INTRODUCTION: Bladder outlet obstruction (BOO) due to prostatic hyperplasia is often accompanied by overactive bladder (OAB) symptoms, which often disappear after specific BOO pharmacotherapy. The aim of this study was to map out the spectrum in BOO pharmacotherapy to find out the occurrence of OAB in this population and to find its treatment. MATERIALS AND METHODS: Follow-up consists of a retrospective and a prospective part, which includes all the patient's data related to the lower urinary tract symptoms in BOO and OAB. In all, 654 data record forms were distributed during the study and 98% of those were validated. RESULTS: According to our observations, alpha-blockers were used most frequently at the beginning of BOO treatment (73%), followed by phytopharmaca (19.9%) and finally finasteride (5.5%). If the treatment is changed, the proportion of finasteride increases. Only a small number of patients with BOO and OAB are treated in combination with antimuscarinics. CONCLUSIONS: A combined therapy (alpha-blocker + antimuscarinics) is effective in a majority of men with infravesical obstruction and symptoms of OAB. However, OAB in our study was primarily underdiagnosed in almost 50% of all patients treated for LUTS.
- MeSH
- antagonisté muskarinových receptorů farmakologie MeSH
- dospělí MeSH
- finasterid farmakologie MeSH
- hyperaktivní močový měchýř komplikace diagnóza MeSH
- hyperplazie prostaty patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- obstrukce hrdla močového měchýře farmakoterapie patologie MeSH
- prevalence MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Názvy látek
- antagonisté muskarinových receptorů MeSH
- finasterid MeSH
OBJECTIVE: Androgenetic alopecia is recognized as a risk factor for cardiovascular diseases, glucose metabolism disorders, and benign prostate hyperplasia and/or carcinoma. Finasteride, used for treatment of androgenetic alopecia at a dose of 1mg/day, is an effective inhibitor of type II 5alpha-reductase, the enzyme responsible for the reduction of testosterone to dihydrotestosterone. Recent studies reported that dihydrotestosterone, among other activities, might play some role in visceral fat metabolism. It thus seemed reasonable to examine whether finasteride treatment of androgenetic alopecia ameliorates some features of metabolic syndrome frequently seen associated with this condition. METHODS: We examined 12 men with premature balding (defined as frontoparietal and vertex hair loss before age 30 with alopecia defined as grade 3 vertex or more on the Norwood-modified Hamilton alopecia classification). Hormonal levels and metabolic parameters were determined and insulin tolerance tests performed for all individuals. Finasteride (1 mg/day) was administrated for 12 months. The hormonal profile and lipid spectrum were monitored after 4, 8 and 12 months of treatment and insulin tolerance tests were repeated after 12 months of the treatment. RESULTS: After treatment with finasteride the expected changes in the steroid spectrum were seen, namely a decrease in dihydrotestosterone and increase in testosterone, androstenedione and free testosterone index. We observed an initial increase in total cholesterol and HDL- and LDL-cholesterol, which stabilized with prolonged treatment. We founded a significant decrease in glycated hemoglobin HbA1c and insulin resistance measured using rate constant for plasma glucose disappearance (kITT) showed only a borderline decrease. CONCLUSIONS: Finasteride is an efficient 5alpha-reductase inhibitor even at low doses of 1 mg/day. In men treated with this dose for 12 months, we observed mild differences in metabolic profile with slight amelioration of glucose metabolism regulation.
- MeSH
- 3-oxo-5-alfa-steroid-4-dehydrogenasa metabolismus MeSH
- alopecie krev farmakoterapie patofyziologie MeSH
- androstendion krev MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- dospělí MeSH
- finasterid aplikace a dávkování MeSH
- glykovaný hemoglobin metabolismus MeSH
- inhibitory 5-alfa-reduktasy MeSH
- inhibitory enzymů aplikace a dávkování MeSH
- inzulinová rezistence MeSH
- krevní glukóza účinky léků metabolismus MeSH
- lidé MeSH
- lipidy krev MeSH
- stupeň závažnosti nemoci MeSH
- testosteron krev MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- 3-oxo-5-alfa-steroid-4-dehydrogenasa MeSH
- androstendion MeSH
- biologické markery MeSH
- finasterid MeSH
- glykovaný hemoglobin MeSH
- hemoglobin A1c protein, human MeSH Prohlížeč
- inhibitory 5-alfa-reduktasy MeSH
- inhibitory enzymů MeSH
- krevní glukóza MeSH
- lipidy MeSH
- testosteron MeSH
Finasteride is the 5alpha-reductase inhibitor that received clinical approval for the treatment of human benign prostate hyperplasia and androgenetic alopecia. The 5alpha-reductase is enzyme responsible for the reduction of testosterone to dihydrostestosterone, progesterone to dihydroprogesterone and deoxycorticosterone to dihydrodeoxycorticosterone, steroids modulating the action of gamma-aminobutyric acid on GABA receptors. These neuroactive steroids possess anticonvulsant, antidepressant and anxiolytic effects. The objective of the study was to determine the effect of finasteride therapy on a broad steroid spectrum in men with benign prostate hyperplasia. A group of 20 men with benign prostate hyperplasia was involved in the present study. Finasteride in the daily dose of 5 mg/day was administrated for 4 months. In all individuals, their hormonal profile of steroid hormones was determined before and after 4 months lasting finasteride treatment. Finasteride treatment resulted in a significant decrease all alpha-reduced and increase of most 5beta-reduced metabolites of testosterone and progesterone as well as in an increase of 7alpha-hydoxyderivatives, which are known as neuroactive steroids acting by modulation of GABAA and NMAD receptors in the brain. In the course of finasteride treatment the decrease of the concentration of circulating steroids with known inhibitory activity on GABA-ergic excitation in the brain is very probably an important factors contributing to the development of the symptoms of depression seen in some isolated cases of finasteride administration.
