What are the recommended medications for treating Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

The recommended medications for treating Benign Prostatic Hyperplasia (BPH) include alpha-blockers, 5-alpha reductase inhibitors, and phosphodiesterase-5 inhibitors, with combination therapy of an alpha-blocker and a 5-alpha reductase inhibitor being the most effective option for men with larger prostates and moderate to severe symptoms, as supported by the most recent guideline from 2021 1.

Treatment Options

• Alpha-blockers such as tamsulosin (0.4 mg daily), alfuzosin (10 mg daily), doxazosin (4-8 mg daily), and terazosin (5-10 mg daily) work quickly to relax prostate and bladder neck muscles, improving urine flow within days to weeks.
• 5-alpha reductase inhibitors like finasteride (5 mg daily) and dutasteride (0.5 mg daily) shrink the prostate gland over 3-6 months by blocking the conversion of testosterone to dihydrotestosterone.
• For men with both BPH and erectile dysfunction, tadalafil (5 mg daily) can address both conditions.

Combination Therapy

• Combination therapy with an alpha-blocker and a 5-alpha reductase inhibitor is often more effective than either medication alone for men with larger prostates and moderate to severe symptoms, as shown in studies such as the Medical Therapy of Prostatic Symptoms (MTOPS) and Combination of Avodart and Tamsulosin (CombAT) trials 1.
• The combination of an alpha-adrenergic receptor blocker and a 5 alpha-reductase inhibitor has been found to be more effective in relieving and preventing the progression of symptoms than alpha-blocker monotherapy, and also reduces the long-term risk of acute urinary retention and the need for BPH-related surgery 1.

Side Effects and Monitoring

• Patients should be aware that alpha-blockers may cause dizziness and orthostatic hypotension, especially with the first dose, while 5-alpha reductase inhibitors can reduce libido and cause erectile dysfunction in some men.
• Regular follow-up with a healthcare provider is necessary to monitor symptom improvement and medication side effects.

From the FDA Drug Label

Tadalafil tablets for Once Daily Use for Benign Prostatic Hyperplasia The recommended dose of tadalafil tablets for once daily use is 5 mg, taken at approximately the same time every day. 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. Tamsulosin Hydrochloride Capsules 0.4 mg once daily is recommended as the dose for the treatment of the signs and symptoms of BPH.

The recommended medications for treating Benign Prostatic Hyperplasia (BPH) are:

• Tadalafil: 5 mg once daily
• Finasteride: for the treatment of symptomatic BPH
• Tamsulosin: 0.4 mg once daily 2, 3, 4

From the Research

Medications for Treating Benign Prostatic Hyperplasia (BPH)

The following medications are recommended for treating BPH:

• 5alpha-reductase inhibitors, such as finasteride and dutasteride, which reduce prostate volume, improve lower urinary tract symptoms, increase peak urinary flow, and decrease the risk of acute urinary retention and need for surgical intervention 5, 6, 7
• Alpha1-adrenergic antagonists, such as doxazocin, terazosin, tamsulosin, and alfuzosin, which relax the smooth muscle of the bladder neck and prostate, decreasing resistance to urine flow and improving lower urinary tract symptoms 5, 6, 8
• Combination therapy of a 5alpha-reductase inhibitor and an alpha1-adrenergic antagonist, which significantly reduces the clinical progression of BPH over either drug class alone 5, 8

Effectiveness of Medications

The effectiveness of these medications has been demonstrated in several studies:

• Finasteride and dutasteride have been shown to decrease prostate volume, improve lower urinary tract symptoms, and reduce the risk of acute urinary retention and need for surgical intervention 5, 6, 7
• Alpha1-adrenergic antagonists have been shown to improve lower urinary tract symptoms and increase peak urinary flow, but may not reduce the long-term risk of urinary retention or need for surgical intervention 5, 6, 8
• Combination therapy has been shown to reduce the risk of overall clinical progression of BPH, including acute urinary retention and the need for invasive therapy 8

Treatment Options

Treatment options for BPH include:

• Medical therapy with 5alpha-reductase inhibitors, alpha1-adrenergic antagonists, or combination therapy 5, 6, 8, 7, 9
• Surgical intervention, such as transurethral resection of the prostate, which may be necessary in severe cases or when medical therapy is ineffective 6, 9