From the Guidelines
Alfuzosin is the alpha blocker with the fewest ejaculatory side effects for the treatment of benign prostatic hyperplasia (BPH), making it a preferred choice when preserving ejaculatory function is a priority. When considering alpha blockers for BPH, it's essential to weigh the benefits of symptom relief against potential sexual side effects, particularly ejaculatory dysfunction. The choice of alpha blocker should be based on patient age, comorbidities, and different adverse event profiles, including ejaculatory dysfunction and changes in blood pressure 1. Key factors to consider include:
- The selectivity of the medication for alpha-1A receptors, which affects both prostate symptoms and ejaculatory function
- The efficacy of the medication in relieving BPH symptoms, as measured by the International Prostate Symptom Score (IPSS)
- The potential for adverse events, including orthostatic hypotension, dizziness, and nasal congestion, in addition to ejaculatory dysfunction. According to the most recent guidelines, alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin are all effective options for the treatment of BPH, but they differ in their adverse event profiles 1. In particular, tamsulosin and silodosin are associated with higher rates of ejaculatory dysfunction, while alfuzosin, doxazosin, and terazosin have fewer sexual side effects 1. Therefore, when preserving ejaculatory function is a priority, alfuzosin is often considered the best choice, as it provides effective relief of BPH symptoms with minimal sexual side effects.
From the FDA Drug Label
Abnormal ejaculation was associated with Tamsulosin Hydrochloride Capsules administration and was dose-related in the U. S. studies. Withdrawal from these clinical studies of Tamsulosin Hydrochloride Capsules because of abnormal ejaculation was also dose-dependent, with 8 of 492 patients (1.6%) in the 0.8 mg group and no patients in the 0. 4 mg or placebo groups discontinuing treatment due to abnormal ejaculation.
Tamsulosin has the fewest ejaculatory side effects among the alpha blockers, with an incidence of 1.6% in the 0.8 mg group 2.
Table 1. Adverse Reactions Occurring more than 1% More Frequently in BPH Patients Treated with Doxazosin Versus Placebo Doxazosin Placebo REPRODUCTIVE SYSTEM AND BREAST DISORDERS
There is no information about the incidence of ejaculatory side effects for doxazosin in the provided drug label 3.
From the Research
Alpha Blockers for BPH with Fewest Ejaculatory Side Effects
- The alpha blockers alfuzosin and tamsulosin are considered to have a better tolerability profile compared to other alpha blockers, with a lower incidence of vasodilatatory and cardiovascular side effects 4, 5.
- Alfuzosin has been associated with a lower incidence of ejaculatory dysfunction compared to tamsulosin 4, 5, 6.
- A study found that the prevalence of ejaculatory dysfunction in patients with BPH treated with alpha blockers was 82.6%, with alfuzosin having the best sexual function profile among the alpha blockers analyzed 6.
- Silodosin is a highly selective alpha blocker that has been shown to have a favorable cardiovascular safety profile, but it is associated with a high incidence of abnormal ejaculation 7.
- Alfuzosin has been found to be an effective and well-tolerated treatment for LUTS/BPH, with a lower rate of sexual disorders compared to other alpha blockers 8.
Comparison of Alpha Blockers
- Alfuzosin and tamsulosin are considered to be uroselective alpha blockers, with a lower incidence of cardiovascular side effects compared to non-selective alpha blockers like terazosin and doxazosin 5.
- Silodosin is a highly selective alpha blocker that exhibits true selectivity for the alpha 1-adrenoceptor subtypes, which may account for its favorable cardiovascular safety profile 7.
- The choice of alpha blocker should be tailored to the individual patient, taking into account the potential side effects and the patient's medical history 5.