From the Guidelines
Alternatives to Flomax (tamsulosin) include other alpha-blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), terazosin (Hytrin), and silodosin (Rapaflo), as recommended by the American Urological Association in 2021 1. These medications work similarly to tamsulosin by relaxing muscles in the prostate and bladder neck, improving urine flow in men with benign prostatic hyperplasia (BPH).
- The typical starting dose for alfuzosin is 10 mg once daily
- doxazosin 1 mg daily (gradually increased if needed)
- terazosin 1 mg at bedtime (also gradually increased)
- and silodosin 8 mg once daily. 5-alpha reductase inhibitors like finasteride (Proscar) and dutasteride (Avodart) are another class of medications that can treat BPH by shrinking the prostate, though they work more slowly over months, and should be offered as a treatment option only 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. For milder symptoms, some patients try saw palmetto or other plant extracts, though scientific evidence for these is limited. The best alternative depends on your specific health conditions, other medications, and side effect profile, so consult with your healthcare provider before switching from Flomax to ensure the alternative is appropriate for your situation. When prescribing an alpha blocker for the treatment of LUTS/BPH, the choice of alpha blocker should be based on patient age and comorbidities, and different adverse event profiles (eg, ejaculatory dysfunction [EjD], changes in blood pressure) 1.
From the Research
Alternatives to Flomax (Tamsulosin)
The following alternatives to Flomax (tamsulosin) are available for the treatment of benign prostatic hyperplasia (BPH):
- Alfuzosin (Xatral) 2, 3, 4, 5
- Silodosin (Rapaflo) 2
- Terazosin 3, 4, 5
- Doxazosin 3, 4, 5
- Prazosin 3
- Finasteride (Proscar) 2, 3
- Dutasteride (Avodart) 2
- Tadalafil (once daily 5 mg) 2
Mechanism of Action
These alternatives work through different mechanisms, including:
- Alpha blockers: relax smooth muscle in the prostate and bladder neck, enhancing bladder emptying 2, 3, 4, 5, 6
- 5-alpha reductase inhibitors: shrink prostate stroma, resulting in improved voiding 2, 3
- Phosphodiesterase-5 (PDE-5) inhibitors: improve BPH-related symptoms 2
Efficacy and Safety
The efficacy and safety of these alternatives have been evaluated in various studies:
- Alpha blockers: comparable effectiveness, with differences in adverse event profiles 4, 5
- 5-alpha reductase inhibitors: effective in reducing prostate size and improving voiding symptoms, with fewer adverse effects than other antiandrogen therapies 3
- PDE-5 inhibitors: improve BPH-related symptoms, with a favorable safety profile 2