From the Guidelines
Medications like meclizine and Bentyl (dicyclomine) can exacerbate benign prostatic hyperplasia (BPH) symptoms due to their anticholinergic properties, and their use should be carefully considered in patients with BPH. When managing BPH, the focus is on reducing lower urinary tract symptoms (LUTS) and improving quality of life. According to the American Urological Association (AUA) guideline on the management of LUTS attributed to BPH 1, combination therapy is a common approach, but the choice of medications is crucial.
The AUA guideline suggests that anticholinergic agents, alone or in combination with an alpha blocker, may be offered as a treatment option to patients with moderate to severe predominant storage LUTS, but this is a conditional recommendation with an evidence level of Grade C 1. However, medications with anticholinergic properties, such as meclizine and dicyclomine, can worsen urinary symptoms in men with BPH by causing urinary retention.
Key considerations for managing BPH include:
- Avoiding medications that can worsen urinary symptoms
- Using combination therapy judiciously, based on the patient's specific symptoms and prostate size
- Monitoring urinary symptoms closely in patients taking medications that could potentially exacerbate BPH symptoms
- Considering alternative treatments that do not worsen prostate symptoms
Given the potential for meclizine and Bentyl to worsen BPH symptoms, it is recommended to use these medications with caution in patients with BPH and to closely monitor for any worsening of urinary symptoms. If symptoms such as difficulty starting urination, weak stream, or incomplete bladder emptying worsen while taking these medications, patients should contact their healthcare provider promptly for further evaluation and potential adjustment of their medication regimen.
From the Research
Medications for BPH
- The primary medications used to treat Benign Prostatic Hyperplasia (BPH) are alpha-blockers and 5-alpha-reductase inhibitors 2, 3.
- Alpha-blockers are the mainstay of treatment, and research is exploring the synergistic benefits of combining them with 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase-5 (PDE5) inhibitors, and beta-3 agonists 2.
- The alpha-blocker + 5-ARI combination remains ideal for enlarged prostates, significantly reducing clinical progression risk compared to monotherapy 2.
Combination Therapies
- Combination therapies, such as alpha-blocker + PDE5 inhibitor combinations, appear safe and potentially beneficial for men with concomitant erectile dysfunction 2.
- Beta-3 agonists show synergistic effects with alpha blockers for residual storage symptoms, offering similar efficacy to anticholinergics but with a better side effect profile 2.
- Anticholinergics are only effective versus placebo when combined with an alpha-blocker 4.
Treatment Options
- Medical management has become a common step in the treatment of BPH, often postponing or eliminating the need for surgical intervention 3, 5.
- Pharmacological agents and minimally invasive procedures, when appropriate, are generally preferred to more invasive surgery 5.
- Patients with mild or moderate symptoms usually can be treated by a primary care physician; more complicated cases should be referred to a urologist for evaluation and management 5.
Meclizine and Bentyl
- There is no direct evidence in the provided studies regarding the use of meclizine and bentyl for BPH treatment.
- Meclizine is an antihistamine used to treat vertigo and bentyl is an anticholinergic used to treat irritable bowel syndrome, but their use in BPH treatment is not mentioned in the studies 2, 3, 6, 5, 4.