HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use
PROPECIA safely and effectively. See full prescribing information
for PROPECIA.

----------------------- WARNINGS AND PRECAUTIONS ----------------------
PROPECIA is not indicated for use in women or pediatricpatients (5.1, 5.4).

Women should not handle crushed or broken PROPECIA tablets
when they are pregnant or may potentially be pregnant due topotential risk to a male fetus (5.1, 8.1, 16).

PROPECIA causes a decrease in serum PSA levels. Any
confirmed increase in PSA while on PROPECIA may signal thepresence of prostate cancer and should be evaluated, even if
those values are still within the normal range for men not taking a
5α-reductase inhibitor (5.2).

5α-reductase inhibitors may increase the risk of high-grade
prostate cancer (5.3, 6.1).

PROPECIA® (finasteride) tablets for oral use
Initial U.S. Approval: 1992----------------------------INDICATIONS AND USAGE ---------------------------
PROPECIA is a 5α-reductase inhibitor indicated for the treatmentof male pattern hair loss (androgenetic alopecia) in MEN ONLY(1).
PROPECIA is not indicated for use in women (1, 4, 5.1).
----------------------- DOSAGE AND ADMINISTRATION ----------------------
PROPECIA may be administered with or without meals (2).

One tablet (1 mg) taken once daily (2).

In general, daily use for three months or more is necessary before
benefit is observed (2).

------------------------------ ADVERSE REACTIONS -----------------------------The most common adverse reactions, reported in ≥1% of patientstreated with PROPECIA and greater than in patients treated withplacebo are: decreased libido, erectile dysfunction and ejaculation
disorder (6.1).

--------------------- DOSAGE FORMS AND STRENGTHS --------------------1 mg tablets (3).

To report SUSPECTED ADVERSE REACTIONS, contact Organon
LLC, a subsidiary of Organon & Co., at 1-844-674-3200 or FDA at
1-800-FDA-1088 or www.fda.gov/medwatch.

-------------------------------CONTRAINDICATIONS ------------------------------
Pregnancy (4, 5.1, 8.1, 16).
Hypersensitivity to any components of this product (4).

See 17 for PATIENT COUNSELING
FDA-approved patient labeling.

INFORMATION

andRevised: 08/2022

FULL PRESCRIBING INFORMATION: CONTENTS*
1
2
3
4
5

6
7

8

8.3 Nursing Mothers
8.4 Pediatric Use
8.5 Geriatric Use
8.6 Hepatic Impairment
8.7 Renal Impairment
10 OVERDOSAGE
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.2 Pharmacodynamics
12.3 Pharmacokinetics
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
14 CLINICAL STUDIES
14.1 Studies in Men
14.2 Study in Women
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION

INDICATIONS AND USAGE
DOSAGE AND ADMINISTRATIONDOSAGE FORMS AND STRENGTHSCONTRAINDICATIONSWARNINGS AND PRECAUTIONS
5.1 Exposure of Women — Risk to Male Fetus
5.2 Effects on Prostate Specific Antigen (PSA)
5.3 Increased Risk of High-Grade Prostate Cancer with 5αReductase Inhibitors
5.4 Pediatric Patients
ADVERSE REACTIONS
6.1 Clinical Trials Experience
6.2 Postmarketing Experience
DRUG INTERACTIONS
7.1 Cytochrome P450-Linked Drug Metabolizing Enzyme
System
7.2 Other Concomitant Therapy
USE IN SPECIFIC POPULATIONS
8.1 Pregnancy*Sections or subsections omitted from the full prescribing information
are not listed.

1

FULL PRESCRIBING INFORMATION
1

INDICATIONS AND USAGE

PROPECIA® is indicated for the treatment of male pattern hair loss (androgenetic alopecia) in MEN
ONLY.
Efficacy in bitemporal recession has not been established.
PROPECIA is not indicated for use in women.
2

DOSAGE AND ADMINISTRATIONPROPECIA may be administered with or without meals.
The recommended dose of PROPECIA is one tablet (1 mg) taken once daily.
In general, daily use for three months or more is necessary before benefit is observed. Continued use
is recommended to sustain benefit, which should be re-evaluated periodically. Withdrawal of treatment
leads to reversal of effect within 12 months.
3

DOSAGE FORMS AND STRENGTHSPROPECIA tablets (1 mg) are tan, octagonal, film-coated convex tablets with “stylized P” logo on one
side and PROPECIA on the other.
4

CONTRAINDICATIONSPROPECIA is contraindicated in the following: Pregnancy. Finasteride use is contraindicated in women when they are or may potentially be
pregnant. Because of the ability of Type II 5-reductase inhibitors to inhibit the conversion of
testosterone to 5α-dihydrotestosterone (DHT), finasteride may cause abnormalities of theexternal genitalia of a male fetus of a pregnant woman who receives finasteride. If this drug isused during pregnancy, or if pregnancy occurs while taking this drug, the pregnant woman should
be apprised of the potential hazard to the male fetus. [See Warnings and Precautions (5.1), Usein Specific Populations (8.1), How Supplied/Storage and Handling (16) and Patient Counseling
Information (17).] In female rats, low doses of finasteride administered during pregnancy haveproduced abnormalities of the external genitalia in male offspring.
 Hypersensitivity to any component of this medication.

