Propecia and Nizoral. Were you using both? Interaction?

[correiovip]

Nizoral contains Ketoconazole which inhibits cytochrome P450 enzime in the liver. Finasteride is only metabolized by the same enzime. Could Ketoconazole use lead to increased plasma levels of finasteride and accumulation of it in the body? How many of you were using Nizoral shampoo on a regular basis when taking Propecia?

I was using Nizoral about three times a week when taking Propecia.

[boston332]

I think alot of us were using Nizoral. That was the protocol. I’m not sure about the “accumlation” theory but you’re right thinking ketoconazole isnt something we should be using. I believe it also drops T levels.

[correiovip]

What i meant by accumulation is this:
Suppose i use Nizoral today. Then tomorrow i start Propecia 1 mg and it is not metabolized by the liver because P450 isn t active due to Ketoconazole. The next day i take another pill of propecia 1mg and shampoo with nizoral again. So i have now 2 mg of propecia in my bloodstream… Something that was never supposed to happen.
I don t know how long Ketoconazole inhibits this enzime, but this could be very dangerous in theory. What if you use Nizoral everyday? Then in a month would you have 30 mg of propecia in your bloodstream?

[martinM]

I was only using it about 1 time a week but there were times when I’d use it every day for a week when the itching was bad.

[John_winter]

nozoral will drog t levels orally, not topically. If thats the case then nizoral will be taken of the market, due to men developing feminine qualaties. Million sof people use nizoral… Nothing wrong with nizoral

[martinM]

@John winter

nozoral will drog t levels orally, not topically. If thats the case then nizoral will be taken of the market, due to men developing feminine qualaties. Million sof people use nizoral… Nothing wrong with nizoral

Your skin absorbs it just like propecia. If it should be taken off the market for men developing feminine qualities, why hasn’t fin been taken off the market.

Millions of people using fin, nothing wrong with fin. (SARCASM)

Seriously, WTF?

[bryce54]

@martinM

@John winter

nozoral will drog t levels orally, not topically. If thats the case then nizoral will be taken of the market, due to men developing feminine qualaties. Million sof people use nizoral… Nothing wrong with nizoral

Your skin absorbs it just like propecia. If it should be taken off the market for men developing feminine qualities, why hasn’t fin been taken off the market.

Millions of people using fin, nothing wrong with fin. (SARCASM)

Seriously, WTF?

lol… so true.

I was actually using Nizoral three times a week during, before, and after propecia use and continued to use it until I ran out of a bottle… maybe another couple of months?

[bryce54]

@correiovip

Nizoral contains Ketoconazole which inhibits cytochrome P450 enzime in the liver. Finasteride is only metabolized by the same enzime. Could Ketoconazole use lead to increased plasma levels of finasteride and accumulation of it in the body? How many of you were using Nizoral shampoo on a regular basis when taking Propecia?

I was using Nizoral about three times a week when taking Propecia.

Hey op, do you have any links to what you are talking about or more information on it? I really don’t know the sciency stuff behind what you are talking about, but what do you think is going on? Because it seems like a lot of people were maybe using it and that could lead to something?

[bryce54]

Ketoconazole is a substrate and potent inhibitor of CYP3A4. Therefore, the following
drug interactions may occur when NIZORAL® is co-administered with other drugs that
interact with CYP3A4. (See Table 1 and Table 2 for an overview of these drug
interactions; details are provided in the text that follows these tables.)

1. NIZORAL® may decrease the elimination of drugs metabolized by CYP3A4,
   thereby increasing their plasma concentrations. Increased exposure to these
   drugs may cause an increase or prolongation of their therapeutic and/or
   adverse effects. Concomitant use with NIZORAL® Tablets is contraindicated
   for drugs known to present a risk of serious side effects with increased
   exposure (see BOXED WARNING, CONTRAINDICATIONS section, and
   PRECAUTIONS: Drug Interactions, Table 1). For others, monitoring of
   plasma concentrations is advised when possible. Clinical signs and symptoms
   associated with these drugs should be monitored, with dosage adjusted as
   needed

accessdata.fda.gov/drugsatfd … 040lbl.pdf

Identification of human cytochrome P450 isozymes responsible for the in vitro oxidative metabolism of finasteride.

