Document: Finpros film-coated tablet ENG SmPC change

• Finpros film-coated tablet SmPC
• Finpros film-coated tablet ENG SmPC

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1. NAME OF THE MEDICINAL PRODUCT

Finpros 5 mg film-coated tablets

2. QUALITATIVE AND QUANTITATIVE COMPOSITION

Each film-coated tablet contains 5 mg finasteride.

Excipient with known effect:

Lactose monohydrate (90.95 mg/tablet).

For the full list of excipients, see section 6.1.

3. PHARMACEUTICAL form

Film-coated tablet.

Blue, round biconvex tablet marked “F5”. The diameter is 7 mm.

4. CLINICALPARTICULARS

Finpros is indicated for the treatment and control of benign prostatic hyperplasia (BPH) in patients with an enlarged prostate to:

• cause regression of the enlarged prostate, improve urinary flow and improve the symptoms associated with BPH

• reduce the incidence of acute urinary retention and the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.

Finpros 5 mg tablets should only be administered in patients with an enlarged prostate (prostate volume above ca. 40 ml).

Posology

The recommended dosage is one 5 mg tablet daily with or without food.

Even if improvement can be seen within a short time, treatment for at least 6 months may be necessary in order to determine objectively whether a satisfactory response to treatment has been achieved.

Elderly patients

Dosage adjustments are not necessary although pharmacokinetic studies have shown that the elimination rate of finasteride is slightly decreased in patients above 70 years of age.

Patientswith renal impairment

Dosage adjustments are not necessary in patients with varying degrees of renal insufficiency (with creatinine clearance down to as low as 9 ml/min) as in pharmacokinetic studies renal insufficiency was not found to affect the elimination of finasteride. Finasteride has not been studied in patients on haemodialysis.

Patients with hepatic impairment

There are no data available in patients with hepatic insufficiency (see section 4.4).

Paediatric population

Finpros is not indicated for use in children(see section 4.3).

Method of administration

For oral use only.

The tablet should be swallowed whole and must not be divided or crushed (see section 6.6).

4.3 Contraindications

Finasteride is not indicated for use in women or children.

Finasteride is contraindicated in the following:

• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

• Pregnancy - Use in women when they are or may potentially be pregnant (see 4.6 Pregnancy and lactation, Exposure to finasteride - risk to male fetus).

4.4 Special warnings and precautions for use

General:

Effects on PSA and prostate cancer detection

No clinical benefit has yet been demonstrated in patients with prostate cancer treated with finasteride5 mg. Patients with BPH and elevated serum prostate specific antigen (PSA)were monitored in controlled clinical studies with serial PSAs and prostate biopsies. In these BPH studies, finasteride 5 mg did not appear to alter the rate of prostate cancer detection, and the overall incidence of prostate cancer was not significantly different in patients treated with finasteride 5 mg or placebo.

Digital rectal examinations as well as other evaluations for prostate cancer are recommendedprior to initiating therapy with finasteride 5 mg and periodically thereafter. Serum PSA is also used for prostate cancer detection. Generally a baseline PSA>10ng/mL (Hybritech)prompts further evaluation and consideration of biopsy; for PSA levels between 4and 10ng/mL, further evaluation is advisable. There is considerable overlap in PSA levels among men with and without prostate cancer. Therefore, in men with BPH, PSA values within the normal reference range do not rule out prostate cancer,regardless of treatment with finasteride5 mg. A baseline PSA<4ng/mLdoes not exclude prostate cancer.

Finasteride 5 mg causes a decrease in serum PSA concentrations by approximately 50% in patients with BPH,even in the presence of prostate cancer. This decrease in serum PSA levels in patients with BPH treated with finasteride 5 mg should be considered when evaluating PSA data and does not rule out concomitant prostate cancer. This decrease is predictable over the entire range of PSA values, although it may vary in individual patients. Analysis of PSA data from over 3000 patients in the 4-year, double-blind, placebo-controlled finsteride Long-Term Efficacyand Safety Study(PLESS) confirmed that in typical patients treated with finasteride5 mgfor six months or more, PSA values should be doubled for comparison with normal ranges in untreated men. This adjustment preserves the sensitivity andspecificity of the PSA assay and maintains its ability to detect prostate cancer.

Any sustained increase in PSA levels of patients treated with finasteride 5 mg should be carefully evaluated, including consideration of non-compliance to therapy with finasteride 5 mg.

