Balding Blog

Dear Dr Rassman,

Can Propecia be taken along with Paxil (Paroxetine)? Do you have any patients on the combination?

Background: I am a 22 year old male. I have had social anxiety disorder and was prescribed Paxil CR 25 mg. I had weaned myself off it 15 months ago. Now my hair has started thinning and I was prescribed Propecia. But within 2 weeks of use I have had intense anxiety.

Please help me with your suggestions. thank you.

As far as I am aware, you can take Paxil and Propecia, but you need to ask your prescribing doctor before starting or stopping any medication as he/she may have more insight into what is going on with your problems. I am not your doctor and my suggestion to you is to speak to your doctor and ask him/her these questions.

A couple of days ago I had sent an email indicating that there is a belief that nutrasweet products interfere with the efficacy of propecia. The following site describes one such incidence.

https://205.238.137.71/hairloss-forums/viewthread.cfm?f=1&t=11649#33739

Please give me your opinion on this as I have been using propecia for 8 weeks with no effect.

I looked at the reference you cited. The piece proposes that nutrasweet may interfere with the action of Propecia, but it is conjunctural, not factual. Formaldahyde, if it were a significant metabolite of nutrisweet, would/could cause liver disease, which is not a reported side effect.

My husband has been taking Propecia for about 3 years or so. He is a relatively moody person in general, but nothing out of the ordinary. In the past few years it has been pretty bad to the point where he has tried antidepressants, tried seeing psychologists, etc. Then, this past summer, we went on a vacation and he forgot his Propecia. That was the best week I can remember him having. He felt good and it showed to those around him. I didn’t think much about it except that when he began using Propecia again, he went back to how he felt before and I noticed changes in him right away (within a day or so). When I made the connection that the main difference was that he was off of the Propecia when he felt and acted better, he acknowledged it, but was pretty adament that he would rather be in a bad mood all of the time then lose the rest of his hair. Just this week, I had noticed a difference in his mood and demeanor. I didn’t say anything though…hoping it would last. He then mentioned that he hadn’t taken his Propecia for 4 days. He said he felt really good and it shows. I guess what I am asking, as have others on your site, could there be a connection with Propecia and Mood Swings/Depression? At least with certain people’s chemistry? I would love to know more about this.

Although rare, there have been concerns that finasteride (Propecia) or dutasteride (Avodart) may have some impact on personality or emotions. That would not surprise me as we have seen changes in brain function with testosterone and women have seen hormone cyclical changes that affect mood. The good news is that very few patients out of my large practice have seen significant changes and reported them to me. The literature does have mention of occasional depression which may have been caused or influenced by these medications. I would suggest that if any person has mood alterations with these drugs, they should consult with the doctor who has prescribed it.

I have been taking propecia for about 6 years. I also have Primary Scholerosing Cholangitis (PSC), a liver disease. Do you know of any studies or have any other knowledge about the impact of propecia on the liver? Thank you.

There are warnings on the use of Propecia for those people with liver disease, however, it is not clear if the drug can negatively impact the liver directly in those with active liver disease. What I suspect is that the metabolism of the drug may be affected by active liver dysfunction. I will ask Merck, the makers of Propecia, about it and get clarification from them, getting back to you in the very near future. They are usually responsive to my questions.

UPDATE (May 3, 2005): Please see the response from Merck here.

I just heard back from the manufacturer of Propecia, Merck, concerning the question raised on April 29th (see: Propecia and Liver Disease). The question related to a person with a liver disease called Primary Scholerosing Cholangitis (PSC) and the safety issues with using Propecia.

A detailed three page answer was forwarded to me (with quotes from many scientific publications), so I will summarize it as simply as I can. The drug experience comes from Merck’s experience with Proscar (5mgs of Finasteride) and Propecia (1mg of Finasteride). A liver adverse effect has not been listed in the clinical trials of the drug for hair loss treatment. The drug itself is broken down by the liver, so decreased liver function will directly impact the rate at which the drug is metabolized by the liver and will keep serum levels higher in people known to have decreased liver function. In other words, the ability of the liver to clear this drug from the body may cause the serum levels to be higher than on someone without liver disease. There has been no study performed on the effects of hepatic insufficiency for Finasteride pharmacokinetics. Also, a search of the medical literature did show a rise in liver enzymes in one of 14 subjects studied in healthy volunteers (Shimazaki and Nose). One case of hepatitis induced by Finasteride was reported in a patient with many organ problems including a high alcohol intake. The inability to find another cause for the hepatitis on this patient led the doctors to believe that this drug may have been the cause for the liver disease on this one patient. When the drug Finasteride has been used with Flutamide, there was some impact possibly inducing liver disease.

In conclusion, I would strongly suggest that if you have known liver disease, that you use this drug with caution. Follow the use of the drug as prescribed in the literature and have a doctor follow your liver function tests periodically with the use of this medication. Liver disease in healthy people has not been reported (based upon the Merck communication with me). I would not consider liver disease as a significant risk in the typical patient’s routine use. But as a caution, every medication that anyone takes has potential risks associated with it. Even vitamins and Aspirin have their problems, yet we seem to continue to use them as well. The challenge is to balance reasonable risks against the alternative hair loss that might be slowed, stopped or reversed on this medication.

First of all, I’d like to say that this site is very informative, and thanks for providing it. My question concerns Propecia. I take high blood pressure medication, specifically a beta blocker (Toprol XL) and a diuretic (Triam-Hctz, the generic of dyazide). Are there any known cases of these types of drugs having an unfavorable reaction with Propecia? I ask only because a friend told me he once knew someone who had to stop taking it after having chest pains that he hadn’t had since he started his high bp meds. I would like to get on Propecia, but I’d rather be bald than have a heart attack. I’m just wondering if my friend was exagerrating.

There is no impact to my knowledge of Propecia on blood pressure medications or diuretics. The medication minoxidil (brand name Rogaine) may impact blood pressure as it was originally defined as a blood pressure medication. Maybe your friend is confusing the two.