5

WARNINGS AND PRECAUTIONS

5.1

Exposure of Women — Risk to Male Fetus
PROPECIA is not indicated for use in women. Women should not handle crushed or broken
PROPECIA tablets when they are pregnant or may potentially be pregnant because of the possibility ofabsorption of finasteride and the subsequent potential risk to a male fetus. PROPECIA tablets are coatedand will prevent contact with the active ingredient during normal handling, provided that the tablets havenot been broken or crushed. [See Indications and Usage (1), Contraindications (4), Use in Specific
Populations (8.1), How Supplied/Storage and Handling (16) and Patient Counseling Information (17).]5.2
Effects on Prostate Specific Antigen (PSA)
In clinical studies with PROPECIA (finasteride, 1 mg) in men 18-41 years of age, the mean value ofserum prostate specific antigen (PSA) decreased from 0.7 ng/mL at baseline to 0.5 ng/mL at Month 12.
Further, in clinical studies with PROSCAR (finasteride, 5 mg) when used in older men who have benign
prostatic hyperplasia (BPH), PSA levels are decreased by approximately 50%. Other studies withPROSCAR showed it may also cause decreases in serum PSA in the presence of prostate cancer. Thesefindings should be taken into account for proper interpretation of serum PSA when evaluating men treatedwith finasteride. Any confirmed increase from the lowest PSA value while on PROPECIA may signal thepresence of prostate cancer and should be evaluated, even if PSA levels are still within the normal range
for men not taking a 5α-reductase inhibitor. Non-compliance to therapy with PROPECIA may also affect
PSA test results.

2

5.3

Increased Risk of High-Grade Prostate Cancer with 5α-Reductase Inhibitors
Men aged 55 and over with a normal digital rectal examination and PSA ≤3.0 ng/mL at baseline taking
finasteride 5 mg/day (5 times the dose of PROPECIA) in the 7-year Prostate Cancer Prevention Trial(PCPT) had an increased risk of Gleason score 8-10 prostate cancer (finasteride 1.8% vs placebo 1.1%).
[See Adverse Reactions (6.1).] Similar results were observed in a 4-year placebo-controlled clinical trial
with another 5α-reductase inhibitor (dutasteride, AVODART) (1% dutasteride vs 0.5% placebo). 5αreductase inhibitors may increase the risk of development of high-grade prostate cancer. Whether theeffect of 5α-reductase inhibitors to reduce prostate volume, or study-related factors, impacted the resultsof these studies has not been established.
5.4
Pediatric Patients
PROPECIA is not indicated for use in pediatric patients [see Use in Specific Populations (8.4)].
6

ADVERSE REACTIONS

6.1

Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observedin the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug andmay not reflect the rates observed in clinical practice.
Clinical Studies for PROPECIA (finasteride 1 mg) in the Treatment of Male Pattern Hair Loss
In three controlled clinical trials for PROPECIA of 12-month duration, 1.4% of patients taking
PROPECIA (n=945) were discontinued due to adverse experiences that were considered to be possibly,
probably or definitely drug-related (1.6% for placebo; n=934).
Clinical adverse experiences that were reported as possibly, probably or definitely drug-related in 1%of patients treated with PROPECIA or placebo are presented in Table 1.
TABLE 1: Drug-Related Adverse Experiences for PROPECIA (finasteride 1 mg) inYear 1 (%)
MALE PATTERN HAIR LOSS
Placebo
PROPECIA
N=934
N=945
Decreased Libido

1.8

1.3

Erectile Dysfunction

1.3

0.7

1.2
(0.8)

0.7
(0.4)

1.2

0.9

Ejaculation Disorder(Decreased Volume ofEjaculate)
Discontinuation due todrug-related sexual
adverse experiences

Integrated analysis of clinical adverse experiences showed that during treatment with PROPECIA, 36(3.8%) of 945 men had reported one or more of these adverse experiences as compared to 20 (2.1%) of
934 men treated with placebo (p=0.04). Resolution occurred in men who discontinued therapy withPROPECIA due to these side effects and in most of those who continued therapy. The incidence of eachof the above adverse experiences decreased to 0.3% by the fifth year of treatment with PROPECIA.
In a study of finasteride 1 mg daily in healthy men, a median decrease in ejaculate volume of 0.3 mL (11%) compared with 0.2 mL (-8%) for placebo was observed after 48 weeks of treatment. Two otherstudies showed that finasteride at 5 times the dosage of PROPECIA (5 mg daily) produced significant
median decreases of approximately 0.5 mL (-25%) compared to placebo in ejaculate volume, but this wasreversible after discontinuation of treatment.
In the clinical studies with PROPECIA, the incidences for breast tenderness and enlargement,
hypersensitivity reactions, and testicular pain in finasteride-treated patients were not different from thosein patients treated with placebo.

3

Controlled Clinical Trials and Long-Term Open Extension Studies for PROSCAR® (finasteride
5 mg) and AVODART (dutasteride) in the Treatment of Benign Prostatic Hyperplasia
In the PROSCAR Long-Term Efficacy and Safety Study (PLESS), a 4-year controlled clinical study,
3040 patients between the ages of 45 and 78 with symptomatic BPH and an enlarged prostate were
evaluated for safety over a period of 4 years (1524 on PROSCAR 5 mg/day and 1516 on placebo). 3.7%
(57 patients) treated with PROSCAR 5 mg and 2.1% (32 patients) treated with placebo discontinued
therapy as a result of adverse reactions related to sexual function, which are the most frequently reported
adverse reactions.
Table 2 presents the only clinical adverse reactions considered possibly, probably or definitely drug
related by the investigator, for which the incidence on PROSCAR was 1% and greater than placebo overthe 4 years of the study. In years 2-4 of the study, there was no significant difference between treatmentgroups in the incidences of impotence, decreased libido and ejaculation disorder.
TABLE 2: Drug-Related Adverse Experiences for PROSCAR(finasteride 5 mg)
BENIGN PROSTATIC HYPERPLASIA
Year 1Years 2, 3 and 4*(%)(%)
Finasteride
PlaceboFinasteride
Placebo
5 mg
5 mg
Impotence
8.1
3.7
5.1
Decreased
6.4
3.4
2.6
LibidoDecreased
Volume of
3.7
0.8
1.5
Ejaculate
0.8
0.1
0.2
Ejaculation
DisorderBreast0.5
0.1
1.8
Enlargement
Breast0.4
0.1
0.7
Tenderness
Rash
0.5
0.2
0.5
*Combined Years 2-4
N = 1524 and 1516, finasteride vs placebo, respectively

