Contraceptives (section 7.3.1) and under Oestrogens one and its analogues (dydrogesterone and medroxy- for HRT (p. 397) progesterone) and testosterone analogues (norethi-

6 Contraceptives (section 7.3.1) and under Oestrogens one and its analogues (dydrogesterone and medroxy- for HRT (p. 397) progesterone) and testosterone analogues (norethi-

Side-effects feminising effects in men; see also under sterone and norgestrel). The newer progestogens Combined Hormonal Contraceptives (section 7.3.1)

(desogestrel, norgestimate, and gestodene) are all deri- and under Oestrogens for HRT (p. 397)

vatives of norgestrel; levonorgestrel is the active isomer Dose

of norgestrel and has twice its potency. Progesterone . Menopausal symptoms and osteoporosis prophylaxis,

and its analogues are less androgenic than the testo- (with progestogen for 12–14 days per cycle in women

sterone derivatives and neither progesterone nor dydro- with intact uterus), 10–50 micrograms daily for 21

gesterone causes virilisation. days, repeated after 7-day tablet-free period

Where endometriosis requires drug treatment, it may . Female hypogonadism, 10–50 micrograms daily,

respond to a progestogen, e.g. norethisterone, adminis- usually on cyclical basis; initial oestrogen therapy

tered on a continuous basis. Danazol, gestrinone, and should be followed by combined oestrogen and pro-

gonadorelin analogues are also available (section 6.7.2). gestogen therapy

Although oral progestogens have been used widely for . Menstrual disorders, 20–50 micrograms daily from

menorrhagia they are relatively ineffective compared day 5 to 25 of each cycle, with progestogen added

with tranexamic acid (section 2.11) or, particularly either throughout the cycle or from day 15 to 25

where dysmenorrhoea is also a factor, mefenamic acid (section 10.1.1); the levonorgestrel-releasing intra- Ethinylestradiol (Non-proprietary) A uterine system (section 7.3.2.3) may be particularly

Tablets , ethinylestradiol 10 micrograms, net price 21- useful for women also requiring contraception. Oral tab pack = £15.55; 50 micrograms, 21-tab pack =

progestogens have also been used for severe dys- £18.55; 1 mg, 28-tab pack = £34.53

menorrhoea, but where contraception is also required in younger women the best choice is a combined oral contraceptive (section 7.3.1).

Raloxifene

Progestogens have also been advocated for the allevia- tion of premenstrual symptoms, but no convincing

Raloxifene is licensed for the treatment and prevention physiological basis for such treatment has been shown. of postmenopausal osteoporosis; unlike hormone replace- ment therapy, raloxifene does not reduce menopausal

Progestogens have been used for the prevention of vasomotor symptoms.

spontaneous abortion in women with a history of recur- rent miscarriage (habitual abortion) but there is no

Raloxifene may reduce the incidence of oestrogen- evidence of benefit and they are not recommended receptor-positive breast cancer but its role in estab-

for this purpose. In pregnant women with anti- lished breast cancer is not yet clear. The manufacturer

phospholipid antibody syndrome who have suffered advises avoiding its use during treatment for breast

recurrent miscarriage, administration of low-dose cancer.

aspirin (section 2.9) and a prophylactic dose of a low

BNF 57

6.4.1 Female sex hormones 403

molecular weight heparin (section 2.8.1) may decrease Contra-indications see notes above; pregnancy the risk of fetal loss (use under specialist supervision

(Appendix 4)

only). Side-effects see notes above; indigestion Dose

Hormone replacement therapy In women with a . uterus a progestogen needs to be added to long-term

By mouth , 2.5–10 mg daily for 5–10 days beginning oestrogen therapy for hormone replacement, to prevent

on day 16 to 21 of cycle, repeated for 2 cycles in cystic hyperplasia of the endometrium and possible

dysfunctional uterine bleeding and 3 cycles in sec- transformation to cancer; it can be added on a cyclical

ondary amenorrhoea or a continuous basis (see section 6.4.1.1). Combined

. Mild to moderate endometriosis, 10 mg 3 times daily packs incorporating suitable progestogen tablets are

for 90 consecutive days, beginning on day 1 of cycle available, see p. 397.

. Progestogenic opposition of oestrogen HRT, 10 mg daily for the last 14 days of each 28-day oestrogen

Oral contraception HRT cycle

Desogestrel, etynodiol (ethyno-

diol), gestodene, levonorgestrel, norethisterone, and Provera c (Pharmacia) A norgestimate are used in combined oral contraceptives

Tablets , all scored, medroxyprogesterone acetate and in progestogen-only contraceptives (section 7.3.1

2.5 mg (orange), net price 30-tab pack = £1.84; 5 mg and section 7.3.2).

