Q. I have less dense hair and thinning of hair. Will there be any problem while taking Finasteride along with Cyclosporine?

Hello Doctor,

I have less dense packed hair with slight thinning in the hairline and on the vertex. I have this condition since 2003.

I am applying Minoxidil 5% since 10 years and from 2005 for every single day. My concern is I was diagnosed for Pure Red Cell Aplasia (PRCA), an autoimmune disorder and have been under immunosuppressive drug Cyclosporine 300mg/day for 2 years, since February 2013. Surprisingly, the Cyclosporine has helped controlling further thinning. But now I would like to take at least 0.25mg of Finasteride per day (1/4 of 1mg tablet) for improvement on already thinned areas. When I discussed with my dermatologist whether I could take the  0.25mg Finasteride while I am on 150mg Cyclosporine twice a day, she told that I can take it and there will not be any problem if I take lower dosage of 0.25mg Finateride.Brief note on my PRCA disease history:

Actually I was first diagnosed with PRCA in January 2008 with hemoglobin 6.4 g/dL. I was put forth on one and a half years of immunosuppression - Cyclosporine tablets 150mg twice a day till September 2009. When my hemoglobin reached 12 g/dL in September 2009 I was advised by my hematologist to stop the Cyclosporine intake. So, from September 2009 till December 2012 I was doing good with my hemoglobin level 12 g/dL without any immunosuppressants. Suddenly after December 2012 the "relapse" of PRCA occurred and as of now I have been advised to be on some amount of immunosuppression dosage with the Cyclosporine throughout life to prevent the relapse again. Right now my hemoglobin level is 12 g/dL. I have attached my latest Complete Blood Count (CBC) report. Cyclosporine intake has been reduced to 100mg twice a day at present.  So, I am just continuing to apply the 5% Minoxidil right from 2004 till date without fail. And during the period between September 2009 to December 2012 while I was doing good without any immunosuppressive Cyclosporine medication, I took Finasteride 1mg for a period of 5 months under supervision of my dermotologist. I did not have any sexual side effects except for my semen become more liquid, but my hair thinning improved a lot. Even I had a good amount of new hair growing out on the hairlines, temple and on the vertex. But I stopped Finasteride with fear of possibly having side effects after a long term usage.

Could you please advise whether it is safe to start taking 0.25mg of Finasteride now. As I am on immunosuppressant Cyclosporine and have to continue at least minimal dosage throughout life, will 0.25mg of Finasteride have interactions with Cyclosporine or any other adverse effects? Also I had discussion with one of my dermatologists. He advised that I can safely take Finasteride 1mg and Minoxidil-Finasteride are US FDA approved for androgenic alopecia. He also clarified that there is no interaction between Cyclosporine or Finasteride. And when I asked him about Saw Palmetto instead of Finasteride, he replied that though they are claimed to block DHT, there are no clinically proven results. Could you please advise me on this?

Thank you so much Doctor for your valuable advise!! I will first consider trying Minoxidil and Finasteride topical solution MORR-F. Also I have a few queries on the oral Finasteride dosage instruction as follows:

• I have been advised to take Cyclosporine 100mg dosage twice a day (morning and evening).

• Could you please advise when can I take Finasteride?

• Is it safe to take it in the morning (after breakfast) or evening (after dinner) along with Cyclosporine?

• Will there be any problem while taking Finasteride along with Cyclosporine?

• Or shall I take Finasteride in the noon after lunch, as a daily dosage?

Also right now, I am taking 2.5mg (half of 5mg) Folic acid tablets only along with Cyclosporine after dinner at night as advised by my hematologist. Thankfully, Folic acid intake nourishes my skin and protects hair including premature greying. Could you please advise whether I can continue with the Folic acid only or instead of that shall I go for Biotin capsules? If so please recommend the brand for Biotin capsules and the dosage level for it.