5.1
2.6
0.5
0.1
1.1
0.3
0.1

The adverse experience profiles in the 1-year, placebo-controlled, Phase III BPH studies and the 5year open extensions with PROSCAR 5 mg and PLESS were similar.
There is no evidence of increased sexual adverse experiences with increased duration of treatment
with PROSCAR 5 mg. New reports of drug-related sexual adverse experiences decreased with durationof therapy.
During the 4- to 6-year placebo- and comparator-controlled Medical Therapy of Prostatic Symptoms(MTOPS) study that enrolled 3047 men, there were 4 cases of breast cancer in men treated withPROSCAR but no cases in men not treated with PROSCAR. During the 4-year placebo-controlled PLESS
study that enrolled 3040 men, there were 2 cases of breast cancer in placebo-treated men, but no cases
were reported in men treated with PROSCAR.
During the 7-year placebo-controlled Prostate Cancer Prevention Trial (PCPT) that enrolled 18,882
men, there was 1 case of breast cancer in men treated with PROSCAR, and 1 case of breast cancer in
men treated with placebo. The relationship between long-term use of finasteride and male breast
neoplasia is currently unknown.
The PCPT trial was a 7-year randomized, double-blind, placebo-controlled trial that enrolled 18,882
healthy men ≥55 years of age with a normal digital rectal examination and a PSA ≤3.0 ng/mL. Menreceived either PROSCAR (finasteride 5 mg) or placebo daily. Patients were evaluated annually with PSA
and digital rectal exams. Biopsies were performed for elevated PSA, an abnormal digital rectal exam, orthe end of study. The incidence of Gleason score 8-10 prostate cancer was higher in men treated withfinasteride (1.8%) than in those treated with placebo (1.1%). In a 4-year placebo-controlled clinical trial
with another 5α-reductase inhibitor [AVODART (dutasteride)], similar results for Gleason score 8-10

4

prostate cancer were observed (1% dutasteride vs 0.5% placebo). The clinical significance of thesefindings with respect to use of PROPECIA by men is unknown.
No clinical benefit has been demonstrated in patients with prostate cancer treated with PROSCAR.
PROSCAR is not approved to reduce the risk of developing prostate cancer.
Sexual Function Questionnaire
A sexual function questionnaire was self-administered by patients participating in the two vertex
baldness trials to detect more subtle changes in sexual function. At Month 12, statistically significant
differences in favor of placebo were found in 3 of 4 domains (sexual interest, erections, and perception ofsexual problems). However, no significant difference was seen in the question on overall satisfaction with
sex life.
In one of the two vertex baldness studies, patients were questioned on non-scalp body hair growth.
PROPECIA did not appear to affect non-scalp body hair.
6.2

Postmarketing Experience
The following adverse reactions have been identified during post approval use of PROPECIA.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always
possible to reliably estimate their frequency or establish a causal relationship to drug exposure:
Hypersensitivity Reaction: hypersensitivity reactions such as rash, pruritus, urticaria, and angioedema(including swelling of the lips, tongue, throat, and face);
Reproductive System: sexual dysfunction that continued after discontinuation of treatment, including
erectile dysfunction, libido disorders, ejaculation disorders, and orgasm disorders; male infertility and/or
poor seminal quality (normalization or improvement of seminal quality has been reported after
discontinuation of finasteride); testicular pain; hematospermia.
Neoplasms: male breast cancer;
Breast disorders: breast tenderness and enlargement;
Nervous System/Psychiatric: depression, suicidal ideation and behavior.
7

DRUG INTERACTIONS

7.1

Cytochrome P450-Linked Drug Metabolizing Enzyme System
No drug interactions of clinical importance have been identified. Finasteride does not appear to affectthe cytochrome P450-linked drug-metabolizing enzyme system. Compounds that have been tested in
man include antipyrine, digoxin, propranolol, theophylline, and warfarin and no clinically meaningfulinteractions were found.
7.2
Other Concomitant Therapy
Although specific interaction studies were not performed, finasteride doses of 1 mg or more wereconcomitantly used in clinical studies with acetaminophen, acetylsalicylic acid, -blockers, analgesics,
angiotensin-converting enzyme (ACE) inhibitors, anticonvulsants, benzodiazepines, beta blockers,
calcium-channel blockers, cardiac nitrates, diuretics, H2 antagonists, HMG-CoA reductase inhibitors,
prostaglandin synthetase inhibitors (also referred to as NSAIDs), and quinolone anti-infectives without
evidence of clinically significant adverse interactions.
8

USE IN SPECIFIC POPULATIONS

8.1

Pregnancy
Pregnancy Category X [see Contraindications (4)]. PROPECIA is contraindicated for use in women
who are or may become pregnant. PROPECIA is a Type II 5α-reductase inhibitor that prevents
conversion of testosterone to 5α-dihydrotestosterone (DHT), a hormone necessary for normal
development of male genitalia. In animal studies, finasteride caused abnormal development of external
genitalia in male fetuses. If this drug is used during pregnancy, or if the patient becomes pregnant while
taking this drug, the patient should be apprised of the potential hazard to the male fetus.
Abnormal male genital development is an expected consequence when conversion of testosterone to
5α-dihydrotestosterone (DHT) is inhibited by 5α-reductase inhibitors. These outcomes are similar to thosereported in male infants with genetic 5α-reductase deficiency. Women could be exposed to finasteridethrough contact with crushed or broken PROPECIA tablets or semen from a male partner taking