(blue), 10-tab pack = £1.23; 10 mg (white), 10-tab pack = £2.47, 90-tab pack = £22.16

Cancer Progestogens also have a role in neoplastic Climanor c disease (section 8.3.2).

(ReSource Medical) A Tablets , f/c, medroxyprogesterone acetate 5 mg, net price 28-tab pack = £3.27

Cautions Progestogens should be used with caution in conditions that may worsen with fluid retention e.g.

Combined preparations epilepsy, hypertension, migraine, asthma, cardiac or

Section 6.4.1.1

renal dysfunction, and in those susceptible to throm- boembolism (particular caution with high dose). Care is also required in liver impairment (avoid if severe), and in

NORETHISTERONE

those with a history of depression. Progestogens can decrease glucose tolerance and diabetes should be Indications see under Dose; HRT (section 6.4.1.1); monitored closely. For interactions see Appendix 1

contraception (section 7.3.1 and section 7.3.2); (progestogens).

malignant disease (section 8.3.2) Cautions see notes above; breast-feeding (Appendix 5) Contra-indications Contra-indications Progestogens should be avoided see notes above; pregnancy

in patients with a history of liver tumours, and in severe

(Appendix 4)

liver impairment. They are also contra-indicated in Side-effects see notes above

Endocrine

those with genital or breast cancer (unless progestogens

Dose

are being used in the management of these conditions), . Endometriosis, by mouth , 10–15 mg daily for 4–6 severe arterial disease, undiagnosed vaginal bleeding

months or longer, starting on day 5 of cycle (if and acute porphyria (section 9.8.2). Progestogens

spotting occurs increase dose to 20–25 mg daily,

syst

should not be used if there is a history during pregnancy reduced once bleeding has stopped) of idiopathic jaundice, severe pruritus, or pemphigoid

. Dysfunctional uterine bleeding, menorrhagia (but see

em

gestationis. notes above), by mouth , 5 mg 3 times daily for 10 days to arrest bleeding; to prevent bleeding 5 mg

Side-effects Side-effects of progestogens include twice daily from day 19 to 26 menstrual disturbances, premenstrual-like syndrome

. Dysmenorrhoea (but see notes above), by mouth , (including bloating, fluid retention, breast tenderness),

5 mg 3 times daily from day 5 to 24 for 3–4 cycles weight change, nausea, headache, dizziness, insomnia,

. Premenstrual syndrome (but not recommended, see drowsiness, depression, change in libido; also skin reac-

notes above), by mouth , 5 mg 2–3 times daily from tions (including urticaria, pruritus, rash, and acne),

day 19 to 26 for several cycles hirsutism and alopecia. Jaundice and anaphylactoid

. Postponement of menstruation, reactions have also been reported.

by mouth , 5 mg 3 times daily starting 3 days before expected onset (menstruation occurs 2–3 days after stopping)

DYDROGESTERONE

Tablets of 5 mg

Indications HRT (section 6.4.1.1) Norethisterone (Non-proprietary) A Cautions see notes above; breast-feeding (Appendix 5)

Tablets , norethisterone 5 mg, net price 30-tab pack = Contra-indications see notes above

Side-effects see notes above Primolut N c (Schering Health) Dose

A Tablets , norethisterone 5 mg. Net price 30-tab pack =

. See under combined preparations (section 6.4.1.1)

Utovlan c (Pharmacia) A

MEDROXYPROGESTERONE ACETATE

Tablets , norethisterone 5 mg, net price 30-tab pack = £1.40, 90-tab pack = £4.21

Indications see under Dose; contraception (section 7.3.2.2); malignant disease (section 8.3.2)

Combined preparations Cautions see notes above; breast-feeding (Appendix 5)

Section 6.4.1.1

6.4.2 Male sex hormones and antagonists BNF 57

to fertility. If fertility is desired, the usual treatment is Indications

PROGESTERONE

with gonadotrophins or pulsatile gonadotrophin-releas- see under preparations

ing hormone (section 6.5.1) which will stimulate sper- Cautions see notes above; breast-feeding (Appendix 5)

matogenesis as well as androgen production. Contra-indications see notes above; missed or

Caution should be used when androgens or chorionic incomplete abortion Side-effects

gonadotrophin are used in treating boys with delayed see notes above; injection-site reactions;

puberty since the fusion of epiphyses is hastened and pain, diarrhoea and flatulence can occur with rectal

may result in short stature; skeletal maturation should administration

be monitored.

