dutasteride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
dutasteride: clinical details
Prescribing considerations
- Confirm the cause and severity of lower urinary tract symptoms and assess for prostate cancer before treatment.
- Clinical benefit develops gradually; set expectations accordingly.
- Use caution in mild to moderate hepatic impairment.
- Assess benefits and risks before combining with an alpha-blocker.
- Discuss possible sexual, fertility, breast and mood effects.
Contraindications and cautions
- Women, children and adolescents
- Hypersensitivity to dutasteride, another 5-alpha-reductase inhibitor or an excipient
- Severe hepatic impairment
Monitoring
- Assess for prostate cancer before treatment and periodically thereafter.
- Establish a new PSA baseline after treatment has affected PSA and monitor subsequent trends.
- Evaluate any confirmed PSA rise from the treatment nadir, even within the usual untreated range.
- Review new mood symptoms, sexual dysfunction, breast changes and suspected adverse reactions.
Clinical pharmacology
Dutasteride inhibits type 1 and type 2 5-alpha-reductase. It is highly protein-bound, extensively metabolised by CYP3A4 and CYP3A5, eliminated mainly in faeces and has a long terminal half-life.
Formulation and product differences
- The selected product is a soft gelatin capsule containing an oily liquid.
- Capsules must remain intact because their contents may irritate mucosa and be absorbed through skin.
- The capsule shell contains gelatin, glycerol, titanium dioxide and yellow iron oxide.
dutasteride preparations and strengths
Capsule
Route: Oral
Strengths: 0.5 mg
dutasteride interactions
Tell the prescriber or pharmacist about all medicines being used. Important examples include:
Verapamil or diltiazem
These can increase dutasteride concentrations and may make adverse effects more likely.
Strong CYP3A4 inhibitors, including ritonavir, indinavir, oral ketoconazole, itraconazole or nefazodone
Long-term use may increase and prolong exposure to dutasteride.
Tamsulosin and other alpha-blockers
Combination treatment may increase adverse effects, so its benefits and risks require review.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.