From the Guidelines
Alternative medications for silodosin include tamsulosin, alfuzosin, doxazosin, and terazosin, which are all alpha-1 blockers that work by relaxing smooth muscles in the prostate and bladder neck to improve urinary symptoms in men with benign prostatic hyperplasia (BPH). These medications are suitable alternatives when silodosin causes intolerable side effects, is ineffective, or unavailable due to cost or supply issues 1.
Key Considerations
- Tamsulosin (0.4 mg daily) is often considered the first alternative due to its similar selectivity for prostate tissue and once-daily dosing.
- Alfuzosin (10 mg daily) is another option with potentially fewer ejaculatory side effects.
- Doxazosin (starting at 1 mg daily, titrated up to 4-8 mg) and terazosin (starting at 1 mg, titrated up to 5-10 mg) are older options that require dose titration and may cause more blood pressure effects.
Switching Medications
When switching from silodosin, allow a washout period of 24-48 hours before starting the new medication to avoid additive effects.
Evidence-Based Recommendations
The American Urological Association (AUA) guidelines recommend offering one of the following alpha blockers as a treatment option for patients with bothersome, moderate to severe LUTS/BPH: alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin 1.
Patient-Specific Factors
The choice of alpha blocker should be based on patient age and comorbidities, and different adverse event profiles (e.g., ejaculatory dysfunction, changes in blood pressure) 1.
Additional Considerations
It is essential to consider the potential side effects and interactions of each medication, as well as the patient's individual needs and medical history, when selecting an alternative to silodosin.
From the Research
Alternate Medication for Silodosin
The following alpha-blockers can be considered as alternate medications for silodosin:
5alpha-Reductase Inhibitors
Additionally, 5alpha-reductase inhibitors can also be used as an alternate treatment for benign prostatic hyperplasia (BPH), including:
Combination Therapy
Combination therapy with an alpha-blocker and a 5alpha-reductase inhibitor may be beneficial for patients who require immediate relief of symptoms 2, 3.