From 1 February 2011, dutasteride (Avodart) may be prescribed on the PBS for men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).1
The streamlined authority listing requires that dutasteride is prescribed in combination with an alpha blocker. Treatment must be initiated by a urologist but can be continued by a general practitioner.1 The listing is based on acceptable cost-effectiveness compared with that of an alpha blocker alone.2
Dutasteride is a 5-alpha-reductase inhibitor (5-ARI). 5-alpha reductase (5-AR) converts testosterone into dihydrotestosterone (DHT), and DHT stimulates the proliferation of prostate tissue. Inhibiting 5-AR reduces prostate size, resulting in improved urinary flow and urinary tract symptoms, and prevents progression of BPH in the longer term.
Dutasteride has a similar efficacy and safety profile to that of finasteride.3,4 Finasteride is available on the Repatriation Pharmaceutical Benefits Scheme (RPBS) and is authority listed when surgery is inappropriate or when drug treatment is contraindicated or has failed.5
Prazosin is currently the only PBS listed alpha blocker. Tamsulosin and terazosin are available on the RPBS.5 Alfuzosin is available on private prescription.
A fixed-dose combination of dutasteride with tamsulosin (Duodart; 0.5 mg dutasteride/0.4 mg tamsulosin hydrochloride) is currently only available on private prescription.6
A full NPS RADAR review of dutasteride will be published in April.
- Australian Department of Health and Ageing. November 2009 PBAC outcomes: positive recommendations. 2009. http://www.health.gov.au/internet/main/publishing.nsf/Content/pbacrec-nov09-positive (accessed 6 January 2011).
- Australian Depart of Health and Ageing. PBAC Public Summary Documents — November 2009: Dutasteride. http://www.health.gov.au/internet/main/publishing.nsf/Content/pbac-psd-mtg-nov09 (accessed 7 January 2011).
- Nickel JC. Comparison of clinical trials with finasteride and dutasteride. Rev Urol 2004;6(Suppl.9):S31-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16985923
- Andriole GL, Kirby R. Safety and tolerability of the dual 5alpha-reductase inhibitor dutasteride in the treatment of benign prostatic hyperplasia. Eur Urol 2003;44:82-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12814679
- Australian Depart of Health and Ageing. Schedule of Pharmaceutical Benefits. 1 January 2011. http://www.pbs.gov.au/pbs/home (accessed 7 January 2011).
- Australian Department of Health and Ageing. November 2010 PBAC outcomes: positive recommendations. 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/pbacrec-nov10-positive (accessed 6 January 2011).