Dose Intramuscular depot preparations of testosterone . See under preparations

esters are preferred for replacement therapy. Testo- Crinone c (Serono) A sterone enantate, propionate or undecanoate, or alter-

Vaginal gel , progesterone 90 mg/application (8%), 15 natively Sustanon c , which consists of a mixture of = £32.73

testosterone esters and has a longer duration of action, Dose by vagina , infertility due to inadequate luteal phase, insert

may be used. Satisfactory replacement therapy can 1 applicatorful daily starting either after documented ovulation or

sometimes be obtained with 1 mL of Sustanon 250 c , on day 18–21 of cycle. In vitro fertilisation, daily application continued for 30 days after laboratory evidence of pregnancy

given by intramuscular injection once a month, although Cyclogest c

more frequent dose intervals are often necessary. (Actavis) AU

Implants of testosterone can be used for hypogonadism; Pessaries , progesterone 200 mg, net price 15 = £7.46;

the implants are replaced every 4 to 5 months. 400 mg, 15 = £10.80 Dose by vagina or rectum , premenstrual syndrome and post-

Testosterone implants can be used in postmenopausal natal depression, 200 mg daily to 400 mg twice daily; for pre-

women as an adjunct to hormone replacement therapy. menstrual syndrome start on day 12–14 and continue until onset

A testosterone patch is also licensed to improve libido in of menstruation (but not recommended, see notes above); rectally

surgically induced menopausal women (receiving conco-

tem if barrier methods of contraception are used, in patients who have

recently given birth or in those who suffer from vaginal infection mitant oestrogen therapy).

sys or recurrent cystitis

Gestone c (Nordic) A Injection , progesterone 50 mg/mL, 1-mL amp =

ocrine

TESTOSTERONE AND ESTERS End

£4.50, 2-mL amp = £4.50 Dose by deep intramuscular injection into buttock, dysfunc-

tional uterine bleeding, 5–10 mg daily for 5–10 days until 2 days Indications see under preparations

6 before expected onset of menstruation

Recurrent miscarriage due to inadequate luteal phase (but not cardiac, renal, or hepatic impairment

Cautions

recommended, see notes above) or following in vitro fertilisation (Appendix 2), elderly, ischaemic heart disease, or gamete intra-fallopian transfer, 25–100 mg 2–7 times a week

hypertension, epilepsy, migraine, diabetes mellitus, from day 15, or day of embryo or gamete transfer, until 8–16

skeletal metastases (risk of hypercalcaemia), under- weeks of pregnancy; max. 200 mg daily

take regular examination of the prostate and breast Utrogestan c (Ferring) A during treatment; monitor full blood count, lipid pro-

Capsules , progesterone (micronised) 100 mg, net file and liver function; pre-pubertal boys (see notes price 30-cap pack = £5.70; 200 mg 15-cap pack =

above and under Side-effects); interactions: Appen- £5.70. Counselling, administration

dix 1 (testosterone)

Excipients include arachis (peanut) oil

Women Regularly assess for androgenic side-effects; women Counselling Capsules should be taken at bedtime on an empty

should be advised to report any signs of virilisation e.g. stomach

deepening of the voice or hirsutism Dose progestogenic opposition of oestrogen HRT 200 mg once

Contra-indications breast cancer in men, prostate daily on days 15–26, or 100 mg once daily on days 1–25, of each

28-day oestrogen HRT cycle cancer, history of primary liver tumours, hypercal-

caemia, pregnancy (Appendix 4), breast-feeding (Appendix 5), nephrotic syndrome

Side-effects prostate abnormalities and prostate

6.4.2 cancer, headache, depression, gastro-intestinal Male sex hormones and

bleeding, nausea, vomiting, cholestatic jaundice,

antagonists

changes in libido, gynaecomastia, polycythaemia, anxiety, irritability, nervousness, asthenia, paraes-

Androgens cause masculinisation; they may be used as thesia, hypertension, electrolyte disturbances includ- replacement therapy in castrated adults and in those

ing sodium retention with oedema and hypercal- who are hypogonadal due to either pituitary or testicular

caemia, weight gain; increased bone growth, muscle disease. In the normal male they inhibit pituitary

cramps, arthralgia; androgenic effects such as hirsut- gonadotrophin secretion and depress spermatogenesis.

