From the Guidelines
Finasteride plus tamsulosin should be used as combination therapy for long-term management of non-neurogenic male lower urinary tract symptoms, despite a higher rate of adverse events compared to monotherapy. The combination of finasteride and tamsulosin has been shown to be more effective than tamsulosin monotherapy, with an absolute risk reduction of 7.7% 1. This combination therapy is recommended for long-term use, as it targets different aspects of the condition, with finasteride reducing prostate size over time and tamsulosin providing immediate symptom relief by relaxing smooth muscle in the prostate and bladder neck. Some key points to consider when using this combination therapy include:
- The typical dosing is finasteride 5mg once daily and tamsulosin 0.4mg once daily, taken together for long-term management
- The adverse events observed during combination treatment are typical of alpha-1 blockers and 5-alpha reductase inhibitors, and include a higher rate of adverse events compared to monotherapy 1
- Patients should be aware of potential side effects, including sexual dysfunction from finasteride and dizziness, retrograde ejaculation, or orthostatic hypotension from tamsulosin
- Regular follow-up with a healthcare provider is necessary to monitor symptom improvement and potential side effects.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Finasteride plus Tamsulosin Combination Therapy
- The combination of finasteride and tamsulosin has been studied in the context of benign prostatic hyperplasia (BPH) treatment 2, 3.
- Finasteride, a 5-alpha-reductase inhibitor, reduces dihydrotestosterone levels, leading to decreased prostate volume and improved urinary flow rates 4.
- Tamsulosin, an alpha-1-adrenergic receptor antagonist, helps to relax the muscles in the prostate and bladder neck, improving urine flow 5, 6.
- Studies have shown that combination therapy with finasteride and tamsulosin can be more effective than monotherapy with either drug alone in improving lower urinary tract symptoms (LUTS) and reducing the risk of disease progression 5, 2, 3.
Efficacy and Safety
- The CombAT trial demonstrated that dutasteride (a 5-alpha-reductase inhibitor) plus tamsulosin was more effective than either drug alone in reducing LUTS and improving health-related quality of life 5.
- A review of combination therapy in BPH patients found that the greatest efficacy was evident in patients with an enlarged prostate, more severe symptoms, and higher PSA levels 2.
- The combination of tadalafil (a phosphodiesterase-5 inhibitor) and finasteride has also been shown to be effective in improving LUTS and sexual function in BPH patients 6.
- Combination therapy with alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors has been found to be safe and well-tolerated, with a side-effect profile similar to that of monotherapy 3.
Comparison with Other Treatments
- Finasteride has been compared to serenoa repens (Permixon) and found to have greater efficacy in improving LUTS and reducing prostate volume 4.
- Combination therapy with finasteride and tamsulosin has been found to be more effective than monotherapy with either drug alone in improving LUTS and reducing the risk of disease progression 5, 2, 3.
- The cost-effectiveness of combination therapy has also been evaluated, with one study finding that finasteride and terazosin were less expensive than transurethral resection of the prostate (TURP) during the first 2 years of initiation 4.