Percent free PSA (free to total PSA ratio) is not significantly decreased by finasteride 5 mg. The ratio of free to total PSAremains constant even under the influence of finasteride5 mg. When percent free PSA is used as an aid in the detection of prostate cancer, no adjustment to its value is necessary.

Drug/laboratory test interactions

Effect on levels of PSA

Serum PSA concentration is correlated with patient age and prostatic volume, and prostatic volume is correlated with patient age. When PSA laboratory determinations are evaluated, consideration should be given to the fact that PSA levels decrease in patients treated with finasteride 5 mg. In most patients, a rapid decrease in PSA is seen within the first months of therapy, after which time PSA levels stabilize to a new baseline. The post-treatment baseline approximates half of the pre-treatment value. Therefore, in typical patients treated with finasteride 5 mg for six months or more, PSA values should be doubled for comparison to normal ranges in untreated men. For clinical interpretation, see 4.4 Special warnings and precautions for use, Effects on PSA and prostate cancer detection.

Breast cancer in men

Breast cancer has been reported in men taking finasteride 5 mg during clinical trials and the post-marketing period. Physicians should instruct their patients to promptly report any changes in their breast tissue such as lumps, pain, gynaecomastiaor nipple discharge.

Paediatric use

Finasteride is not indicated for use in children.

Safety and effectiveness in children have not been established.

Hepatic insufficiency

The effect of hepatic insufficiency on the pharmacokinetics of finasteride has not been studied.

Finpros contains lactose monohydrate. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

No druginteractions of clinical importancehave been identified. Finasteride is metabolized primarily via, but does not appear to affect significantly, the cytochrome P4503A4 system. Although the risk for finasteride to affect the pharmacokinetics of other drugs is estimated to be small, it is probable that inhibitors and inducers of cytochrome P4503A4 will affect the plasma concentration of finasteride. However, based on established safety margins, any increase due to concomitant use of such inhibitors is unlikely to be of clinical significance. Compounds whichhave been testedin man have includedpropranolol, digoxin, glibenclamide, warfarin, theophylline,and phenazoneand no clinically meaningful interactions were found.

Pregnancy

Finasteride is contraindicated for use in women when they are or may potentially be pregnant(See4.3Contraindications).

Because of the ability of type II5α-reductaseinhibitors to inhibitconversion of testosterone to dihydrotestosterone, these drugs, including finasteride, maycause abnormalities of the external genitaliaof a male fetuswhen administered to a pregnant woman.

Exposure to finasteride – risk to male fetus

Women should not handle crushed or broken tabletsof finasteride when they are or may potentially be pregnant because of the possibilityof absorption of finasteride andthe subsequentpotential risk to a male fetus(see 4.6Pregnancy and lactation Pregnancy). Finasteride tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets have not been broken or crushed.

Small amounts of finasteride have been recovered from the semen in subjects receiving finasteride 5 mg/day. It is not known whether a male fetusmay be adversely affected if his mother is exposed to the semen of a patient being treated with finasteride. When the patient’s sexual partner is or may potentially be pregnant, the patient is recommended to minimise exposure of his partner to semen.

Breast-feeding

Finasteride is notindicated for use in women.

It is not known whether finasteride is excreted in humanmilk.

There areno data to suggestthat finasteride affectsthe ability to drive or use machines.

The most frequentadverse reactions are impotence and decreasedlibido. These adverse reactionsoccur early inthe courseof therapy and resolve with continued treatment in the majority of patients.

The adverse reactions reported during clinical trials and/or post-marketing use with finasteride 5mg and/or finasteride at lower doses are listed in the table below.

Frequency of adverse reactions is determined as follows:

• Very common ( 1/10)

• Common ( 1/100 to < 1/10)

• Uncommon ( 1/1,000 to < 1/100)

• Rare ( 1/10,000 to < 1/1,000)

• Very rare (< 1/10,000)

• Not known (cannot be estimated from the available data)

The frequency of adverse reactions reported during post-marketing use cannot be determined as theyare derived from spontaneous reports.

