Discontinuation of Finasteride in Geriatric Patients

Introduction to Finasteride Discontinuation

The American Urological Association recommends considering the discontinuation of finasteride in patients with established incontinence, as the benefits of preventing urinary retention are negated 1
Finasteride is associated with a reduction in risk of acute urinary retention (from 5.6% to 3.3%) and reduction in need for surgical intervention (from 3.3% to 1.7%) in patients without established incontinence 1
The primary benefits of finasteride, including reduction in risk of acute urinary retention and need for surgical intervention, are less meaningful in a patient already experiencing incontinence 1

Geriatric patients, such as those over 94 years old, are significantly older than populations studied in clinical trials for finasteride (most studies included men with mean ages between 62-66 years) 1
The American Geriatrics Society recommends considering age-related factors, including altered pharmacokinetics, when prescribing finasteride to geriatric patients 1

Reducing unnecessary medications is particularly important in elderly patients with cognitive impairment, such as those with Alzheimer's disease 1
The American College of Clinical Pharmacology recommends evaluating the medication burden and potential for adverse effects and drug interactions in geriatric patients 1
Finasteride is associated with sexual adverse effects, including erectile dysfunction (2-4% higher than placebo), decreased libido, decreased ejaculate volume, and gynecomastia, which may negatively impact quality of life 1

Finasteride can be stopped immediately without tapering, and no withdrawal syndrome has been documented 1
The American Urological Association recommends monitoring for changes in urinary symptoms over 1-3 months after discontinuation of finasteride 1
If urinary retention develops (unlikely given established incontinence), reassess the decision to discontinue finasteride 1

The American Urological Association recommends focusing on practical management of incontinence with appropriate products and ensuring adequate hydration while managing fluid intake timing 1
Clearly document the rationale for discontinuation in the medical record to inform other healthcare providers 1
PSA monitoring is recommended, as PSA levels will increase after finasteride discontinuation (approximately doubling within 3-6 months) 1