Treatments for BPH
Drugs and Medications For BPH
Medically reviewed by Dr. J. Kellogg Parsons M.D
If you and your doctor have decided you are not going to follow a “watch and wait” approach, he may suggest you treat the symptoms of your enlarged prostate with one or more of the following medications. Before you run off to the pharmacy to fill the prescription, it’s a good idea to understand the different drug options you have, what they are designed to do, and which side effects you may experience. Drugs and medications for BPH can relieve symptoms, but they cannot cure the disease.
What Drugs and Medications for BPH Are Used to Treat Enlarged Prostate?
Drugs and medications for BPH treatment fall into the following categories:
- Alpha-blockers relax the muscles in the prostate and the neck of the bladder so that urine flows more easily
- 5-alpha reductase inhibitors slow the growth of the prostate and cause it to shrink by altering the actions of certain male hormones
- The phosphodiesterase 5 inhibitor tadalafil (Cialis) can be used to treat erectile dysfunction as well as BPH
- Anticholinergics are often prescribed along with alpha-blockers
- Combination therapy includes (thus far) one drug (Jayln) that is a combination of tamsulosin and dutasteride
What Should You Know about Alpha-Blockers?
Alpha-blockers are often prescribed for men who have moderate to severe BPH symptoms. Although these drugs will do nothing to slow, reverse, or stop enlargement of your prostate, they can provide symptom relief. Drugs in this category include alfuzosin hydrochloride (Uroxatral), silodosin (Rapaflo), tamsulosin hydrochloride (Flomax), and terazosin (Hytrin).
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).
What Should You Know about 5-alpha Reductase Inhibitors?
The 5-alpha reductase inhibitors block 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. These drugs (which include dutasteride [Avodart] and finasteride [Proscar]) are usually prescribed for men who have mild to moderate symptoms and whose prostates are not greatly enlarged.
If you are hoping for immediate results, 5-alpha reductase inhibitors are not the answer you are looking for. You cannot expect any noticeable results until you’ve taken the drug for at least six months.
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 also can make your breasts get larger, as well as cause erectile difficulties and reduce your sex drive. Both dutasteride and finasteride have been associated with a slight increased risk of high-grade prostate cancer and cardiac failure.
What Should You Know about Phosphodiesterase 5 Inhibitors?
For now, the only phosphodiesterase 5 inhibitor approved by the FDA for treatment of an enlarged prostate is tadalafil (Cialis), which was originally approved for erectile dysfunction treatment. 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. Typically you can expect to notice BPH symptom improvement within 2 to 4 weeks of starting treatment.
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.
What Should You Know about Anticholinergics?
Anticholinergics 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 when treated with alpha-blockers. Therefore your doctor may prescribe anticholinergics along with alpha-blockers if you are not getting sufficient symptom relief.
The two anticholinergics prescribed to treat an enlarged prostate are oxybutynin (Ditropan) and tolteridine (Detrol). You should know there is a risk of developing acute urinary retention when taking these drugs for BPH. Other side effects may include blurry vision, constipation, dizziness, dry eyes, dry mouth, headache, indigestion, stomach pain, and urinary tract infection.
What Should You Know about Combination Therapy?
Currently, the only FDA-approved combination therapy for BPH is Jalyn, which is composed of dutasteride, a 5-alpha reductase inhibitor; and tamsulosin hydrochloride, an alpha-blocker. Dutasteride helps reduce the size of the prostate while tamsulosin works by relaxing muscles in the prostate and bladder.
Common side effects include dizziness, drowsiness, ejaculation problems, reduction in the amount of semen/sperm, erectile dysfunction, lightheadedness, runny or stuffy nose, increased breast size, backache, diarrhea, weakness, headache, and breast tenderness.