5

PROPECIA. With regard to finasteride exposure through the skin, PROPECIA tablets are coated and will
prevent skin contact with finasteride during normal handling if the tablets have not been crushed or
broken. Women who are pregnant or may become pregnant should not handle crushed or broken
PROPECIA tablets because of possible exposure of a male fetus. If a pregnant woman comes in contact
with crushed or broken PROPECIA tablets, the contact area should be washed immediately with soap
and water. With regard to potential finasteride exposure through semen, a study has been conducted inmen receiving PROPECIA 1 mg/day that measured finasteride concentrations in semen [see ClinicalPharmacology (12.3)].
In an embryo-fetal development study, pregnant rats received finasteride during the period of majororganogenesis (gestation days 6 to 17). At maternal doses of oral finasteride approximately 1 to 684
times the recommended human dose (RHD) of 1 mg/day (based on AUC at animal doses of 0.1 to 100
mg/kg/day) there was a dose-dependent increase in hypospadias that occurred in 3.6 to 100% of maleoffspring. Exposure multiples were estimated using data from nonpregnant rats. Days 16 to 17 ofgestation is a critical period in male fetal rats for differentiation of the external genitalia. At oral maternal
doses approximately 0.2 times the RHD (based on AUC at animal dose of 0.03 mg/kg/day), maleoffspring had decreased prostatic and seminal vesicular weights, delayed preputial separation andtransient nipple development. Decreased anogenital distance occurred in male offspring of pregnant ratsthat received approximately 0.02 times the RHD (based on AUC at animal dose of 0.003 mg/kg/day). No
abnormalities were observed in female offspring exposed to any dose of finasteride in utero.
No developmental abnormalities were observed in the offspring of untreated females mated withfinasteride-treated male rats that received approximately 488 times the RHD (based on AUC at animaldose of 80 mg/kg/day). Slightly decreased fertility was observed in male offspring after administration of
about 20 times the RHD (based on AUC at animal dose of 3 mg/kg/day) to female rats during lategestation and lactation. No effects on fertility were seen in female offspring under these conditions.
No evidence of male external genital malformations or other abnormalities were observed in rabbit
fetuses exposed to finasteride during the period of major organogenesis (gestation days 6-18) at maternal
doses up to 100 mg/kg/day (finasteride exposure levels were not measured in rabbits). However, thisstudy may not have included the critical period for finasteride effects on development of male external
genitalia in the rabbit.
The fetal effects of maternal finasteride exposure during the period of embryonic and fetal
development were evaluated in the rhesus monkey (gestation days 20-100), in a species anddevelopment period more predictive of specific effects in humans than the studies in rats and rabbits.
Intravenous administration of finasteride to pregnant monkeys at doses as high as 800 ng/day (estimatedmaximal blood concentration of 1.86 ng/mL or about 930 times the highest estimated exposure ofpregnant women to finasteride from semen of men taking 1 mg/day) resulted in no abnormalities in male
fetuses. In confirmation of the relevance of the rhesus model for human fetal development, oral
administration of a dose of finasteride (2 mg/kg/day or approximately 120,000 times the highest estimatedblood levels of finasteride from semen of men taking 1 mg/day) to pregnant monkeys resulted in external
genital abnormalities in male fetuses. No other abnormalities were observed in male fetuses and nofinasteride-related abnormalities were observed in female fetuses at any dose.
8.3 Nursing Mothers
PROPECIA is not indicated for use in women.
It is not known whether finasteride is excreted in human milk.
8.4 Pediatric Use
PROPECIA is not indicated for use in pediatric patients.
Safety and effectiveness in pediatric patients have not been established.
8.5 Geriatric Use
Clinical efficacy studies with PROPECIA did not include subjects aged 65 and over. Based on thepharmacokinetics of finasteride 5 mg, no dosage adjustment is necessary in the elderly for PROPECIA[see Clinical Pharmacology (12.3)]. However, the efficacy of PROPECIA in the elderly has not been
established.
8.6 Hepatic Impairment
Caution should be exercised in the administration of PROPECIA in those patients with liver function
abnormalities, as finasteride is metabolized extensively in the liver [see Clinical Pharmacology (12.3)].

6

8.7

Renal Impairment
No dosage adjustment is necessary in patients with renal impairment [see Clinical Pharmacology(12.3)].
10

OVERDOSAGEIn clinical studies, single doses of finasteride up to 400 mg and multiple doses of finasteride up to
80 mg/day for three months did not result in adverse reactions. Until further experience is obtained, no
specific treatment for an overdose with finasteride can be recommended.
Significant lethality was observed in male and female mice at single oral doses of 1500 mg/m2(500 mg/kg) and in female and male rats at single oral doses of 2360 mg/m2 (400 mg/kg) and
5900 mg/m2 (1000 mg/kg), respectively.
11

DESCRIPTIONPROPECIA (finasteride) tablets contain finasteride as the active ingredient. Finasteride, a synthetic
4-azasteroid compound, is a specific inhibitor of steroid Type II 5-reductase, an intracellular enzyme thatconverts the androgen testosterone into 5-dihydrotestosterone (DHT).
The chemical name of finasteride is N-tert-Butyl-3-oxo-4-aza-5α-androst-1-ene-17β-carboxamide. The
empirical formula of finasteride is C23H36N2O2 and its molecular weight is 372.55. Its structural formula is:

