Drugs for BPH (Enlarged Prostate)

The following medications may be prescribed for BPH (otherwise known as benign prostatic hyperplasia or “enlarged prostate”) depending on the severity of your symptoms:

Alpha-blockers:

These drugs (see Medications for BPH) work by relaxing the muscles in the prostate and the neck of the bladder so that urine flows more easily. Alpha-blockers are usually prescribed for men who have moderate to severe symptoms. These drugs do nothing to stop, slow, or reverse prostate enlargement, but you can get relief from symptoms. Side effects include fatigue, dizziness, fainting, headache, nasal congestion, and retrograde ejaculation (when the semen moves into the bladder during ejaculation instead of out of the urethra). Although alpha-blockers generally do not cause erectile dysfunction or low libido, these side effects have been reported in some cases.

5-alpha reductase inhibitors:

These drugs (see Medications for BPH) can slow the growth of the prostate and may even cause it to shrink by blocking the conversion of testosterone to dihydrotestosterone, which may result in a reduction in the size of the prostate by up to 20 percent after six months of treatment. The 5-alpha reductase inhibitors are usually prescribed for men who have mild to moderate symptoms and whose prostates are not greatly enlarged. These drugs typically do not produce any noticeable results until you have taken them for six months or longer.  The 5-alpha reductase inhibitors may stop your prostate from growing larger, but they may not reduce your symptoms because the size of the prostate does not determine the severity of symptoms. In addition, while these drugs may stop your prostate from growing, they may also make your breasts get larger, as well as cause erectile difficulties and reduce your sex drive. More on hormones and prostate health

See also:

Drugs that can cause Erectile Dysfunction

BPH Drugs May Cause Erectile Dysfunction

Finasteride (Proscar) May Reduce Libido, Cause Erectile Dysfunction

Can Finasteride and Dutasteride Prevent Prostate Cancer?

FDA Issues Prostate Cancer Warning on Jalyn, Avodart, Propecia and Proscar

FDA Requires Labeling on Proscar Warning of Sexual Side Effects

Phosphodiesterase Inhibitor (Cialis)

Use of Cialis (tadalafil), a phosphodiesterase 5 inhibitor originally approved by the Food and Drug Administration (FDA) for erectile dysfunction treatment, was approved for BPH treatment (benign prostatic hyperplasia) in October 2011. Studies of men with BPH revealed that those who took 5 mg of tadalafil once daily had a statistically significant improvement in BPH symptoms compared with men who took a placebo. Among men who suffered with both BPH and erectile dysfunction, 5 mg daily of tadalafil improved erectile dysfunction and symptoms of BPH compared with men who took a placebo.

Men who take tadalafil/Cialis for BPH should not also take alpha blockers because the drug combination has not been studied adequately, and there is a risk of lowering blood pressure.

See also

FDA Approves Cialis for Treatment of BPH

Anticholinergics:

Anticholinergics (see Medications for BPH) are a class of drugs that can help with urge incontinence, frequency or urgency, all symptoms of an overactive bladder that are not always reduced significantly with alpha-blockers. Therefore some doctors will prescribe anticholinergics along with alpha-blockers to achieve better symptom control. Anticholinergics should be prescribed with caution in men who have an enlarged prostate, however, because there is a risk of developing acute urinary retention when these drugs are taken. Side effects may include blurry vision, constipation, dizziness, dry eyes, dry mouth, headache, indigestion, stomach pain, and urinary tract infection.

CAUTION:

If you are taking drugs for erectile dysfunction (Cialis, Levitra, Viagra), you need to be cautious before taking some medications for BPH. For example, the combination of alpha-blockers and drugs for erectile dysfunction can result in abnormally low blood pressure (hypotension). The recommendation from the manufacturer and distributors is that you should not take Viagra within four hours of taking an alpha-blocker, that you should not use Levitra if you are using alpha-blockers, and that you can use Cialis along with only one alpha-blocker: Flomax, the 0.4-mg dose only. No studies show negative interactions between erectile dysfunction drugs and the 5-alpha-reductase inhibitors. Always consult your doctor about all your medications and fully disclose all treatments so that the appropriate medical advice can be received from a medical professional.

What About Combination BPH Drug Treatment?

For men who decide to use medication for their BPH symptoms, combination treatment may be an option. The results of a four-year study (CombAT, or Combination of Avodart and Tamsulosin) found that while use of either Avodart (dutasteride) or tamsulosin (Flomax) alone provided symptom relief, men who took a combination of the two BPH drugs experienced even better results.  Based on the results of the CombAT study, the Food and Drug Administration (FDA) has approved Jalyn, a single drug that combines both dutasteride and tamsulosin.

In the CombAT study, researchers evaluated 4,844 men 50 years or older who had moderate to severe BPH. The men were assigned to one of three treatment groups: dutasteride alone, tamsulosin alone, or the two drugs combined. Men who took the combination therapy reported fewer symptoms than men in the other two treatment groups, and the investigators also found that the combination therapy reduced prostate volume by 25 percent. Specifically, when compared with tamsulosin alone, combination treatment reduced acute urinary retention by 67 percent and the need for BPH-related surgery by 70 percent. Men with BPH now have a single treatment option, Jalyn, that combines the benefits of two drugs known to be effective in treating BPH, tamsulosin and dutasteride.

All therapy regimens employed in the study appear to be generally well-tolerated. The profile of events for combination therapy was consistent with those reported for monotherapies. The most common adverse events for combination therapy were erectile dysfunction (7.4%), retrograde ejaculation (4.2%) and altered or decreased libido (3.4%). The most common adverse events for Avodart monotherapy were erectile dysfunction (6.0%), altered or decreased libido (2.8%) and breast enlargement (1.8%), while the most common adverse events for tamsulosin monotherapy were erectile dysfunction (3.8%), altered or decreased libido (1.7%) and dizziness (1.7%).

See also

Jalyn Approved for Treatment of BPH

BPH Drugs May Contribute to Sexual Dysfunction

BPH Drug Dutasteride (Avodart) and Prostate Cancer

GSK no longer seeking approvals for Avodart for prostate cancer treatment

Can Finasteride and Dutasteride Prevent Prostate Cancer?

Reference

Roehrborn CG et al. Effect of dutasteride on prostate biopsy rates and the diagnosis of prostate cancer in men with lower urinary tract symptoms and enlarged prostates in the combination of Avodart and tamsulosin trial. Eur Urol 2010 Nov 4

Roehrborn C et al. Safety and tolerability of dutasteride, tamsulosin and a combination of dutasteride and tamsulosin: Two-year results from the Combination of Avodart(R) and Tamsulosin (CombAT) study. Societe Internationale d’Urologie, 2007, Paris, France.