What medications are appropriate for Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

Alpha-blockers, 5-alpha reductase inhibitors, and combination therapy are the most effective treatment options for Benign Prostatic Hyperplasia (BPH), with the choice of medication depending on symptom severity, prostate size, and patient comorbidities. When considering treatment options, it is essential to weigh the benefits and risks of each medication. Alpha-blockers, such as tamsulosin (0.4 mg daily), alfuzosin (10 mg daily), doxazosin (1-8 mg daily), and terazosin (1-10 mg daily), are first-line options that relax prostate smooth muscle to improve urine flow, with effects typically noticeable within days to weeks 1. 5-alpha reductase inhibitors, such as finasteride (5 mg daily) and dutasteride (0.5 mg daily), shrink the prostate by blocking testosterone conversion to DHT, but require 3-6 months for full effect and work best for larger prostates (>40g) 2. Combination therapy with an alpha-blocker plus a 5-alpha reductase inhibitor is often more effective than either medication alone for moderate to severe symptoms or larger prostates, particularly in patients with a prostate volume of >30cc on imaging, a PSA >1.5ng/mL, or palpable prostate enlargement on DRE 2. Some key points to consider when selecting a treatment option include:

• The patient's symptom severity and prostate size
• The potential side effects of each medication, such as dizziness and ejaculatory problems with alpha-blockers, and reduced libido and erectile dysfunction with 5-alpha reductase inhibitors
• The patient's comorbidities and medical history
• The cost and availability of each medication It is also important to note that anticholinergic agents and beta-3-agonists may be used in combination with alpha-blockers for patients with moderate to severe storage LUTS, but should be used cautiously in men with significant obstruction 2. Overall, the treatment of BPH should be individualized to each patient's specific needs and circumstances, taking into account the latest evidence and guidelines 2, 1.

From the FDA Drug Label

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.

UROXATRAL is a prescription medicine that is called an "alpha-blocker". UROXATRAL is used in adult men to treat the symptoms of benign prostatic hyperplasia (BPH). UROXATRAL may help to relax the muscles in the prostate and the bladder which may lessen the symptoms of BPH and improve urine flow

The recommended dose of tadalafil tablets for once daily use is 5 mg, taken at approximately the same time every day, for Benign Prostatic Hyperplasia

Medications for BPH:

• Finasteride 3
• Alfuzosin (UROXATRAL) 4
• Tadalafil 5

These medications are used to treat the symptoms of Benign Prostatic Hyperplasia (BPH) in men. Finasteride and Tadalafil can be used to improve symptoms, while Alfuzosin is an alpha-blocker that helps relax the muscles in the prostate and bladder. Tadalafil can also be used for once daily use for BPH.

From the Research

Medications for Benign Prostatic Hyperplasia (BPH)

The following medications are appropriate for the treatment of 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 6
• 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 6, 7
• 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 6, 8, 9, 10

Combination Therapy

Combination therapy with alpha(1)-adrenergic receptor antagonists (alpha(1)-ARAs) and 5alpha-reductase inhibitors (5ARIs) has been shown to be effective in reducing BPH-related symptoms and lowering the rate of clinical progression 8, 9, 10

• The combination of doxazosin and finasteride was significantly more effective than either component alone in reducing symptoms and clinical progression 8
• The combination of tamsulosin and dutasteride resulted in a significantly greater decrease in International Prostate Symptom Score (IPSS) when compared with either monotherapy 9, 10

Patient Selection

The greatest efficacy for combination therapy was shown in patients with:

• Larger prostate size 8, 9, 10
• More severe symptoms 8, 9
• Higher prostate-specific antigen (PSA) levels 8