ism, male-pattern baldness, seborrhoea, acne, pru- Androgens also have an anabolic action which led to the

ritus, excessive frequency and duration of penile development of anabolic steroids (section 6.4.3).

erection, precocious sexual development and pre- mature closure of epiphyses in pre-pubertal males,

Androgens are useless as a treatment of impotence and suppression of spermatogenesis in men and virilism in impaired spermatogenesis unless there is associated

women; rarely liver tumours; sleep apnoea also hypogonadism; they should not be given until the hypo-

reported; with patches, buccal tablets, and gel, local gonadism has been properly investigated. Treatment

irritation and allergic reactions (including burn-like should be under expert supervision.

lesions with patches), and taste disturbances When given to patients with hypopituitarism they can

Dose

lead to normal sexual development and potency but not . See under preparations

BNF 57

6.4.2 Male sex hormones and antagonists 405

Oral Transdermal preparations Restandol c Testocaps (Organon) A Andropatch c (GSK) A Capsules , orange, testosterone undecanoate 40 mg in

Patches , self-adhesive, releasing testosterone approx. oily solution. Net price 30-cap pack = £8.89; 60-cap

2.5 mg/24 hours, net price 60-patch pack = £49.10; pack = £17.79. Label: 21, 25

releasing testosterone approx. 5 mg/24 hours, net Dose androgen deficiency, 120–160 mg daily for 2–3 weeks;

price 30-patch pack = £49.10. Counselling, adminis- maintenance 40–120 mg daily

tration Dose androgen deficiency in men (over 15 years) associated with

Buccal primary or secondary hypogonadism, apply to clean, dry, unbro-

c Striant ken skin on back, abdomen, upper arms or thighs, removing after SR (Ardana) A 24 hours and siting replacement patch on a different area (with an Mucoadhesive buccal tablets , m/r, testosterone

interval of 7 days before using the same site); initially apply

30 mg, net price 60-tab pack = £45.84. Counselling, patches equivalent to testosterone 5 mg/24 hours (2.5 mg/ see under Dose below

24 hours in non-virilised patients) at night (approx. 10 p.m.), then Dose hypogonadism, 30 mg every 12 hours; CHILD and ADO-

adjust to 2.5 mg to 7.5 mg every 24 hours according to plasma- LESCENT under 18 years not recommended

testosterone concentration (those with a body-weight over 130 kg Counselling Place rounded side of tablet on gum above front

may require 7.5 mg every 24 hours) teeth and hold lip firmly over the gum for 30 seconds. If tablet

detaches within 4 hours of next dose, replace with new tablet Intrinsa c (Procter & Gamble) TA which is considered the second dose for the day.

Patches , self-adhesive, releasing testosterone approx. 300 micrograms/24 hours, net price 8-patch pack =

Intramuscular £28.00. Counselling, administration Testosterone Enantate (Cambridge) A Dose hypoactive sexual desire disorder associated with surgi- cally induced menopause (in women receiving concomitant oes-

Injection (oily), testosterone enantate 250 mg/mL. trogen therapy (section 6.4.1.1)), apply 1 patch twice weekly Net price 1-mL amp = £11.01

continuously to clean, dry, unbroken skin on lower abdomen Dose by slow intramuscular injection , hypogonadism, initially

below waistline; site replacement patch on a different area (avoid 250 mg every 2–3 weeks; maintenance 250 mg every 3–6 weeks

using same area for 7 days); assess treatment after 3–6 months, Breast cancer, 250 mg every 2–3 weeks

discontinue if no benefit Note Not recommended for women naturally menopausal or

Nebido c (Bayer) TA those taking conjugated oestrogens. Safety and efficacy of use Injection (oily), testosterone undecanoate 250 mg/

beyond 1 year not established mL. Net price 4-mL amp = £76.70

Dose by deep intramuscular injection , hypogonadism in men Testim c (Ipsen) TA over 18 years, 1 g every 10–14 weeks; if necessary, second dose

Gel , testosterone 50 mg/5 g tube, net price 30-tube may be given after 6 weeks to achieve rapid steady state plasma

pack = £33.00. Counselling, administration testosterone levels and then every 10–14 weeks

Excipients include propylene glycol (see section 13.1.3) c Dose hypogonadism due to testosterone deficiency in men (over

Sustanon 100 (Organon) A 18 years), 50 mg testosterone (5 g gel) applied once daily; sub- Injection (oily), testosterone propionate 20 mg,

