-prostatic-hyperplasia-old-steroids-new-tricks/
  8. Sarkar RR, Parsons JK, Bryant AK et al Association of Treatment With 5alpha-Reductase Inhibitors With Time to Diagnosis and Mortality in Prostate Cancer. JAMA Intern Med. 2019;179(6):812-819. PMID: 31058923 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2732119
  9. Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022