Finasteride, a prescription drug for the treatment of benign prostatic hypertrophy and alleviation of symptoms associated with benign prostatic hypertrophy and alleviation of symptoms associated with benign prostatic hypertrophy, has been shown to be metabolized in rat hepatic microsomes by hydroxylation at the t-butyl group (omega-OH finasteride), followed by further oxidation to the corresponding acid (omega-oic acid finasteride), with omega-aldehyde finasteride as an intermediate. In this study, we identified specific human cytochrome P450 (CYP) isozyme(s) involved in the in vitro metabolism of [14C]finasteride using CYP isozyme-selective inhibitors and microsomes containing specific recombinant human CYP isozymes (expressed in human AHH-1 TK+/-cells). Each of the three steps of the oxidative pathway was examined separately by using [14C]finasteride and its consecutive metabolites (omega-OH finasteride and omega-aldehyde finasteride) as substrates, and human liver microsomes or expressed recombinant CYP isozymes as the enzyme source. Gestodene, a mechanism-based inhibitor of CYP3A isozymes, showed a concentration-dependent inhibition of the oxidative metabolism of [14C]finasteride. In addition, the respective omega-OH finasteride and omega-oic acid finasteride metabolites were generated only by microsomes containing recombinant CYP3A4, but not the other isozymes (CYP1A1, CYP2B6, CYP2C8, CYP2C9, CYP2D6, and CYP2E1). Similar results were obtained for the oxidation of omega-OH finasteride to omega-aldehyde finasteride, suggesting that human CYP3A isozymes were involved in the oxidation of omega-OH finasteride. When omega-aldehyde finasteride was incubated with human liver microsomes in the presence of an NADPH regenerating system, both the omega-oic acid finasteride and the omega-OH finasteride were detected, suggesting that oxidative and reductive reactions were occurring simultaneously and that they were NADPH- or NADP-dependent. Inhibitors of CYP3A isozymes inhibited the oxidation of omega-aldehyde finasteride in a concentration-dependent manner; an increase in the reduction was also observed, presumably caused by inhibition of the competitive oxidative reaction. Other selective CYP inhibitors for CYP1A1/2 (alpha-naphthoflavone), CYP2C8-10 (sulfaphenazole), CYP2D6 (quinidine), and CYP2E1 (diallylsulfone) showed minor or no effects on both reactions. Consistent with these results, only microsomes containing human recombinant CYP3A4 catalyzed the oxidation of omega-aldehyde finasteride to omega-oic acid finasteride. These results indicate that the oxidation of omega-aldehyde finasteride was NADPH-dependent and was mediated at least in part by CYP3A4. In addition, NAD-dependent enzymes in cytosolic, microsomal, and mitochondrial fractions were capable of oxidizing omega-aldehyde finasteride to omega-oic acid finasteride. Other cellular fractions, particularly mitochondria, were shown to convert finasteride to omega-oic acid finasteride in a similar fashion.

ncbi.nlm.nih.gov/pubmed/8654202

So how to reactivate this… ? Here’s what I found so far.

St. John’s wort induces hepatic drug metabolism
through activation of the pregnane X receptor

pnas.org/content/97/13/7500.full.pdf

More info…

aturally occurring compounds may also induce or inhibit CYP activity. For example, bioactive compounds found in grapefruit juice and some other fruit juices, including bergamottin, dihydroxybergamottin, and paradicin-A, have been found to inhibit CYP3A4-mediated metabolism of certain medications, leading to increased bioavailability and, thus, the strong possibility of overdosing.[17] Because of this risk, avoiding grapefruit juice and fresh grapefruits entirely while on drugs is usually advised.[18]
Other examples:
Saint-John’s wort, a common herbal remedy induces CYP3A4, but also inhibits CYP1A1, CYP1B1, and CYP2D6.[19][20]
Tobacco smoking induces CYP1A2 (example CYP1A2 substrates are clozapine, olanzapine, and fluvoxamine)[21]
At relatively high concentrations, starfruit juice has also been shown to inhibit CYP2A6 and other CYPs.[22] Watercress is also a known inhibitor of the Cytochrome P450 CYP2E1, which may result in altered drug metabolism for individuals on certain medications (ex., chlorzoxazone).[23]

en.wikipedia.org/wiki/Cytochrome_P450_oxidase

Sigh… a little at a loss here for what to do if this is actually the case. CYP3A4 pulls toxins out of your body… this could be what is actually wrong here. If finasteride is actually metabolized and removed via this… it could still be in our bodies as causing prolonged problems as outlined by Nizoral? Although I don’t think everyone was on it so it doesn’t really explain it.

If you were on it or not… please respond here so we can get an idea. Or any kind of anti dandruff shampoo that would be helpful.

[ihatefin]

I was not on Nizoral. I was on nothing but 1mg name-brand Propecia.

[Livingdead]

Never used Nizoral either.

[Cap]

I used it a few months ago but not during my Fin usage.

[Finatruth]

Never used it