Endocrine

sequent application adjusted according to response; max. 100 mg

testosterone phenylpropionate 40 mg, and testo-

(10 g gel) daily

sterone isocaproate 40 mg/mL. Net price 1-mL amp Counselling Squeeze entire content of tube on to one palm = £1.09

and apply as a thin layer on clean, dry, healthy skin of Excipients include arachis (peanut) oil, benzyl alcohol (see Excipients

shoulder or upper arm, preferably in the morning after p. 2)

washing or bathing (if 2 tubes required use 1 per shoulder or

syst

Dose by deep intramuscular injection , androgen deficiency, upper arm); rub in and allow to dry before putting on 1 mL every 2 weeks

clothing to cover site; wash hands with soap after applica-

em

tion; avoid washing application site for at least 6 hours Sustanon 250 Avoid skin contact with application sites to prevent testo- c (Organon) A sterone transfer to other people, especially pregnant women Injection (oily), testosterone propionate 30 mg,

and children—consult product literature testosterone phenylpropionate 60 mg, testosterone isocaproate 60 mg, and testosterone decanoate

Testogel c (Schering Health) A 100 mg/mL. Net price 1-mL amp = £2.55 Excipients

Gel include arachis (peanut) oil, benzyl alcohol (see Excipients , testosterone 50 mg/5 g sachet, net price 30-

sachet pack = £33.00. Counselling, administration Dose by deep intramuscular injection , androgen deficiency,

p. 2)

Dose hypogonadism due to androgen deficiency in men (over 18 1 mL usually every 3 weeks

years), 50 mg testosterone (5 g gel) to be applied once daily; subsequent application adjusted according to response in 25-mg

Virormone c (Nordic) A (2.5 g gel) increments to max. 100 mg (10 g gel) daily , testosterone propionate 50 mg/mL. Net Counselling Injection Apply thin layer of gel on clean, dry, healthy skin such as shoulders, arms or abdomen, immediately after sachet is price 2-mL amp = 45p

opened. Not to be applied on genital area as high alcohol content Dose by intramuscular injection , androgen deficiency, 50 mg 2–3

may cause local irritation. Allow to dry for 3–5 minutes before times weekly

dressing. Wash hands with soap and water after applying gel, Delayed puberty, 50 mg weekly

avoid shower or bath for at least 6 hours Breast cancer in women, 100 mg 2–3 times weekly

Avoid skin contact with gel application sites to prevent testo- sterone transfer to other people, especially pregnant women and children—consult product literature

Implant Testosterone (Organon) A Tostran c (ProStrakan) A Implant , testosterone 100 mg, net price = £7.40;

Gel , testosterone 2% (10 mg/metered application), 200 mg = £13.79

net price 60-g multidose dispenser = £26.67. Coun- Dose by implantation , male hypogonadism, 100–600 mg;

selling, administration 600 mg usually maintains plasma-testosterone concentration

Excipients include butylhydroxytoluene, propylene glycol (see section within the normal range for 4–5 months

Postmenopausal women, 50–100 mg every 4–8 months, as an Dose hypogonadism due to testosterone deficiency in men (over adjunct to oestrogen replacement therapy

18 years), initially 60 mg testosterone (3 g gel) applied once daily;

6.4.2 Male sex hormones and antagonists BNF 57

subsequent applications adjusted according to response; max. 80 mg (4 g gel) daily

(rarely leading to galactorrhoea and benign breast Counselling Apply gel on clean, dry, intact skin of abdomen or

nodules); rarely hypersensitivity reactions, rash and both inner thighs, preferably in the morning. Gently rub in with a

osteoporosis; inhibition of spermatogenesis (see notes finger until dry before dressing. Wash hands with soap and water

above); hepatotoxicity reported (including jaundice, after applying gel; avoid washing application site for at least 2

hepatitis and hepatic failure usually in men given 200– hours. Not to be applied on genital area.

300 mg daily for prostatic cancer, see section 8.3.4.2 Avoid skin contact with gel application sites to prevent testo- sterone transfer to other people, especially pregnant women and

for details and warnings) children—consult product literature

Dose . Male hypersexuality, 50 mg twice daily after food

Cyproterone Acetate (Non-proprietary) A Indications

MESTEROLONE

, cyproterone acetate 50 mg, net price 56-tab see under Dose

Tablets pack = £31.54. Label: 21 counselling, driving

Cautions see under Testosterone and Esters Contra-indications see under Testosterone and Esters

Androcur c (Schering Health) A Side-effects see under Testosterone and Esters but

Tablets , scored, cyproterone acetate 50 mg. Net price spermatogenesis unimpaired

