From the Guidelines
Alternatives to tamsulosin for treating benign prostatic hyperplasia (BPH) include other alpha-blockers such as alfuzosin, doxazosin, terazosin, and silodosin, as well as 5-alpha reductase inhibitors like finasteride and dutasteride, which can be used alone or in combination with alpha-blockers for patients with demonstrable prostatic enlargement 1.
Alternatives to Tamsulosin
- Other alpha-blockers:
- Alfuzosin (10 mg once daily)
- Doxazosin (1-8 mg daily)
- Terazosin (1-10 mg daily)
- Silodosin (8 mg daily)
- 5-alpha reductase inhibitors:
- Finasteride (5 mg daily)
- Dutasteride (0.5 mg daily)
Considerations for Choosing Alternatives
- Symptom severity
- Prostate size
- Comorbidities
- Potential side effects
- Patient preferences
Combination Therapy
- Combination of an alpha-blocker and a 5-alpha reductase inhibitor may be offered 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.
- Anticholinergic agents or beta-3-agonists may be offered in combination with an alpha-blocker for patients with moderate to severe predominant storage LUTS 1.
Additional Options
- Phosphodiesterase-5 inhibitors such as tadalafil (5 mg daily) for patients with concurrent erectile dysfunction
- Minimally invasive procedures like transurethral resection of the prostate (TURP), laser therapies, or newer options like prostatic urethral lift (UroLift) or water vapor therapy (Rezūm) for patients with moderate to severe symptoms unresponsive to medications 1.
From the FDA Drug Label
Dutasteride capsules are a 5 alpha-reductase inhibitor indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to: (1.1) improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for BPH-related surgery. Dutasteride in combination with the alpha-adrenergic antagonist, tamsulosin, is indicated for the treatment of symptomatic BPH in men with an enlarged prostate.
The alternative to tamsulosin (alpha-blocker) for treating benign prostatic hyperplasia (BPH) is dutasteride, a 5 alpha-reductase inhibitor, which can be used as monotherapy to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for BPH-related surgery 2.
- Key points:
- Dutasteride is indicated for the treatment of symptomatic BPH in men with an enlarged prostate.
- Dutasteride can be used alone or in combination with tamsulosin.
- Dutasteride is not approved for the prevention of prostate cancer 2.
From the Research
Alternatives to Tamsulosin for Treating Benign Prostatic Hyperplasia (BPH)
- Other alpha-blockers such as alfuzosin, doxazosin, and terazosin can be used as alternatives to tamsulosin for treating BPH 3, 4, 5.
- 5alpha-reductase inhibitors like finasteride and dutasteride are also effective in treating BPH, especially in men with large prostates 3, 6, 7.
- Combination therapy of alpha-blockers and 5alpha-reductase inhibitors can be used for patients with a high risk of progression 3, 7.
- Silodosin is another alpha-blocker that has been shown to be effective in treating BPH, with similar efficacy to alfuzosin and tamsulosin 5.
Comparison of Alternatives
- Alfuzosin, tamsulosin, and silodosin have been compared in a study, showing similar efficacy in improving lower urinary tract symptoms (LUTS) secondary to BPH 5.
- The combination of finasteride and doxazosin has been shown to have an additive effect in treating BPH, especially in men with enlarged prostates 7.
- Alpha-blockers like alfuzosin, tamsulosin, and silodosin have a rapid onset of action, while 5alpha-reductase inhibitors like finasteride and dutasteride may take longer to show effects 4, 6.
Considerations for Choosing Alternatives
- The choice of alternative medication should be based on the individual patient's symptoms, prostate size, and medical history 3, 6.
- Patients with diabetes mellitus and the elderly may benefit from tamsulosin, which does not interfere with concomitant antihypertensive therapy 4.
- The potential for side effects, such as ejaculatory dysfunction and hypotensive effects, should be considered when choosing an alternative medication 4, 5.