From the Guidelines
Taking two alpha blockers simultaneously for benign prostatic hyperplasia (BPH) is not recommended due to increased risk of side effects without additional therapeutic benefit. Alpha blockers such as tamsulosin (Flomax), alfuzosin (Uroxatral), doxazosin (Cardura), or terazosin (Hytrin) work by relaxing smooth muscles in the prostate and bladder neck to improve urine flow. The American Urological Association (AUA) guideline on the management of lower urinary tract symptoms attributed to BPH recommends combination therapy with an alpha blocker and a 5-alpha reductase inhibitor (5-ARI) for 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.
Some key points to consider when managing BPH symptoms include:
- Combination therapy with an alpha blocker and a 5-ARI may be offered to patients with LUTS associated with demonstrable prostatic enlargement 1
- Anticholinergic agents or beta-3-agonists may be used in combination with an alpha blocker for patients with moderate to severe predominant storage LUTS, although the evidence level for these recommendations is Grade C 1
- The combination of low-dose daily 5mg tadalafil with alpha blockers is not recommended as it offers no advantages in symptom improvement over either agent alone 1
If one alpha blocker isn't effectively controlling your BPH symptoms, your doctor might consider either switching to a different alpha blocker or adding a medication from another class, such as a 5-alpha reductase inhibitor like finasteride (Proscar) or dutasteride (Avodart), as these combination approaches can be more effective than increasing alpha blocker therapy. Always consult with your healthcare provider before making any changes to your medication regimen, as they can evaluate your specific situation and recommend the most appropriate treatment strategy.
From the Research
Alpha Blockers for BPH
- Alpha blockers are a common treatment for benign prostatic hyperplasia (BPH) and have been shown to be effective in relieving lower urinary tract symptoms (LUTS) 2, 3, 4.
- There are several types of alpha blockers available, including terazosin, doxazosin, tamsulosin, and alfuzosin, each with its own characteristics and side effect profile 2, 3.
Combination Therapy
- Some studies have investigated the use of combination therapy with two alpha blockers for the treatment of BPH 5, 6.
- A study published in 2014 found that double dose alpha-blocker treatment (tamsulosin + alfuzosin) was superior to single dose treatment (tamsulosin) in managing patients with acute urinary retention caused by BPH 6.
- Another study found that combination therapy with an alpha blocker and a 5 alpha-reductase inhibitor was beneficial in the treatment of BPH, particularly in patients with an enlarged prostate, more severe symptoms, and higher PSA levels 5.
Safety and Efficacy
- The safety and efficacy of using two alpha blockers for BPH have been evaluated in several studies 2, 3, 6, 4.
- While the use of two alpha blockers may be effective in some cases, it is essential to consider the potential side effects and interactions between the medications 6.
- The choice of alpha blocker and the decision to use combination therapy should be tailored to the individual patient, taking into account their specific needs and medical history 2, 3.