Sunday, October 15, 2017

說到雄性禿口服藥finasteride(柔沛)的長期副作用,十億人都驚呆了!!

柔沛(finasteride)的長期副作用(不良反應)真的有夠少,少到筆者都在想:「我為什麼要在這裡發廢文?


先前提過許多人來找筆者看雄性禿,聽到筆者建議趕快吃柔沛(finasteride),立刻像在桌上看到飯匙倩一樣倒彈一步。這些人會怕柔沛,不外乎是由於很多流傳已久的副作用(不良反應),像是生殖方面(性功能、懷孕)、精神方面(憂鬱)、以及肝臟、腎臟、癌症等長期副作用(不良反應)。

筆者進皮膚科前也這麼覺得,但隨著自己成為皮膚科醫師,多讀了一些書,開藥給病人們吃了幾年之後,發現了很令人震驚的真相:

很多傳聞中的副作用(不良反應)都不存在,就算有比例也極少。少到筆者都在想:「我為什麼要在這裡發廢文?」。

但由於很多病人因坊間流傳的謠言而放棄治療,平白損失很多頭髮。為此,筆者決定收集一些新進的研究實證來破除這些流言。今天就來跟大家談一下主流醫學界發現的柔沛長期副作用(肝臟、腎臟、癌症方面)。關於性功能方面的副作用(不良反應)可看雄性禿口服藥finasteride(柔沛)對性功能影響甚小,別讓錯誤訊息誤了您的頭髮!」這篇。至於懷孕(男性或女性吃)方面的副作用(不良反應),這是又是一個很大的題目,留待下一篇來探討。(參1)


先說明一下找尋資料的方法


除了取信於大家,這裡先說一下找資料的方法,也歡迎各位自行嘗試找看看,如果發現了筆者沒注意的證據,歡迎寫信給筆者。

我們可到美國國家圖書館網頁(https://www.ncbi.nlm.nih.gov/pubmed/),在最上方的搜尋欄打finasteride(柔沛的學名)與adverse effect(不良反應),再分別加上liver(肝臟)、hepatic(肝臟的)、kidney(腎臟)、renal(腎臟的)、cancer(癌症)等名詞。

由於美國國家圖書館幾乎收錄了全世界所有重要的醫學文獻,如果都找不到,大概就是極為罕見或是根本沒發生過。


肝臟方面的副作用(不良反應)


關鍵字:finasteride adverse effect liver
關鍵字:finasteride adverse effect hepatic 

由於柔沛是由肝臟代謝,仿單上有提到肝功能異常者須小心給藥,主要是怕肝臟代謝差會導致藥物濃度增加。但因為柔沛本身沒有肝毒性,體內濃度增高頂多造成性慾暫時下降,臨床上遇到的問題倒是很少見。我們用上述關鍵字查詢,只找到四篇,兩篇是老鼠實驗的結果(參2、3)與一篇藥物動力學的研究(參4),都不是在討論人類的不良反應。另外一篇則是討論tamsulosin這個藥,完全無關(參5)。由此可知,人類身上完全沒報告過肝臟方面的副作用。


腎臟方面的副作用(不良反應)


關鍵字:finasteride adverse effect renal


關鍵字:finasteride adverse effect kidney



用上述關鍵字查詢,只找到
四篇,兩篇是在討論對攝護腺癌與攝護腺肥大的影響(參6、7),一篇是先前提到的藥物動力學研究(參4),另外一篇則是討論tamsulosin這個藥,完全無關(參5)。由此可知,人類身上完全沒報告過finasteride在腎臟方面的副作用。


癌症的風險


關鍵字:finasteride cancer

這些關鍵字找到的資料就比較多,因此我們看比較新的幾篇就好。討論攝護腺癌的幾篇包括剛剛提到的攝護腺癌影響),發現不影響攝護腺癌的惡性等級(grade)(參6),一篇則是說用finasteride來預防攝護腺癌不會有明顯副作用(參8),另一篇則是說不管使用劑量多寡,都可以降低攝護腺癌的風險(參9)

過去的文獻有提到男性乳癌的風險,不過討論乳癌的最新文獻則顯示吃finasteride會增加男性女乳症的風險(如果遇到,減藥就會消失),但完全不會增加男性乳癌的風險(參10)

由此可知,柔沛(finasteride)在肝臟、腎臟、癌症方面的副作用(不良反應)幾乎可以完全忽略。如果為了這些不存在的問題放棄雄性禿的治療,就是跟自己的頭髮過意不去!

參考資料

1. 柔沛仿單
2. Diabetes. 2015 Feb;64(2):447-58. doi: 10.2337/db14-0249. Epub 2014 Sep 19. 5α-Reductase type 1 deficiency or inhibition predisposes to insulin resistance, hepatic steatosis, and liver fibrosis in rodents.
3. J Pharmacol Exp Ther. 2011 Aug;338(2):718-23. doi: 10.1124/jpet.111.182865. Epub 2011 May 23. Influence of dosing time on the efficacy and safety of finasteride in rats.
4. Clin Pharmacokinet. 1996 Jan;30(1):16-27. Clinical pharmacokinetics and pharmacodynamics of finasteride.
5. Drugs. 1996 Dec;52(6):883-898. doi: 10.2165/00003495-199652060-00012. Tamsulosin : A Review of its Pharmacological Properties and Therapeutic Potential in the Management of Symptomatic Benign Prostatic Hyperplasia.
6. J Urol. 2017 Aug 5. pii: S0022-5347(17)77259-X. doi: 10.1016/j.juro.2017.08.006. [Epub ahead of print] Impact of 5α-reductase inhibitors on disease reclassification among men on active surveillance for localized prostate cancer with favorable features.
7. N Engl J Med. 2003 Dec 18;349(25):2387-98. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia.
8. J Natl Cancer Inst. 2016 Aug 26;108(12). pii: djw168. doi: 10.1093/jnci/djw168. Print 2016 Dec. Long-term Consequences of Finasteride vs Placebo in the Prostate Cancer Prevention Trial.
9. PLoS One. 2015 May 8;10(5):e0126672. doi: 10.1371/journal.pone.0126672. eCollection 2015. Finasteride concentrations and prostate cancer risk: results from the Prostate Cancer Prevention Trial.

10. Clin Epidemiol. 2017 Feb 10;9:83-91. doi: 10.2147/CLEP.S124674. eCollection 2017.Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia.

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3 comments:

  1. Hi 鄭醫師,感謝你的post,對於近期決定要用藥的我給了一點信心!
    我想詢問,我是前額禿,額頭兩側已經凹進去了,不過在凹進去的額頭區可以見到很多細毛(這些細毛從我注意到前額禿後一直留到現在,至少也有五年以上了)
    這些細毛如果變粗了就很像會變成正常的髮際線
    但我一直聽說前額禿吃藥沒效orz,這樣的說法是真的嗎?

    另外請問,如果我之後吃藥搭配落健5%,但等到前額真的長出毛後停用落健5%是沒問題的嗎?
    這樣停用落健(但藥還是持續吃)是否會讓之前生好的頭髮掉光呢?
    不管如何,感謝你的文章!

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