Medications for Benign Prostatic Hyperplasia (BPH)

Main Page | Risk Factors | Symptoms | Diagnosis | Treatment | Screening | Reducing Your Risk | Talking to Your Doctor | Living With BPH | Resource Guide

En Español (Spanish Version)

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

A couple of medicines are available to treat less advanced cases of BPH. One type relaxes the smooth muscle in the prostate; the other kind decreases the amount of hormone stimulating prostate growth. Symptoms of BPH can also be relieved by antimuscarinics, a group of drugs that works to relax bladder contractions.

Prescription Medicines

Alpha1-adrenergic Blockers

  • Prazosin (Minipress)
  • Doxazosin (Cardura)
  • Terazosin (Hytrin)
  • Tamsulosin (Flomax)
  • Alfuzosin (Uroxatral)
  • Silodosin (Rapaflo)

Dihydrotestosterone Reducers

  • Finasteride (Proscar)
  • Dutasteride (Avodart)

Antimusarinics

  • Oxybutynin (Ditropan, Oxytrol)
  • Solifenacin (Vesicare)
  • Tolterodine (Detrol)
  • Darifenacin (Enablex)
  • Trospium (Sanctura)
  • Fesoterodine (Toviaz)

Phosphodiesterase-5 enzyme inhibitor

  • Tadalafil (Cialis)

Combination Medicines

  • Dutasteride and tamsulosin (Jalyn)

Alpha1-adrenergic Blockers

  • Prazosin (Minipress)
  • Doxazosin (Cardura)
  • Terazosin (Hytrin)
  • Tamsulosin (Flomax)
  • Alfuzosin (Uroxatral)
  • Silodosin (Rapaflo)

Prazosin, doxazosin, and terazosin were developed to treat high blood pressure. However, the same effect that lowers blood pressure lowers the tension in the muscular valve at the bottom of the bladder, making it easier to pass urine. Over two-thirds of patients with BPH who take these drugs experience rapid improvement in their symptoms without negative effects on their blood pressure.

These drugs are generally well-tolerated. The most common side effects are headache, fatigue, and dizziness. A "first dose" effect may occur that causes blood pressure to drop, which may result in fainting. For this reason, it is recommended that the first pill be taken at bedtime.

There are two different alpha-adrenergic systems, one for the blood pressure and one for the bladder. Tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo), types of alpha-adrenergic blocker, are specifically targeted at the bladder and prostate. Therefore, they are less likely to cause low blood pressure or fainting, although these adverse effects can still occur. Other side effects include runny nose, abnormal ejaculation, fatigue, and dizziness. Alfuzonsin (Uroxatral) has been reported to be associated with less risk of abnormal ejaculation. Silodosin (Rapaflo) also works selectively on the bladder and prostate.

Dihydrotestosterone Reducers

  • Finasteride (Proscar)
  • Dutasteride (Avodart)

Finasteride (Proscar) and dutasteride (Avodart) prevent the formation of the male hormone dihydrotestosterone, which is responsible for the growth of the prostate. These medicines may reduce your symptoms and improve your ability to urinate. Finasteride may also reduce your risk of needing surgery.

Side effects for both of these medicines include changes in your sexual ability or desire and breast enlargement.

Antimuscarinics

  • Oxybutynin (Ditropan, Oxytrol)
  • Solifenacin (Vesicare)
  • Tolterodine (Detrol)
  • Darifenacin (Enablex)
  • Trospium (Sanctura)
  • Fesoterodine (Toviaz)

These drugs work be reducing the strength of bladder contractions. They may relieve symptoms of urgency and frequency. Side effects include dry mouth, constipation , dry eyes, and confusion. They may also cause increased difficulty emptying the bladder in some patients.

Phosphodiesterase-5 Enzyme Inhibitor

Tadalafil [Cialis]

Tadalafil is a medicine that is often prescribed to treat the symptoms of erectile dysfunction (impotence). The Food and Drug Administration (FDA) has recently approved tadalafil as a treatment for BPH, as well. The medicine can reduce symptoms, like difficulty starting to urinate, weak urination stream, and the urge to urinate frequently.

Potential side effects of tadalafil include flushing, headache, stomach upset, back pain, and congestion.

Note: You should not take tadalafil if you are also taking nitrates (eg, nitroglycerin) because your blood pressure may become dangerously low. Also, tadalafil should not be taken in combination with alpha-blockers.

Combination Therapy

Research has shown that using alpha-blockers with dihydrotestosterone reducers may work better than using either drug alone in men with larger prostates. This type of therapy, called combination therapy, can decrease the development of complications and the need for surgical intervention. For instance, Jalyn is a medication that contains both tamsulosin and dutasteride, a 5-alpha reductase inhibitor.

Special Considerations

Certain over-the-counter medicines, notably antihistamines and sleeping pills that contain alpha-adrenergic products, and several kinds of prescription medicine (anticholinergic and narcotic) can cause a worsening of urine flow. These medicines can even lead to complete urinary obstruction in patients with BPH. Read labels carefully and check with your physician before you take any new medicines or supplements.

A special precaution is issued for the use of alpha-blockers with medicines used to treat erectile dysfunction. These medicines include:

  • Tadalafil (Cialis)
  • Sildenafil (Viagra)
  • Vardenafil (Levitra)

When taken together, these medicines may cause a drop in blood pressure.

Whenever you are taking a prescription medicine, take the following precautions:

  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what results and side effects to expect. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you do notrun out.

References:

BPH. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 27, 2012. Accessed September 14, 2012.

Greco KA, McVary KT. The role of combination medical therapy in benign prostatic hyperplasia. Int J Impot Res . 2008 Dec;20 Suppl 3:S33-43.

Dutasteride. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 30, 2011. Accessed September 14, 2012.

Finasteride. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 30, 2011. Accessed September 14, 2012.

Tadalafil. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated June 28, 2010. Accessed September 14, 2012.

Marks LS, Gittelman MC, Hill LA, Volinn W, Hoel G. Rapid efficacy of the highly selective alpha1A-adrenoceptor antagonist silodosin in men with signs and symptoms of benign prostatic hyperplasia: pooled results of 2 phase 3 studies. J Urol . 2009 Jun;181(6):2634-40. Epub 2009 Apr 16.

Medical Management of BPH. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=09&topic=101 . Updated January 2011. Accessed September 14, 2012.

BPH. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/#treatment . Updated March 23, 2012. Accessed September 14, 2012.

Roehrborn CG, Siami P, Barkin J, et al; CombAT Study Group. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol . 2010 Jan;57(1):123-31. Epub 2009 Sep 19.

Tadalafil. PubMed Health website. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000252/ . Accessed September 14, 2012.

1/4/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Tacklind J, Fink H, MacDonald R, Rutks I, Wilt T. Finasteride for benign prostatic hyperplasia. Cochrane Database Syst Rev . 2010;(10):CD006015.

10/14/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. FDA approves Cialis to treat benign prostatic hyperplasia. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm . Updated October 6, 2011. Accessed October 14, 2011.



Last reviewed September 2012 by Adrienne Carmack, MD


Last updated Updated: 09/27/2012

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.