What is a suitable anxiolytic medication for a patient with Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

For a patient with benign prostatic hyperplasia (BPH) who needs anti-anxiety medication, buspirone would be a good first choice. Buspirone is typically started at 5-7.5 mg twice daily and can be gradually increased to 20-30 mg daily in divided doses. Unlike benzodiazepines, buspirone doesn't worsen urinary symptoms in BPH patients because it lacks muscle relaxant properties that could affect urinary sphincter tone.

Key Considerations

• SSRIs like escitalopram (10-20 mg daily) or sertraline (50-200 mg daily) are also reasonable options for longer-term anxiety management in BPH patients, though they may occasionally cause urinary hesitancy.
• It's essential to avoid benzodiazepines like diazepam or alprazolam in BPH patients as they can worsen urinary retention through their muscle relaxant effects.
• Some tricyclic antidepressants should be avoided due to their anticholinergic properties that can exacerbate BPH symptoms.
• When prescribing any anti-anxiety medication for a BPH patient, start with lower doses and monitor for changes in urinary symptoms, adjusting as needed, as suggested by the American Urological Association guidelines 1.

Medication Selection

• The choice of anti-anxiety medication should be informed by the patient's overall health status, the severity of their BPH symptoms, and their personal preferences.
• Physician-prescribed SSRIs or anxiolytics with choice informed by side effect profiles, interactions, response, patient age, and preference are recommended 1.

Monitoring and Adjustment

• Regular monitoring for adherence, side effects, and adverse events is crucial when prescribing anti-anxiety medications to BPH patients.
• Adjustments to the medication regimen may be necessary to minimize adverse effects and optimize therapeutic benefits.

From the Research

Anti-Anxiety Medications for BPH Patients

When considering anti-anxiety medications for patients with Benign Prostatic Hyperplasia (BPH), it's essential to evaluate the potential interactions and side effects of various medications.

• Bupropion, an antidepressant, can be used in combination with selective serotonin reuptake inhibitors (SSRIs) to treat depression, but it may increase the risk of serotonin syndrome 2.
• Benzodiazepines (BZDs) are commonly prescribed for anxiety, but they have a high potential for addiction and withdrawal symptoms 3.
• Buspirone, an anxiolytic medication, may be used to treat SSRI-associated sexual dysfunction, which can be a common side effect of antidepressant medications 4.
• The combination of bupropion and SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) can be effective in treating major depressive disorder (MDD) and reversing antidepressant-associated sexual dysfunction 5.

Considerations for BPH Patients

When selecting an anti-anxiety medication for a patient with BPH, consider the following:

• Potential interactions with other medications, such as alpha-blockers or 5-alpha-reductase inhibitors, which are commonly used to treat BPH.
• The risk of serotonin syndrome when combining bupropion with SSRIs or SNRIs 2.
• The potential for addiction and withdrawal symptoms associated with benzodiazepines 3.
• The effectiveness of buspirone in treating anxiety and SSRI-associated sexual dysfunction 4.