can 5 alpha reductase inhibitor drugs work for life or do they lose effectivness?
does 5 alpha reductase inhibitor drugs like finasteride and dutasteride losses their effectiveness over time, and why do some drugs like Hiv regimen work prolonged time without tolerance and other drugs ex. antidepressant drugs have the tolerance issue after short time.
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1 Expert Answer
Thomas B. answered • 04/27/20
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As far as I am aware 5-alpha reductase inhibitors do not lose their effect over time. HIV meds may need to be changed overtime for several reasons usually due to adaptation by the virus or reinfection with a different strain that may have different antiviral requirements. Other drugs where you build tolerance is usually due to up regulation or down regulation to the target receptors of the drug. This is apparent in those with opioid use disorders.
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Casey T.
I haven't encountered any instances of drugs like finasteride or dutasteride becoming less effective over time, and cannot find any reliable literature stating that this is a known issue. Much of the problem with the "tolerance" question is actually because the patient's condition is worsening, not that the drug is actually any less effective. For example, the prostate can continue to grow larger due to a variety of conditions, not just those reasons that can be fixed by inhibiting 5-alpha-reductase. Similarly, many HIV medications, if taken correctly, will continue to remain effective because the virus cannot figure out a way to get around them. What many patients think of as "tolerance" is really just the virus learning and mutating in such a way that they can operate in spite of the drug. This is more likely if the drug is taken incorrectly, or only taken intermittently (it's easier for the virus to "figure it out" if it's given an opening every few days when you're drug-free). Antidepressants and allergy medications are commonly thought to become less effective when used for several years, but this is also more likely to be caused by an overall worsening of symptoms. This is commonly proven by the fact that you can come off the drug for several months, even up to a year or two, and it still doesn't work the way it once did when you go back to it. If it were true "tolerance," the drug would keep its effectiveness if you took a "drug holiday" every once in a while, which isn't the case.10/17/19