	Common	Uncommon	Not known
Immune system disorders			hypersensitivity reactions including swelling of the lips and face
Psychiatric disorders	decreased libido		depression, decreased libido that continued after discontinuation of treatment
Cardiac disorders			palpitation
Hepatobiliary disorders			increased hepatic enzymes
Skin and subcutaneous tissue disorders		rash	pruritus, urticaria
Reproductive system and breast disorders	impotence	ejaculation disorder, breast tenderness, breast enlargement	testicular pain, erectile dysfunction that continued after discontinuation of treatment; male infertility and/or poor seminal quality
Investigations	decreased volume of ejaculate

In addition, the following has been reported in clinical trials and post-marketing use: male breast cancer (see 4.4Special warnings and precautions for use).

Medical Therapy of Prostate Symptoms (MTOPS)

The MTOPS study compared finasteride 5 mg/day (n=768), doxazosin 4 or 8 mg/day (n=756), combination therapy of finasteride 5 mg/day and doxazosin 4 or 8 mg/day (n=786), and placebo (n=737). In this study, the safety and tolerability profile of the combination therapy was generally consistent with the profiles of the individual components. The incidence of ejaculation disorder in patients receiving combination therapy was comparable to the sum of incidences of this adverse experience for the two monotherapies.

OtherLong-Term Data

In a 7-year placebo-controlled trial that enrolled 18,882 healthy men, of whom 9060 had prostate needle biopsy data available for analysis, prostate cancer was detected in 803 (18.4%) men receiving finasteride 5 mg and 1147 (24.4%) men receiving placebo. In the finasteride 5 mg group, 280 (6.4%) men had prostate cancer with Gleason scores of 7-10 detected on needle biopsy vs.237 (5.1%)menin the placebo group. Additional analyses suggest that the increase in the prevalence of high-grade prostate cancer observed in the finasteride 5 mg group may be explained by a detection bias due to the effect of finasteride 5 mg on prostate volume. Of the total cases of prostate cancer diagnosed in this study, approximately 98% were classified as intracapsular (clinical stage T1 or T2) at diagnosis.The clinical significanceof theGleason 7-10 data is unknown.

Laboratory Test Findings

When PSA laboratory determinations are evaluated, consideration should be given to the fact that PSA levels are decreased in patients treated with finasteride (see section 4.4 Special warnings and precautions for use).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.

Patients have receivedsingle doses of finasteride up to 400 mg and multiple doses up to 80 mg/day for three monthswithout adverseeffects.

No specific treatment of overdosagewith finasteride isrecommended.

5. PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Testosterone-5α-reductase-inhibitors

ATC-Code: G04CB01

Finasteride is a synthetic 4-azasteroid, a specific competitive inhibitor of the intracellular enzyme Type-II-5α-reductase. The enzyme converts testosterone into the more potent androgen dihydrotestosterone (DHT). The prostate gland and, consequently, also the hyperplasic prostate tissue are dependent on the conversion of testosterone to DHT for their normal function and growth. Finasteride has no affinity for the androgen receptor.

Clinical studies show a rapid reduction of the serum DHT levels of 70%, which leads to a reduction of prostate volume. After 3 months, a reduction of approx. 20% in the volume of the gland occurs, and the shrinking continues and reaches approx. 27% after 3 years. Marked reduction takes place in the periurethral zone immediately surrounding the urethra. Urodynamic measurements have also confirmed a significant reduction of detrusor pressure as a result of the reduced obstruction.

Significant improvements in maximum urinary flow rate and symptoms have been obtained after a couple of weeks, compared with the start of treatment. Differences from placebo have been documented at 4 and 7 months, respectively.

All efficacy parameters have been maintained over a 3 year follow-up period.

Effects of four years treatment with finasteride on incidence of acute urine retention, need for surgery, symptom score and prostate volume:

In clinical studies of patients with moderate to severe symptoms of BPH, an enlarged prostate on digital rectal examination and low residual urinary volumes, finasteride reduced the incidence of acute retention of urine from 7/100 to 3/100 over four years and the need for surgery (TURP or prostatectomy) from 10/100 to 5/100. These reductions were associated with a 2 point improvement in QUASI-AUA symptom score (range 0–34), a sustained regression in prostate volume of approximately 20% and a sustained increase in urinary flow rate.

5.2 Pharmacokinetic properties

Absorption

The bioavailability of finasteride is approx. 80%. Peak plasma concentrations are reached approx. 2 hours after intake, and absorption is complete after 6–8 hours.

Distribution

Binding to plasma proteins is approx. 93%.

Clearance and volume of distribution are approx. 165 ml/min (70–279 ml/min) and 76 l (44–96 l), respectively. Accumulation of small amounts of finasteride is seen on repeated administration. After a daily dose of 5 mg the lowest steady-state concentration of finasteride has been calculated to be 8–10 ng/ml, which remains stable over time.