Finasteride is a white crystalline powder with a melting point near 250°C. It is freely soluble inchloroform and in lower alcohol solvents but is practically insoluble in water.
PROPECIA (finasteride) tablets are film-coated tablets for oral administration. Each tablet contains
1 mg of finasteride and the following inactive ingredients: lactose monohydrate, microcrystalline cellulose,
pregelatinized starch, sodium starch glycolate, hydroxypropyl methylcellulose, hydroxypropyl cellulose,titanium dioxide, magnesium stearate, talc, docusate sodium, yellow ferric oxide, and red ferric oxide.
12

CLINICAL PHARMACOLOGY

12.1 Mechanism of Action
Finasteride is a competitive and specific inhibitor of Type II 5-reductase, an intracellular enzyme thatconverts the androgen testosterone into DHT. Two distinct isozymes are found in mice, rats, monkeys,
and humans: Type I and II. Each of these isozymes is differentially expressed in tissues anddevelopmental stages. In humans, Type I 5-reductase is predominant in the sebaceous glands of mostregions of skin, including scalp, and liver. Type I 5-reductase is responsible for approximately one-thirdof circulating DHT. The Type II 5-reductase isozyme is primarily found in prostate, seminal vesicles,
epididymides, and hair follicles as well as liver, and is responsible for two-thirds of circulating DHT.
In humans, the mechanism of action of finasteride is based on its preferential inhibition of the Type II
isozyme. Using native tissues (scalp and prostate), in vitro binding studies examining the potential offinasteride to inhibit either isozyme revealed a 100-fold selectivity for the human Type II 5-reductase
over Type I isozyme (IC50=500 and 4.2 nM for Type I and II, respectively). For both isozymes, theinhibition by finasteride is accompanied by reduction of the inhibitor to dihydrofinasteride and adduct7

formation with NADP+. The turnover for the enzyme complex is slow (t1/2 approximately 30 days for theType II enzyme complex and 14 days for the Type I complex). Inhibition of Type II 5-reductase blocks
the peripheral conversion of testosterone to DHT, resulting in significant decreases in serum and tissue
DHT concentrations.
In men with male pattern hair loss (androgenetic alopecia), the balding scalp contains miniaturized hairfollicles and increased amounts of DHT compared with hairy scalp. Administration of finasteridedecreases scalp and serum DHT concentrations in these men. The relative contributions of these
reductions to the treatment effect of finasteride have not been defined. By this mechanism, finasterideappears to interrupt a key factor in the development of androgenetic alopecia in those patients genetically
predisposed.
12.2 Pharmacodynamics
Finasteride produces a rapid reduction in serum DHT concentration, reaching 65% suppression within
24 hours of oral dosing with a 1-mg tablet. Mean circulating levels of testosterone and estradiol wereincreased by approximately 15% as compared to baseline, but these remained within the physiologic
range.
Finasteride has no affinity for the androgen receptor and has no androgenic, antiandrogenic, estrogenic,
antiestrogenic, or progestational effects. The relationship between these pharmacodynamic activities andthe mechanisms(s) by which PROPECIA exerts its clinical effect is unknown. In studies with finasteride,no clinically meaningful changes in luteinizing hormone (LH), follicle-stimulating hormone (FSH) or
prolactin were detected. In healthy volunteers, treatment with finasteride did not alter the response of LH
and FSH to gonadotropin-releasing hormone indicating that the hypothalamic-pituitary-testicular axis was
not affected. Finasteride had no effect on circulating levels of cortisol, thyroid-stimulating hormone, or
thyroxine, nor did it affect the plasma lipid profile (e.g., total cholesterol, low-density lipoproteins, highdensity lipoproteins and triglycerides) or bone mineral density.
12.3
Pharmacokinetics
Absorption
In a study in 15 healthy young male subjects, the mean bioavailability of finasteride 1-mg tablets was
65% (range 26-170%), based on the ratio of area under the curve (AUC) relative to an intravenous (IV)reference dose. At steady state following dosing with 1 mg/day (n=12), maximum finasteride plasma
concentration averaged 9.2 ng/mL (range, 4.9-13.7 ng/mL) and was reached 1 to 2 hours postdose;
AUC(0-24 hr) was 53 ng•hr/mL (range, 20-154 ng•hr/mL). Bioavailability of finasteride was not affected byfood.
Distribution
Mean steady-state volume of distribution was 76 liters (range, 44-96 liters; n=15). Approximately 90%
of circulating finasteride is bound to plasma proteins. There is a slow accumulation phase for finasteride
after multiple dosing.
Finasteride has been found to cross the blood-brain barrier.
Semen levels have been measured in 35 men taking finasteride 1 mg/day for 6 weeks. In 60% (21 of35) of the samples, finasteride levels were undetectable (<0.2 ng/mL). The mean finasteride level was
0.26 ng/mL and the highest level measured was 1.52 ng/mL. Using the highest semen level measured
and assuming 100% absorption from a 5-mL ejaculate per day, human exposure through vaginal
absorption would be up to 7.6 ng per day, which is 650-fold less than the dose of finasteride (5 g) that
had no effect on circulating DHT levels in men. [See Use in Specific Populations (8.1).]
Metabolism
Finasteride is extensively metabolized in the liver, primarily via the cytochrome P450 3A4 enzyme
subfamily. Two metabolites, the t-butyl side chain monohydroxylated and monocarboxylic acidmetabolites, have been identified that possess no more than 20% of the 5-reductase inhibitory activity offinasteride.
Excretion
Following intravenous infusion in healthy young subjects (n=15), mean plasma clearance of finasteride
was 165 mL/min (range, 70-279 mL/min). Mean terminal half-life in plasma was 4.5 hours (range, 3.313.4 hours; n=12). Following an oral dose of 14C-finasteride in man (n=6), a mean of 39% (range, 3246%) of the dose was excreted in the urine in the form of metabolites; 57% (range, 51-64%) was excreted
in the feces.

