Sexual side effects from prostrate drug

People's Pharmacy answers reader queries about sexual side effects from a prostrate drug; alternatives for hot flashes; and saline nasal sprays as an alternative for congestion.

Q: I am suffering with side effects from finasteride to control prostate symptoms. I have erectile dysfunction, loss of libido and enlarged breasts. Does it make sense for me to take testosterone to overcome these side effects?

A: Finasteride is the active ingredient in two drugs: Proscar for benign prostate problems and Propecia for male-pattern baldness.

The Food and Drug Administration (FDA) recently added warnings to finasteride labels that some sexual side effects may continue even after the drug is stopped. We found no studies showing that testosterone counteracts the sexual side effects of finasteride.

Discuss your concerns with your physician and ask if there is another way to treat your enlarged prostate. The FDA recently approved the erectile-dysfunction drug Cialis for prostate symptoms. A new analysis shows that this drug can ease prostate problems without triggering sexual side effects (European Urology, May 2012). Not all insurance companies pay for this new use of Cialis.

Q: I am at my wits' end. I've been taking Prempro for hot flashes. Now my doctor wants me to stop because of cancer concerns. Whenever I quit, though, the hot flashes return worse than ever.

My friends swear by bioidentical hormones, but my doctor says that they have not been proven any safer than Prempro. She wants me to try Effexor XR, but I am not ready to take an antidepressant for hot flashes. Help!

A: Your doctor may be reacting to a study reported at the American Association for Cancer Research this spring. The Nurses' Health Study acquired data from 60,000 women over several decades. Those who took postmenopausal estrogen were at greater risk of breast cancer. Progesterone increased the risk even more.

Bioidentical hormones have not been tested so thoroughly, so your doctor is erring on the side of caution.

Although antidepressants like fluoxetine (Sarafem), venlafaxine (Effexor) and paroxetine (Paxil) may ease hot flashes, stopping such drugs suddenly can cause unpleasant withdrawal symptoms, including dizziness, headache and hot flashes.

Q: I have suffered with severe, chronic nasal congestion and sinus headaches for decades. Periodically I get addicted to over-the-counter nasal sprays and have a terrible time weaning myself off. Sleeping with a stuffy nose is the pits. What can you recommend besides antihistamines, which leave me groggy?

A: Many people have reported dependence upon vasoconstrictors found in nasal sprays like Afrin and Neo-Synephrine. A safe alternative involves saline (saltwater) nasal sprays.