Biotransformation

Finasteride is metabolised in the liver. Finasteride does not significantly affect the cytochrome P 450 enzyme system. Two metabolites with low 5α-reductase-inhibiting effects have been identified.

Elimination

The plasma half life is a mean of 6 hours (4–12 hours) (in men > 70 years: 8 hours, range 6–15 hours).

Following administration of radioactively labelled finasteride, approx. 39% (32–46%) of the dose was excreted in the urine in the form of metabolites. Virtually no unchanged finasteride was recovered in the urine. Approx. 57% (51–64%) of the total dose was excreted in the faeces.

In patients with renal impairment (creatinine clearance above 9 ml/min), no changes in the elimination of finasteride have been seen (see section 4.2).

Finasteride has been found to cross the blood-brain barrier. Small amounts of finasteride have been recovered in the seminal fluid of treated . In 2 studies of healthy subjects (n=69) receiving finasteride 5 mg/day for 6–24 weeks, finasteride concentrations in semen ranged from undetectable (<0.1 ng/ml) to 10.54 ng/ml. In an earlier study using a less sensitive assay, finasteride concentrations in the semen of 16 subjects receiving finasteride 5 mg/day ranged from undetectable (<1.0 ng/ml) to 21 ng/ml. Thus, based on a 5-ml ejaculate volume, the amount of finasteride in semen was estimated to be 50- to 100-fold less than the dose of finasteride (5 μg) that had no effect on circulating DHT levels in men (see also section 5.3.)

5.3 Preclinical safety data

Non-clinical data reveal no special hazard for humans based on conventional studies of repeated dose toxicity, genotoxicity, and carcinogenic potential.

Reproduction toxicology studies in male rats have demonstrated reduced prostate and seminal vesicular weights, reduced secretion from accessory genital glands and reduced fertility index (caused by the primary pharmacological effect of finasteride). The clinical relevance of these findings is unclear.

As with other 5-alpha-reductase inhibitors, femininisation of male rat foetuses has been seen with administration of finasteride in the gestation period. Intravenous administration of finasteride to pregnant rhesus monkeys at doses up to 800 ng/day during the entire period of embryonic and foetal development resulted in no abnormalities in male foetuses. This dose is about 60–120 times higher than the estimated amount in semen of a man who have taken 5 mg finasteride, and to which a woman could be exposed via semen. In confirmation of the relevance of the Rhesus model for human foetal development, oral administration of finasteride 2 mg/kg/day (the systemic exposure (AUC) of monkeys was slightly higher (3 x) than that of men who have taken 5 mg finasteride, or approximately 1–2 million times the estimated amount of finasteride in semen) to pregnant monkeys resulted in external genital abnormalities in male foetuses. No other abnormalities were observed in male foetuses and no finasteride-related abnormalities were observed in female foetuses at any dose.

6. PHARMACEUTICAL PARTICULARS

6.1 List of excipients

Tablet core:

Lactose monohydrate

Microcrystalline cellulose

Pregelatinised starch (maize)

Lauroyl macrogolglycerides

Sodium starch glycolate (Type A)

Magnesium stearate

Film-coating:

Hypromellose

Macrogol 6000

Titanium dioxide (E 171)

Indigo carmine aluminium lake (E 132)

6.2 Incompatibilities

Not applicable.

6.3 Shelf life

3 years

6.4 Special precautions for storage

This medicine does not require any special storage conditions.

6.5 Nature and contents of container

Blister packs Aluminium/PVC or Aluminium/Aluminium: 7, 14, 28, 30, 49, 50, 60, 90, 98, 100 and 300 (10x30) tablets.

Plastic bottles (HDPE): 10, 30, 50, 100 and 300 tablets.

Not all pack sizes may be marketed.

6.6 Special precautions for disposal and other handling

Women who are pregnant or may become pregnant should not handle crushed or broken finasteride tablets because of the possibility of absorption of finasteride and the subsequent potential risk to a male foetus (see section 4.6).

7. MARKETING AUTHORISATION HOLDER

<To be completed nationally>

8. MARKETING AUTHORISATION NUMBER(S)

<To be completed nationally>

9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

Date of first authorisation: 17 February 2006

Date of latest renewal: 17 February 2011

10. DATE OF REVISION OF THE TEXT

17 November 2014