8Mean terminal half-life is approximately 5-6 hours in men 18-60 years of age and 8 hours in men morethan 70 years of age.
TABLE 3: Mean (SD) Pharmacokinetic Parameters in
Healthy Men (ages 18-26)
Mean ( SD)
n=15
Bioavailability
65% (26-170%)*
Clearance (mL/min)
165 (55)
Volume of Distribution (L)76 (14)*RangeTABLE 4: Mean (SD) Noncompartmental
Pharmacokinetic Parameters After Multiple Doses of 1
mg/day in Healthy Men (ages 19-42)
Mean ( SD)(n=12)
53 (33.8)
AUC (nghr/mL)
Peak Concentration (ng/mL)
9.2 (2.6)
Time to Peak (hours)
1.3 (0.5)
Half-Life (hours)*
4.5 (1.6)*First-dose values; all other parameters are last-dose values

Renal Impairment
No dosage adjustment is necessary in patients with renal impairment. In patients with chronic renal
impairment, with creatinine clearances ranging from 9.0 to 55 mL/min, AUC, maximum plasma
concentration, half-life, and protein binding after a single dose of 14C-finasteride were similar to thoseobtained in healthy volunteers. Urinary excretion of metabolites was decreased in patients with renal
impairment. This decrease was associated with an increase in fecal excretion of metabolites. Plasma
concentrations of metabolites were significantly higher in patients with renal impairment (based on a 60%
increase in total radioactivity AUC). However, finasteride has been tolerated in men with normal renal
function receiving up to 80 mg/day for 12 weeks where exposure of these patients to metabolites would
presumably be much greater.
Hepatic Impairment
The effect of hepatic impairment on finasteride pharmacokinetics has not been studied. Caution
should be used in the administration of PROPECIA in patients with liver function abnormalities, as
finasteride is metabolized extensively in the liver.
13

NONCLINICAL TOXICOLOGY

13.1
Carcinogenesis, Mutagenesis, Impairment of Fertility
No evidence of a tumorigenic effect was observed in a 24-month study in Sprague-Dawley rats
receiving doses of finasteride up to 160 mg/kg/day in males and 320 mg/kg/day in females. These doses
produced respective systemic exposure in rats of 888 and 2192 times those observed in man receiving
the recommended human dose of 1 mg/day. All exposure calculations were based on calculated
AUC(0-24 hr) for animals and mean AUC(0-24 hr) for man (0.05 g•hr/mL).
In a 19-month carcinogenicity study in CD-1 mice, a statistically significant (p0.05) increase in theincidence of testicular Leydig cell adenomas was observed at 1824 times the human exposure (250mg/kg/day). In mice at 184 times the human exposure, estimated (25 mg/kg/day) and in rats at 312 times
the human exposure (40 mg/kg/day) an increase in the incidence of Leydig cell hyperplasia wasobserved. A positive correlation between the proliferative changes in the Leydig cells and an increase inserum LH levels (2- to 3-fold above control) has been demonstrated in both rodent species treated withhigh doses of finasteride. No drug-related Leydig cell changes were seen in either rats or dogs treatedwith finasteride for 1 year at 240 and 2800 times (20 mg/kg/day and 45 mg/kg/day, respectively), or inmice treated for 19 months at 18.4 times the human exposure, estimated (2.5 mg/kg/day).
No evidence of mutagenicity was observed in an in vitro bacterial mutagenesis assay, a mammaliancell mutagenesis assay, or in an in vitro alkaline elution assay. In an in vitro chromosome aberration
assay, using Chinese hamster ovary cells, there was a slight increase in chromosome aberrations. In an

9in vivo chromosome aberration assay in mice, no treatment-related increase in chromosome aberration
was observed with finasteride at the maximum tolerated dose of 250 mg/kg/day (1824 times the human
exposure) as determined in the carcinogenicity studies.
In sexually mature male rabbits treated with finasteride at 4344 times the human exposure (80mg/kg/day) for up to 12 weeks, no effect on fertility, sperm count, or ejaculate volume was seen. In
sexually mature male rats treated with 488 times the human exposure (80 mg/kg/day), there were no
significant effects on fertility after 6 or 12 weeks of treatment; however, when treatment was continued for
up to 24 or 30 weeks, there was an apparent decrease in fertility, fecundity, and an associated significant
decrease in the weights of the seminal vesicles and prostate. All these effects were reversible within 6
weeks of discontinuation of treatment. No drug-related effect on testes or on mating performance has
been seen in rats or rabbits. This decrease in fertility in finasteride-treated rats is secondary to its effecton accessory sex organs (prostate and seminal vesicles) resulting in failure to form a seminal plug. The
seminal plug is essential for normal fertility in rats but is not relevant in man.
14

