How to take tamsulosin (alpha-blocker) and finasteride (5-alpha-reductase inhibitor) together for Benign Prostatic Hyperplasia (BPH)?

How to Take Tamsulosin and Finasteride Together for BPH

For men with BPH and prostate enlargement, tamsulosin 0.4mg should be taken once daily approximately 30 minutes after the same meal each day, while finasteride 5mg should be taken once daily at any time, with or without food. 1, 2

Medication Administration

• Tamsulosin 0.4mg should be taken approximately 30 minutes following the same meal each day to ensure consistent absorption 1
• Tamsulosin capsules should not be crushed, chewed, or opened 1
• Finasteride 5mg can be taken once daily at any time, with or without food 2
• Both medications can be taken together or at different times during the day 3

Dosage Considerations

• The standard dose of tamsulosin is 0.4mg once daily, which can be increased to 0.8mg once daily if there is inadequate response after 2-4 weeks 1, 4
• Finasteride is prescribed at a fixed dose of 5mg once daily 2
• If tamsulosin therapy is interrupted for several days, restart at the 0.4mg dose rather than the 0.8mg dose 1

Combination Therapy Benefits

• Combination therapy with tamsulosin and finasteride is specifically indicated for patients with demonstrable prostatic enlargement (prostate volume >30cc, PSA >1.5ng/mL, or palpable prostate enlargement on DRE) 3
• The combination provides better symptom improvement than either medication alone for men with moderate-to-severe LUTS due to BPH with prostatic enlargement 5
• Combination therapy significantly reduces the risk of BPH clinical progression, acute urinary retention, and need for BPH-related surgery compared to monotherapy 5

Expected Timeframe for Effects

• Tamsulosin provides relatively rapid symptom relief, typically within 1-2 weeks 6
• Finasteride works more slowly, with maximum benefits often not seen until after 3-6 months of continuous use 6, 7
• Combination therapy shows progressive improvement over time, with significant benefits at 3 months and increasing benefits at 6 months and beyond 7, 5

Monitoring and Follow-up

• Patients should be monitored for symptom improvement using standardized measures such as the International Prostate Symptom Score (IPSS) 7
• Post-void residual (PVR) should be obtained before starting treatment and monitored at follow-up visits, especially when using combination therapy 3
• PSA levels should be monitored, noting that finasteride reduces PSA by approximately 50% after 6 months of treatment 3

Potential Side Effects

• Common side effects of tamsulosin include dizziness, headache, and ejaculatory dysfunction 4
• Finasteride may cause sexual side effects including decreased libido, erectile dysfunction, and ejaculation disorders 2
• Combination therapy may have higher rates of sexual side effects than either medication alone 7, 8
• Tamsulosin has less effect on blood pressure than other alpha blockers, making it safer for elderly patients 4

Special Considerations

• If cataract or glaucoma surgery is planned, inform the ophthalmologist about tamsulosin use due to risk of Intraoperative Floppy Iris Syndrome 3
• Finasteride should not be handled by pregnant women or women who may become pregnant due to potential risks to male fetuses 2
• Combination therapy should be continued long-term for sustained benefits in reducing BPH progression 5