- MeSH
- finasterid škodlivé účinky terapeutické užití MeSH
- hyperplazie prostaty farmakoterapie MeSH
- inhibitory 5-alfa-reduktasy * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mozek metabolismus MeSH
- receptory GABA-A metabolismus MeSH
- receptory N-methyl-D-aspartátu metabolismus MeSH
- senioři MeSH
- steroidy metabolismus MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- finasterid MeSH
- inhibitory 5-alfa-reduktasy * MeSH
- receptory GABA-A MeSH
- receptory N-methyl-D-aspartátu MeSH
- steroidy MeSH
Androgenetic alopecia (AGA) is a common dermatological condition affecting both men and women. In the case of men, up to 30% over the age of 30 and more than 50% over the age of 50 are affected. AGA also affects women although clinical signs are usually milder and associated with diffuse thinning of the scalp hair. AGA invariably causes serious psychological problems especially in women. By far the most promising approaches to the treatment of baldness in men are drug therapies, such as topical minoxidil and finasteride administered systemically. Mild to moderate AGA in women can be treated with antiandrogens and/or topical minoxidil with good results in many cases.
- MeSH
- alopecie farmakoterapie psychologie chirurgie MeSH
- finasterid terapeutické užití MeSH
- inhibitory 5-alfa-reduktasy MeSH
- inhibitory enzymů terapeutické užití MeSH
- lidé MeSH
- minoxidil terapeutické užití MeSH
- vazodilatancia terapeutické užití MeSH
- vlasový folikul účinky léků MeSH
- vlasy, chlupy účinky léků růst a vývoj MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- finasterid MeSH
- inhibitory 5-alfa-reduktasy MeSH
- inhibitory enzymů MeSH
- minoxidil MeSH
- vazodilatancia MeSH
This review is focused on the different chromatographic strategies for determination of finasteride and its analogues in biological fluids. These compounds are used for the treatment of benign prostatic hyperplasia. Particular attention is paid to high-performance liquid chromatography with spectrophotometric and mass spectrometric detection, the clean-up procedures are also included. The relationships between pharmacokinetics of finasteride, dose administered and required limit of quantitation of the chromatographic assays are discussed. Tandem mass spectrometry is recommended as the detection method for measuring concentrations <1 ng/ml, while cheaper spectrophotometric detection may be selected for determination of higher concentrations.
A high-performance liquid chromatographic method for the quantitation of finasteride in human plasma is presented. The method is based on liquid-liquid extraction with hexane-isoamylalcohol (98:2, v/v) and reversed-phase chromatography with spectrophotometric detection at 210 nm. The mobile phase consists of acetonitrile-15 mM potassium dihydrogenphosphate (40:60, v/v). Clobazam is used as the internal standard. The limit of quantitation is 4 ng/ml and the calibration curve is linear up to 300 ng/ml. Within-day and between-day precision expressed by relative standard deviation is less than 5% and inaccuracy does not exceed 8%. The assay was used for pharmacokinetic studies.
- MeSH
- finasterid krev farmakokinetika MeSH
- inhibitory enzymů krev farmakokinetika MeSH
- lidé MeSH
- referenční standardy MeSH
- reprodukovatelnost výsledků MeSH
- senzitivita a specificita MeSH
- spektrofotometrie ultrafialová MeSH
- vysokoúčinná kapalinová chromatografie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- finasterid MeSH
- inhibitory enzymů MeSH
The concentrations of the antiandrogenic endogenous steroid epitestosterone (epiT) and of testosterone, dihydrotestosterone (DHT) and androstenedione in the prostate were determined in tissue samples obtained from 21 patients who underwent suprapubic prostatectomy for benign prostatic hyperplasia. Fifteen patients received no hormonal treatment before surgery and the other 6 patients were pretreated for 8 weeks before surgery with an oral dose of 5 mg/day finasteride. The steroids were extracted and separated by high pressure liquid chromatography and determined by specific radioimmunoassays. The concentration of epiT (mean 58.4 +/- 40.4 S.D., range 14.0-144.0 fmol/mg protein) exceeded that of testosterone and was nearly as high as that of DHT. The prostatic tissue from the patients treated with finasteride for 8 weeks showed a significant decrease not only in DHT but also in androstenedione and epiT, whereas the concentration of testosterone increased significantly.
- MeSH
- androstendion metabolismus MeSH
- dihydrotestosteron metabolismus MeSH
- epitestosteron krev MeSH
- finasterid terapeutické užití MeSH
- hyperplazie prostaty farmakoterapie enzymologie metabolismus MeSH
- inhibitory 5-alfa-reduktasy * MeSH
- inhibitory enzymů terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- steroidy metabolismus MeSH
- testosteron metabolismus MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- Názvy látek
- androstendion MeSH
- dihydrotestosteron MeSH
- epitestosteron MeSH
- finasterid MeSH
- inhibitory 5-alfa-reduktasy * MeSH
- inhibitory enzymů MeSH
- steroidy MeSH
- testosteron MeSH