CLINICAL STUDIES

14.1
Studies in Men
The efficacy of PROPECIA was demonstrated in men (88% Caucasian) with mild to moderate
androgenetic alopecia (male pattern hair loss) between 18 and 41 years of age. In order to prevent
seborrheic dermatitis which might confound the assessment of hair growth in these studies, all men,whether treated with finasteride or placebo, were instructed to use a specified, medicated, tar-based
shampoo (Neutrogena T/Gel® Shampoo) during the first 2 years of the studies.
There were three double-blind, randomized, placebo-controlled studies of 12-month duration. The two
primary endpoints were hair count and patient self-assessment; the two secondary endpoints were
investigator assessment and ratings of photographs. In addition, information was collected regarding
sexual function (based on a self-administered questionnaire) and non-scalp body hair growth. The threestudies were conducted in 1879 men with mild to moderate, but not complete, hair loss. Two of thestudies enrolled men with predominantly mild to moderate vertex hair loss (n=1553). The third enrolled
men having mild to moderate hair loss in the anterior mid-scalp area with or without vertex balding(n=326).
Studies in Men with Vertex Baldness
Of the men who completed the first 12 months of the two vertex baldness trials, 1215 elected tocontinue in double-blind, placebo-controlled, 12-month extension studies. There were 547 men receiving
PROPECIA for both the initial study and first extension periods (up to 2 years of treatment) and 60 men
receiving placebo for the same periods. The extension studies were continued for 3 additional years, with
323 men on PROPECIA and 23 on placebo entering the fifth year of the study.
In order to evaluate the effect of discontinuation of therapy, there were 65 men who received
PROPECIA for the initial 12 months followed by placebo in the first 12-month extension period. Some ofthese men continued in additional extension studies and were switched back to treatment withPROPECIA, with 32 men entering the fifth year of the study. Lastly, there were 543 men who received
placebo for the initial 12 months followed by PROPECIA in the first 12-month extension period. Some ofthese men continued in additional extension studies receiving PROPECIA, with 290 men entering the fifth
year of the study (see Figure 1 below).
Hair counts were assessed by photographic enlargements of a representative area of active hair loss.
In these two studies in men with vertex baldness, significant increases in hair count were demonstrated at
6 and 12 months in men treated with PROPECIA, while significant hair loss from baseline wasdemonstrated in those treated with placebo. At 12 months there was a 107-hair difference from placebo(p<0.001, PROPECIA [n=679] vs placebo [n=672]) within a 1-inch diameter circle (5.1 cm2). Hair count
was maintained in those men taking PROPECIA for up to 2 years, resulting in a 138-hair difference
between treatment groups (p<0.001, PROPECIA [n=433] vs placebo [n=47]) within the same area. In
men treated with PROPECIA, the maximum improvement in hair count compared to baseline wasachieved during the first 2 years. Although the initial improvement was followed by a slow decline, haircount was maintained above baseline throughout the 5 years of the studies. Furthermore, because thedecline in the placebo group was more rapid, the difference between treatment groups also continued to10

increase throughout the studies, resulting in a 277-hair difference (p<0.001, PROPECIA [n=219] vsplacebo [n=15]) at 5 years (see Figure 1 below).
Patients who switched from placebo to PROPECIA (n=425) had a decrease in hair count at the end of
the initial 12-month placebo period, followed by an increase in hair count after 1 year of treatment withPROPECIA. This increase in hair count was less (56 hairs above original baseline) than the increase (91hairs above original baseline) observed after 1 year of treatment in men initially randomized to
PROPECIA. Although the increase in hair count, relative to when therapy was initiated, was comparable
between these two groups, a higher absolute hair count was achieved in patients who were started ontreatment with PROPECIA in the initial study. This advantage was maintained through the remaining 3
years of the studies. A change of treatment from PROPECIA to placebo (n=48) at the end of the initial 12months resulted in reversal of the increase in hair count 12 months later, at 24 months (see Figure 1
below).
At 12 months, 58% of men in the placebo group had further hair loss (defined as any decrease in haircount from baseline), compared with 14% of men treated with PROPECIA. In men treated for up to 2
years, 72% of men in the placebo group demonstrated hair loss, compared with 17% of men treated withPROPECIA. At 5 years, 100% of men in the placebo group demonstrated hair loss, compared with 35%
of men treated with PROPECIA.
Figure 1

