Milten (Finasteride)

Finasteride is indicated for conditions that involve excess dihydrotestosterone (DHT) activity.

• Benign prostatic hyperplasia (BPH): reduces prostate volume and improves urinary flow.
• Urinary symptoms associated with BPH: alleviates frequency, urgency and weak stream.
• Male pattern hair loss (androgenetic alopecia): lowers scalp DHT levels, slowing hair loss and promoting regrowth.

• Finasteride selectively inhibits type II 5‑alpha‑reductase, the enzyme responsible for converting testosterone to the more potent androgen dihydrotestosterone (DHT). By decreasing intracellular DHT concentrations in androgen‑responsive tissues such as the prostate and scalp hair follicles, it reduces androgen‑driven cellular proliferation and miniaturization, thereby addressing the underlying pathophysiology of benign prostatic hyperplasia and androgenetic alopecia.

Finasteride may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Decreased libido.
• Erectile dysfunction.
• Breast tenderness or enlargement.

Serious or Rare Side Effects

• Allergic reactions including anaphylaxis.
• Breast cancer (rare).
• Depression or mood changes.

When prescribing Finasteride, several precautions should be observed to ensure safe use.

• Monitor prostate-specific antigen (PSA) levels: assess for prostate cancer screening.
• Evaluate liver function: adjust use in hepatic impairment.
• Review history of breast cancer: contraindicated in patients with known disease.
• Avoid use in women of childbearing potential: teratogenic risk (Category X).
• Counsel about potential sexual side effects: discuss impact on libido and erectile function.
• Store at room temperature: keep in original container, protect from moisture and light.

Finasteride can interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Co‑administration with other 5‑alpha‑reductase inhibitors (e.g., dutasteride): additive hormonal effects.
• Use with testosterone replacement therapy: may counteract Finasteride’s action.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors (ketoconazole, itraconazole): may increase Finasteride plasma levels.
• Anticoagulants (warfarin): monitor INR for potential bleeding changes.
• St John’s wort: may reduce Finasteride concentrations.
• Antifungal azoles: may alter metabolism.