From the Guidelines
5-alpha reductase inhibitors such as finasteride (Proscar) and dutasteride (Avodart) are suitable options for treating BPH without causing hypertension or fluid retention, as they work by blocking testosterone conversion to shrink the prostate. These medications are effective in partially relieving symptoms and reducing the risk of acute urinary retention and the need for BPH-related surgery, as shown in studies such as 1.
Some key points to consider when using these medications include:
- They are most effective in men with enlarged prostates, as noted in 1 and 1
- They can cause sexually related side effects, such as decreased libido, ejaculatory dysfunction, and erectile dysfunction, although these are reversible and uncommon after the first year of therapy, as reported in 1
- They can reduce the size of the prostate, increase peak urinary flow rate, and reduce BPH symptoms, as demonstrated in 1 and 1
In contrast to other classes of medications, such as alpha-blockers and PDE5 inhibitors, 5-alpha reductase inhibitors do not typically cause fluid retention or hypertension, making them a good option for men with these concerns. However, it's essential to weigh the benefits and risks of each medication and consider individual patient factors, such as the presence of hypertension or cardiovascular disease, when making treatment decisions. Always start with the lowest effective dose and monitor for potential side effects, as recommended in 1, 1, and 1.
From the Research
BPH Drugs without Hypertension or Fluid Retention Side Effects
- The studies 2, 3, 4, 5, 6 suggest that 5-alpha reductase inhibitors (5-ARIs) such as finasteride and dutasteride are effective in treating Benign Prostatic Hyperplasia (BPH) without causing hypertension or fluid retention as side effects.
- These drugs work by reducing the serum and intraprostatic concentration of dihydrotestosterone (DHT), which is a key factor in prostate growth, thereby decreasing prostate volume and improving lower urinary tract symptoms (LUTS) and urinary flow rates.
Specific 5-ARIs for BPH Treatment
- Finasteride and dutasteride are the two 5-ARIs currently available for the treatment of BPH, as mentioned in studies 2, 3, 4, 5, 6.
- Both finasteride and dutasteride have been shown to be effective in reducing prostate volume, improving LUTS and urinary flow rates, and reducing the risk of acute urinary retention (AUR) and BPH-related surgery, as reported in studies 2, 4, 6.
- The study 6 compared the efficacy and safety of dutasteride and finasteride in treating men with symptomatic BPH and found that both treatments were similarly effective in reducing prostate volume and improving urinary symptoms.
Safety and Efficacy of 5-ARIs
- The studies 3, 4, 5, 6 demonstrate that 5-ARIs are generally well-tolerated and safe for the treatment of BPH, with no significant difference in adverse events between finasteride and dutasteride.
- The long-term safety and efficacy of finasteride have been established in studies 3, 5, with continuous treatment for up to 3 years showing sustained improvements in LUTS and urinary flow rates.