Patient self-assessment was obtained at each clinic visit from a self-administered questionnaire, which
included questions on their perception of hair growth, hair loss, and appearance. This self-assessment
demonstrated an increase in amount of hair, a decrease in hair loss, and improvement in appearance inmen treated with PROPECIA. Overall improvement compared with placebo was seen as early as 3months (p<0.05), with improvement maintained over 5 years.
Investigator assessment was based on a 7-point scale evaluating increases or decreases in scalp hairat each patient visit. This assessment showed significantly greater increases in hair growth in men treatedwith PROPECIA compared with placebo as early as 3 months (p<0.001). At 12 months, the investigators
rated 65% of men treated with PROPECIA as having increased hair growth compared with 37% in the11placebo group. At 2 years, the investigators rated 80% of men treated with PROPECIA as having
increased hair growth compared with 47% of men treated with placebo. At 5 years, the investigators rated
77% of men treated with PROPECIA as having increased hair growth, compared with 15% of men treatedwith placebo.
An independent panel rated standardized photographs of the head in a blinded fashion based onincreases or decreases in scalp hair using the same 7-point scale as the investigator assessment. At 12
months, 48% of men treated with PROPECIA had an increase as compared with 7% of men treated withplacebo. At 2 years, an increase in hair growth was demonstrated in 66% of men treated withPROPECIA, compared with 7% of men treated with placebo. At 5 years, 48% of men treated withPROPECIA demonstrated an increase in hair growth, 42% were rated as having no change (no further
visible progression of hair loss from baseline) and 10% were rated as having lost hair when compared tobaseline. In comparison, 6% of men treated with placebo demonstrated an increase in hair growth, 19%
were rated as having no change and 75% were rated as having lost hair when compared to baseline.
A 48-week, placebo-controlled study designed to assess by phototrichogram the effect of PROPECIA
on total and actively growing (anagen) scalp hairs in vertex baldness enrolled 212 men with androgenetic
alopecia. At baseline and 48 weeks, total and anagen hair counts were obtained in a 1-cm2 target area ofthe scalp. Men treated with PROPECIA showed increases from baseline in total and anagen hair countsof 7 hairs and 18 hairs, respectively, whereas men treated with placebo had decreases of 10 hairs and 9
hairs, respectively. These changes in hair counts resulted in a between-group difference of 17 hairs intotal hair count (p<0.001) and 27 hairs in anagen hair count (p<0.001), and an improvement in the
proportion of anagen hairs from 62% at baseline to 68% for men treated with PROPECIA.
Study in Men with Hair Loss in the Anterior Mid-Scalp Area
A study of 12-month duration, designed to assess the efficacy of PROPECIA in men with hair loss inthe anterior mid-scalp area, also demonstrated significant increases in hair count compared with placebo.
Increases in hair count were accompanied by improvements in patient self-assessment, investigatorassessment, and ratings based on standardized photographs. Hair counts were obtained in the anterior
mid-scalp area, and did not include the area of bitemporal recession or the anterior hairline.
Summary of Clinical Studies in Men
Clinical studies were conducted in men aged 18 to 41 with mild to moderate degrees of androgenetic
alopecia. All men treated with PROPECIA or placebo received a tar-based shampoo (Neutrogena T/Gel®
Shampoo) during the first 2 years of the studies. Clinical improvement was seen as early as 3 months in
the patients treated with PROPECIA and led to a net increase in scalp hair count and hair regrowth. In
clinical studies for up to 5 years, treatment with PROPECIA slowed the further progression of hair loss
observed in the placebo group. In general, the difference between treatment groups continued to increase
throughout the 5 years of the studies.
Ethnic Analysis of Clinical Data from Men
In a combined analysis of the two studies on vertex baldness, mean hair count changes from baseline
were 91 vs -19 hairs (PROPECIA vs placebo) among Caucasians (n=1185), 49 vs -27 hairs among
Blacks (n=84), 53 vs -38 hairs among Asians (n=17), 67 vs 5 hairs among Hispanics (n=45) and 67 vs -15
hairs among other ethnic groups (n=20). Patient self-assessment showed improvement across racial
groups with PROPECIA treatment, except for satisfaction of the frontal hairline and vertex in Black men,
who were satisfied overall.
14.2
Study in Women
In a study involving 137 postmenopausal women with androgenetic alopecia who were treated withPROPECIA (n=67) or placebo (n=70) for 12 months, effectiveness could not be demonstrated. There was
no improvement in hair counts, patient self-assessment, investigator assessment, or ratings ofstandardized photographs in the women treated with PROPECIA when compared with the placebo group[see Indications and Usage (1)].
16

HOW SUPPLIED/STORAGE AND HANDLINGPROPECIA tablets, 1 mg, are tan, octagonal, film-coated convex tablets with “stylized P” logo on one
side and PROPECIA on the other. They are supplied as follows:
NDC 78206-152-01 bottles of 30 (with desiccant)
NDC 78206-152-02 PROPAK® bottles of 90 (with desiccant).

12

Storage and HandlingStore at room temperature, 15-30°C (59-86°F). Keep container closed and protect from moisture.
Women should not handle crushed or broken PROPECIA tablets when they are pregnant or may
potentially be pregnant because of the possibility of absorption of finasteride and the subsequent potential
risk to a male fetus. PROPECIA tablets are coated and will prevent contact with the active ingredientduring normal handling, provided that the tablets are not broken or crushed [see Warnings andPrecautions (5.1), Use in Specific Populations (8.1) and Patient Counseling Information (17)].
17

PATIENT COUNSELING INFORMATION

Advise the patient to read the FDA-approved patient labeling (Patient Information).
Exposure of Women — Risk to Male Fetus
Physicians should inform patients that women who are pregnant or may potentially be pregnant should
not handle crushed or broken PROPECIA tablets because of the possibility of absorption of finasterideand the subsequent potential risk to a male fetus. PROPECIA tablets are coated and will prevent contact
with the active ingredient during normal handling, provided that the tablets have not been broken or
crushed. If a woman who is pregnant or may potentially be pregnant comes in contact with crushed or
broken PROPECIA tablets, the contact area should be washed immediately with soap and water [seeContraindications (4), Warnings and Precautions (5.1), Use in Specific Populations (8.1) and How
Supplied/Storage and Handling (16)].
Increased Risk of High-Grade Prostate Cancer
Patients should be informed that there was an increase in high-grade prostate cancer in men treatedwith 5α-reductase inhibitors indicated for BPH treatment, compared to those treated with placebo instudies looking at the use of these drugs to prevent prostate cancer [see Warnings and Precautions (5.3)
and Adverse Reactions (6.1)].
Sexual Adverse events
Physicians should inform the patients that PROPECIA may cause symptoms of sexual dysfunction
such as decreased libido, erectile dysfunction, and ejaculation disorder, including decreased ejaculate
volume.
Additional Instructions
Physicians should instruct their patients to promptly report any changes in their breasts such as lumps,
pain or nipple discharge. Breast changes including breast enlargement, tenderness and neoplasm havebeen reported [see Adverse Reactions (6.1)].
Physicians should instruct their patients to read the patient package insert before starting therapy withPROPECIA and to read it again each time the prescription is renewed so that they are aware of current
information for patients regarding PROPECIA.

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