56-tab pack = £25.89. Label: 21 counselling, driving Dose . Androgen deficiency and male infertility associated

Dutasteride and finasteride

with hypogonadism, 25 mg 3–4 times daily for several Dutasteride and finasteride are specific inhibitors of months, reduced to 50–75 mg daily in divided doses

the enzyme 5a-reductase, which metabolises testo- for maintenance; CHILD not recommended

sterone into the more potent androgen, dihydrotestos-

c Pro-Viron terone. This inhibition of testosterone metabolism leads (Schering Health) A to reduction in prostate size, with improvement in Tablets , scored, mesterolone 25 mg. Net price 30-tab

urinary flow rate and in obstructive symptoms. Dutaste-

tem

pack = £4.44 ride and finasteride are alternatives to alpha-blockers

sys (section 7.4.1) particularly in men with a significantly

enlarged prostate. Finasteride is also licensed for use

Anti-androgens

with doxazosin in the management of benign prostatic

ocrine hyperplasia. Cyproterone acetate

A low strength of finasteride is licensed for treating End Cyproterone acetate is an anti-androgen used in the male-pattern baldness in men (section 13.9).

6 treatment of severe hypersexuality and sexual deviation Cautions Dutasteride and finasteride decrease serum in the male. It inhibits spermatogenesis and produces

concentration of prostate cancer markers such as reversible infertility (but is not a male contraceptive);

prostate-specific antigen; reference values may need abnormal sperm forms are produced. Fully informed

adjustment. Both dutasteride and finasteride are consent is recommended and an initial spermatogram.

excreted in semen and use of a condom is recom- As hepatic tumours have been produced in animal

mended if sexual partner is pregnant or likely to become studies, careful consideration should be given to the

pregnant. Women of childbearing potential should avoid risk/benefit ratio before treatment. Cyproterone acetate

handling crushed or broken tablets of finasteride and is also used as an adjunct in prostatic cancer (section

leaking capsules of dutasteride.

8.3.4.2) and in the treatment of acne and hirsutism in women (section 13.6.2). Contra-indications Dutasteride and finasteride are

contra-indicated in women, children, and adolescents. Indications see notes above; prostate cancer (section

CYPROTERONE ACETATE

8.3.4.2) Side-effects The side-effects of dutasteride and finas- Cautions ineffective for male hypersexuality in

teride include impotence, decreased libido, ejaculation chronic alcoholism (relevance to prostate cancer not

disorders, and breast tenderness and enlargement. known); blood counts initially and throughout treat-

ment; monitor hepatic function regularly (liver func- tion tests should be performed before treatment, see also under Side-effects below); monitor adrenocorti-

DUTASTERIDE

cal function regularly; diabetes mellitus (see also Contra-indications) Indications benign prostatic hyperplasia Driving Fatigue and lassitude may impair performance of

Cautions see notes above; interactions: Appendix 1 skilled tasks (e.g. driving)

(dutasteride)

Contra-indications (do not apply in prostate cancer) Contra-indications see notes above; also severe hepatic disease (Appendix 2), severe diabetes (with

hepatic impairment vascular changes); sickle-cell anaemia, malignant or

Side-effects see notes above wasting disease, severe depression, history of

Dose

thrombo-embolic disorders; youths under 18 years . (may arrest bone maturation and testicular develop- 500 micrograms daily (may require 6 months’ treat-

ment before benefit is obtained) ment)

Side-effects fatigue and lassitude, breathlessness, Avodart c (GSK) A weight changes, reduced sebum production (may

Capsules , yellow, dutasteride 500 micrograms, net clear acne), changes in hair pattern, gynaecomastia

price 30-cap pack = £24.81. Label: 25

BNF 57

6.4.3 Anabolic steroids 407

FINASTERIDE

6.5 benign prostatic hyperplasia; male-pat- Hypothalamic and

Indications

pituitary hormones and

tern baldness in men (section 13.9)

Cautions see notes above; also obstructive uropathy

anti-oestrogens

Side-effects see notes above; also testicular pain, hypersensitivity reactions (including lip and face

6.5.1 Hypothalamic and anterior pituitary

swelling, pruritus and rash)

hormones and anti-oestrogens

Dose

6.5.2 Posterior pituitary hormones and

5 mg daily, review treatment after 6 months (may

antagonists

require several months’ treatment before benefit is obtained)

Use of preparations in these sections requires Proscar c (MSD) A detailed prior investigation of the patient and should

Tablets , blue, f /c, finasteride 5 mg. Net price 28-tab

be reserved for specialist centres. pack = £13.94