BPH Drug Chart
α1-antagonists
Drug
1st generation
Phenoxybenzamine
2nd generation
Alfuzosin (Uroxatral®)
Doxazosin (Cardura®/Cardura XL®)
Terazosin (Hytrin®)
Prazosin (Minipress®)
3rd generation
Tamsulosin (Flomax®)
Silodosin (Rapaflo®)
5-α-Reductase Inhibitors
Drug
Finasteride (Proscar®)
Dutasteride 9Avodart®)
preventing the binding of NE to the α1-receptors on the prostate, urethra and bladder neck:
- Relaxation of prostate stromal/smooth muscle cells ► less strain on prostatic urethra ► less obstruction of urethra
- Relaxation of the prostatic urethra
- Relaxation of the bladder neck
Dose ADRs
• tiredness
• dizziness
• impaired ejaculation
• nasal congestion
• hypotension (+ reflex
tachycardia)
• Orthostatic hypotension
• Dizziness/headache
• First dose syncope
0.4mg PO Qdaily, up to • Fatigue
0.8mg/day if no resolution of • Ejaculatory dysfunction
symptoms within 2 weeks of • Nasal congestion
initiation • Flu-like symptoms
• ↑ risk for complications with
8mg cataract surgery = floppy iris
syndrome
Blockade of 5-α-reductase enzyme to inhibit conversion of testosterone to DHT
Dose ADRs
5mg PO QD • Ejaculation disorders
• Erectile dysfunction (5-9%)/↓
libido
0.5mg PO QD • Gynecomastia
• Nausea, abdominal pain,
flatulence
• Rash (finasteride only)
• High grade prostate cancer
CI
- Severe hepatic
insufficiency
- Severe sulfa allergy
(tamsulosin only)
- Use with strong CYP 3A4
inhibitors (tamsulosin &
silodosin only)
- CAD/angina
- Volume depletion
- Cardiac arrhythmias
- Multiple antihypertensives
- Orthostatic hypotension
*** if pt has these symptoms
better to use 3rd generation
CI
• Hepatic dysfunction
(caution)
• No blood donations for 6
months upon
discontinuation of drug
• Pregnancy Category X
Monitoring Parameters Considerations
• Symptom improvement
• BP and HR checks at every visit
not FDA-approved for BPH symptoms and
is not recommended by the AUA due to
CV adverse effects
Monitoring Parameters Considerations
• Obtain baseline PSA & DRE - finasteride – Type II only
• ↓ PSA levels by 50% - Best used in patients with LUTS and
• Follow up with PSA in 3 enlarged prostates (>40 grams)
months, then PSA & DRE - Adequate trial is 6-12 months
annually
- If PSA has not ↓ by
50% at 3-6 months,
evaluate for prostate
cancer