From the Guidelines
Medications for Benign Prostatic Hyperplasia (BPH) include alpha-blockers, 5-alpha-reductase inhibitors, phosphodiesterase-5 inhibitors, and combination therapy.
Medication Options
- Alpha-blockers: help relax the muscles in the prostate and bladder neck, making it easier to urinate. Examples include:
- Alfuzosin (Uroxatral), typically 10mg once daily 1.
- Doxazosin (Cardura), usually starting at 1mg once daily and can be increased to 2-4mg once daily 1.
- Tamsulosin (Flomax), usually 0.4mg once daily, can be increased to 0.8mg once daily 1.
- Terazosin (Hytrin), starting at 1mg once daily and can be increased to 2-5mg once daily 1.
- 5-alpha-reductase inhibitors: shrink the prostate by blocking the conversion of testosterone to dihydrotestosterone (DHT), a hormone involved in prostate growth. Examples include:
- Phosphodiesterase-5 inhibitors: can help with BPH symptoms, especially in men who also have erectile dysfunction. An example is:
- Tadalafil (Cialis), usually 5mg once daily for BPH, which can be taken as needed or daily for erectile dysfunction 1.
- Combination therapy: a combination of an alpha-blocker and a 5-alpha-reductase inhibitor may be prescribed for more severe symptoms, and should be offered as a treatment option only to patients with LUTS associated with demonstrable prostatic enlargement as judged by a prostate volume of >30cc on imaging, a PSA >1.5ng/mL, or palpable prostate enlargement on DRE 1.
It's essential to consult a healthcare provider to determine the best treatment plan, as the choice of medication depends on the severity of symptoms, other health conditions, and potential side effects, as recommended by the AUA guideline 1. Medications should be taken as directed, and it may take a few weeks to notice improvements in symptoms. Regular follow-up with a healthcare provider is recommended to assess the effectiveness of the treatment and to adjust the medication regimen as needed.
From the FDA Drug Label
1.1 Monotherapy Finasteride tablets are indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to: - Improve symptoms - Reduce the risk of acute urinary retention - Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy. What is UROXATRAL UROXATRAL is a prescription medicine that is called an "alpha-blocker". UROXATRAL is used in adult men to treat the symptoms of benign prostatic hyperplasia (BPH). 1.1 Benign Prostatic Hyperplasia (BPH) Doxazosin tablets, USP are indicated for the treatment of the signs and symptoms of BPH.
The medications for Benign Prostatic Hyperplasia (BPH) are:
These medications are used to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for surgery in men with BPH. Alpha-blockers like Alfuzosin and Doxazosin work by relaxing the muscles in the prostate and bladder, while Finasteride works by reducing the size of the prostate.
From the Research
Medications for Benign Prostatic Hyperplasia (BPH)
The following medications are used to treat BPH:
- Alpha-blockers: quickly and effectively decrease lower urinary tract symptoms (LUTS) and symptomatic disease progression 5, 6, 7, 8, 9
- 5-alpha-reductase inhibitors (5ARIs): decrease LUTS and disease progression in men with larger prostates (> 30-40 ml) 5, 6, 7, 8, 9
- Phosphodiesterase type 5 inhibitors (PDE5-Is): an alternative to alpha-blockers, can reduce LUTS and sexual side effects during 5ARI treatment 5, 8
- Muscarinic receptor antagonists: viable treatment option for patients with bladder storage symptoms and a small prostate 5
- Combination therapy: alpha-blocker plus muscarinic receptor antagonist, 5ARI plus alpha-blocker, or PDE5-I plus 5ARI can reduce LUTS and disease progression more effectively than monotherapy 5, 6, 8, 9
Phytotherapy and Other Treatments
- Phytotherapy: can be used in men with mild to moderate LUTS, but lacks proper evidence to establish its advantage 5, 9
- Watchful waiting: a treatment option for patients with mild symptoms 9
- Herbal remedies: such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract, and Lepidium meyenii (Red Maca) may have some improvements on BPH 9
- Ayurvedic medications: discussed as a treatment option for BPH, but requires more investigation 9
- Transurethral resection of the prostate (TURP) and minimally invasive therapies (MITs): expensive and rarely supported by healthcare systems 9