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Medications for Benign Prostatic Hyperplasia (BPH)

The information provided here is meant to give you a general idea about each of the medications 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 medications 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 medications 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 work to relax bladder contractions.

Prescription medications

Alpha1-adrenergic Blockers

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

Dihydrotestosterone Reducers

  • Finasteride (Proscar)
  • Dutasteride (Avodart)

Antimuscarinics

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

Phosphodiesterase-5 enzyme inhibitor

  • Tadalafil (Cialis)

Combination medications

  • 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.

These drugs are generally well-tolerated. The most common side effects are headache, fatigue, and lightheadedness. 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 blockers, 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 lightheadedness. Alfuzosin (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 medications 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 medications 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 by 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 medication that is often prescribed to treat the symptoms of erectile dysfunction , also known as impotence. The Food and Drug Administration (FDA) has recently approved Tadalafil as a treatment for BPH, as well. The medication 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, 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 medications, notably antihistamines and sleeping pills that contain alpha-adrenergic products, and several kinds of prescription medications can cause a worsening of urine flow. These medications can even lead to complete urinary obstruction in patients with BPH. Read labels carefully and check with your physician before you take any new medications or supplements.

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

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

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

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

  • Take your medication 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 medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

Revision Information

  • Benign prostatic hypertrophy (BPH). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 25, 2013. Accessed August 22, 2013.

  • BPH. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement. Updated March 23, 2012. Accessed August 22, 2013.

  • 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.

  • Marks LS, Gittelman MC, et al. 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):2634-2640. Epub 2009 Apr 16.

  • Medical Management of BPH. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=1. Updated January 2011. Accessed August 22, 2013.

  • Roehrborn CG, Siami P, 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):123-131. Epub 2009 Sep 19.

  • 1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Tacklind J, Fink H, et al. Finasteride for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2010;(10):CD006015.

  • 10/14/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: 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.