Benign Prostatic Hyperplasia (BPH) Treatments

BENIGN PROSTATIC HYPERPLASIA TREATMENTS
 
Generic Brand Form Strength Dose Note
5α-REDUCTASE (5AR) INHIBITORS1
dutasteride Avodart caps 0.5mg 0.5mg once daily • Inhibits type I (liver, skin) and II (genitourinary) 5AR  • >90% suppression of baseline serum DHT
finasteride Proscar tabs 5mg 5mg once daily • Inhibits type II (genitourinary) 5AR  • 70% suppression of baseline serum DHT
α1-BLOCKERS2,3
alfuzosin Uroxatral extended-release tabs 10mg 10mg daily • Swallow whole  • Take after meal  • Dose titration not needed
doxazosin Cardura scored tabs 1mg, 2mg, 4mg, 8mg Initially 1mg daily; may double dose every 1–2wks; max 8mg daily  
Cardura XL extended-release tabs 4mg, 8mg Initially 4mg daily; may titrate after 3–4wks; max 8mg daily • Swallow whole  • Take with breakfast
silodosin Rapaflo caps 4mg, 8mg 8mg once daily • Take with a meal  • Renal impairment (CrCl 30–50mL/min): 4mg
tamsulosin Flomax caps 0.4mg Initially 0.4mg daily; may increase to 0.8mg daily after 2–4wks • Swallow whole  • Take ½ hr after same meal each day
terazosin Hytrin caps 1mg, 2mg, 5mg, 10mg Initially 1mg daily; max 20mg daily • Give at bedtime
COMBINATION 5AR INHIBITORS1 & α1-BLOCKERS2,3
dutasteride +
tamsulosin		 Jalyn caps 0.5mg +
0.4mg		 1 cap once daily • Swallow whole  • Take ½ hr after same meal each day
PDE-5 INHIBITOR
tadalafil Cialis tabs 2.5mg, 5mg, 10mg*, 20mg* 5mg taken at approximately the same time every day • Also indicated for erectile dysfunction + BPH: take without regard to timing of sexual activity.  • Moderate renal dysfunction (CrCl 30–50mL/min): Initially 2.5mg, may increase to 5mg.  • Severe renal dysfunction (CrCl <30mL/min): not recommended.  • Mild or moderate hepatic impairment: use caution; severe: not recommended.  • Concomitant alpha blockers: not recommended.  • Concomitant potent CYP3A4 inhibitors: max 2.5mg.
NOTES

* These strengths are not indicated for use in BPH.

15AR inhibitors lower prostate specific antigen (PSA) levels in a predictable fashion, adjust interpretation of PSA levels accordingly.

2α1-blockers may cause orthostatic hypotension; titrate dose slowly. When therapy has been interrupted for several days or longer, patients should be retitrated from the initial dose.

3Although rare, priapism and subsequent permanent impotence has been associated with the use of α1-blockers and patients should be fully informed of this risk.

Not an inclusive list of medications. Please see drug monograph at the CTA Drug Database and/or contact company for full drug labeling.

(Rev. 9/2013)

This article originally appeared on MPR