Author: Dr. William Rassman

Snippet from the article:

Christian Ellis Hageseth, III, of Fort Collins, Colorado was sentenced to serve nine months in county jail and pay the Medical Board of California over $4,000 to reimburse the cost of its investigation of him. Hageseth also was placed on supervised probation for three years.

Medical Board investigators identified Hageseth after receiving information that while not licensed to practice medicine, he prescribed an antidepressant for the treatment of major depressive disorder to a 19-year-old male in California. The man committed suicide fewer than 60 days after receiving the drug. Hageseth prescribed the medication after reviewing information provided by the customer over the Internet.

The Medical Board referred the case for criminal prosecution and Hageseth was charged with violating Business and Professions Code section 2052, a felony, for practicing medicine in California without a license.

Read the full text — Former Colorado physician sentenced in case involving death of Californian to whom he illegally prescribed drugs over the Internet

This crime is far more widespread than most of us realize, as doctors try to make money from their ability to write prescriptions. Shameful.

I have decided to half the dosage to see whether this will help. But my problem is that out of the 7-8 months that I have been on propecia, the first 4 were on proper propecia and then I bought a year’s supply of Dr Reddy’s Finax (generic version) during a visit to India in December. I have been very happy with that. So basically I stopped going to the doctor who initially prescribed me the Propecia here in the UK. I was just being over charged and I felt I was being taken advatange of.

So all I need advice on is how to switch from taking 1mg pill a day to half a pill a day. I don’t want to suffer from shock hair loss and loose all the gains plus more if I stop. But I need to stop for a week perhaps or slighlty longer maybe so that my erections and libido issues have a chance to normalise.

I would really appreciate your guidance on this.

Best regards !

I don’t feel comfortable giving you prescription advice, as I’m not your prescribing physician. Generally speaking, to switch from 1mg to 0.5mg a day, just get a pill cutter and take only half a pill each day. Libido issues should get back to normal on their own with the half dose, and if not, I’d see your doctor again to find out if there’s any other issues at play.

Dear Doctor:

This is a follow-up to the post I had sent regarding Cytochrome P-450 enzymes as they relate to drug metabolism, specifically Finasteride and Dutasteride.

As i had mentioned earlier, grapefruit juice is a potent inhibitor of CYP3A4 in the intestines, however, research indicates that it also inhibits hepatic CYP3A4 when 3 250ml (3 8-oz cups) are consumed daily. This is of particular importance to those takeing statin drugs, antihypertensives, antihistamines, and antiepileptics, as GF juice will significantly RAISE serum levels of these drugs. As a result, side effects are magnified.

Now broccoli has been identified as a potent dual inhibitor of both intestinal and hepatic CYP3A4. More precisely, it is the sulforophanes contained within broccoli. As Dutasteride is actively metabolized by CYP3A4, consumption of GF juice and broccoli will elevate serum levels of the drug considerably, as well as Finasteride, as both are substrates of CYP3A4.

I’m sure there are many who are looking for an inexpensive way to elevate serum levels of Dutasteride to get the “better clinical efficacy”. Caution should be taken however. Yes, it would be great to get .5mg of Avodart to be as effective as the 2.5mg through enzyme inhibition. However, most drugs are metabolized by CYP3A4. Those who are considering this approach must take into serious consideration the effect this approach will have on any and all other medications currently being used.

As i stated above, statins, antihypertensives, allergy medications, antiepileptics, and most other drugs are metabolized by the enzyme that GF juice and broccoli inhibit. Elevation of serum concentration of drugs with a low margin of safety may increase negative side effects, or worse, cause death. I would love to get the effect of 2.5mg of Avodart out of only .5mg, however, I would not want to trade my life for it.

Thanks!

Good review of an interesting subject. Thank you for sending this.

I developed nerve pain and my doctor thought it might be related to Propecia. So with the advice of my doctor, I stopped the Propecia. Naturally, my thinning has progressed though after I stopped it, so now I am considering starting it again if my doctor approves. I am going to speak with him first of course, but, after stopping taking the medication for the past 5 months after taking the medication for 1 year before that, what I want to know is will it still be effective if i restart it? Your response would be extremely appreciated. Thank you for your time.

I am unaware of peripheral neuropathy being a known side effect of Propecia. Your response on restarting it will not be as good as when you originally started it, but it should still have value. Only time will tell.