Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon?
BACKGROUND
Sexual adverse experiences such as erectile dysfunction (ED), loss of libido, and ejaculation disorders have been consistent side effects of finasteride in a maximum percentage of 15% after 1 year of therapy. Such data could be seen as far from reality, if compared to a higher percentage that may be found in any common clinical practice.


OBJECTIVE
This study aims to explain the dichotomy between literature's data and clinical practice data.


METHODS
One hundred twenty patients with a clinical diagnosis of benign prostatic hyperplasia (BPH), sexually active and with an International Index of Erectile Function-erectile function (IIEF-EF) domain >/=25 were randomized to receive finasteride 5 mg concealed as an "X compound of proven efficacy for the treatment of BPH" for 1 year with (group 2) or without (group 1) counseling on the drug sexual side effect. The phrase used to inform group 2 patients was ". . . it may cause erectile dysfunction, decreased libido, problems of ejaculation but these are uncommon".


METHODS
The estimation of side effect was conducted at 6 and 12 months using the male sexual function-4 (MSF-4 item) questionnaire and a self-administered questionnaire.


RESULTS
One hundred seven patients completed the study. Group 2 patients (N = 55) reported a significant higher proportion of one or more sexual side effects as compared to group 1 (N = 52) (43.6% vs. 15.3%) (P = 0.03). The incidence of ED, decreased libido, and ejaculation disorders were 9.6, 7.7, and 5.7% for group 1, and 30.9, 23.6, and 16.3% for group 2, respectively (P = 0.02, P = 0.04, and P = 0.06).


CONCLUSIONS
In the current study, blinded administration of finasteride was associated with a significantly higher proportion of sexual dysfunction in patients informed on sexual side effects (group 2) as compared to those in which the same information was omitted (group 1) (P = 0.03). A scenario similar to group 2 of the current study is likely to occur in clinical practice, where the patient is counseled by the physician and has access to the drug information sheet. The burden of this nocebo effect (an adverse side effect that is not a direct result of the specific pharmacological action of the drug) has to be taken into account when managing finasteride sexual side effects.
Mondaini
Nicola
N
UO Urology, S Maria Annunziata Hospital, University of Florence, Florence, Italy. nicola.mondaini@unifi.it
Gontero
Paolo
P
Giubilei
Gianluca
G
Lombardi
Giuseppe
G
Cai
Tommaso
T
Gavazzi
Andrea
A
Bartoletti
Riccardo
R
D000368:Aged; D004311:Double-Blind Method; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D007172:Erectile Dysfunction / Q000139:chemically induced* / Q000517:prevention & control; D018120:Finasteride / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007989:Libido / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009948:Orgasm / Q000187:drug effects; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D012725:Sexual Behavior; D020018:Sexual Dysfunctions, Psychological / Q000139:chemically induced* / Q000517:prevention & control; D011795:Surveys and Questionnaires
D004791:Enzyme Inhibitors; D018120:Finasteride