Medication for Benign Prostatic Hyperplasia

Medication is recommended for patients diagnosed with benign prostatic hyperplasia (BPH). This treatment is recommended when symptoms are bothersome and affect quality of life.

Several drug groups are used to treat BPH-related symptoms:
Herbal medicines
Alpha-blockers
5-alpha reductase inhibitors (5ARIs)
Muscarinic receptor antagonists (MRAs)
Phosphodiesterase 5 inhibitors (PDE5Is)
Combinations of these drugs
Each drug group works through a different pathway and has different effects and side effects.

Herbal Medicines
Pumpkin seed, South African star grass, African plum and rye pollen are among the drugs in this group. How effective they are is also unclear. Because there are so many herbal medicines, no specific recommendation can be made about their use. You should not use herbal medicines without your doctor's advice.

Alpha-blockers
Alpha-blockers are a group of drugs that improve symptoms and urine flow by relaxing the smooth muscles of the prostate. They are the drug group most frequently recommended for men with BPH.

Alfuzosin, doxazosin, tamsulosin, terazosin and silodosin are among the drugs in this group.

The drugs usually show their full effect within a few weeks. Alpha-blockers do not reduce the size of the prostate or prevent its growth. Some patients will eventually need surgical intervention to relieve their symptoms.

The side effects of alpha-blockers are mild, and most patients do not experience any side effects despite long-term use. Patients who do experience side effects report weakness (asthenia), dizziness and mildly low blood pressure (hypotension).

Alpha-blockers can also cause retrograde ejaculation (semen being ejaculated into the bladder). This is an uncommon side effect and will disappear when treatment is stopped.

5-alpha reductase inhibitors
5-alpha reductase inhibitors (5ARIs) are a group of drugs that prevent the growth of the prostate and can even cause it to shrink. These drugs are more effective if the prostate is larger than 40 milliliters and are prescribed when prostate enlargement causes bothersome symptoms. These drugs can reduce the risk of urinary retention and the need for surgical intervention. Because they take a very long time to improve symptoms, 5ARIs are recommended for treatment lasting longer than 1 year.

There are 2 types of 5ARI, and both give similar results: dutasteride and finasteride
The side effects of these drugs mainly concern sexual function. These include reduced ability to maintain intercourse, erectile dysfunction and ejaculation problems. Side effects are not very common and disappear when treatment is stopped. There is evidence that 5ARI use may increase the risk of prostate cancer. Because of their side effects, 5ARIs are generally recommended for patients with moderate or severe symptoms.

Muscarinic receptor antagonists
Muscarinic receptor antagonists (MRAs) are a group of drugs that reduce abnormal contractions of the bladder. In men, they can help with urgency symptoms caused by BPH. These drugs are generally not prescribed if the bladder cannot empty completely and too much urine remains in the bladder after urination. There are several types of MRA:

Darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine and trospium chloride are among the drugs in this group.

The side effects of MRAs are generally mild. These include dry mouth and eyes, constipation, difficulty urinating, cold-like symptoms, blurred vision and dizziness.

Phosphodiesterase 5 inhibitors
Phosphodiesterase 5 inhibitors (PDE5Is) are drugs used to treat erectile dysfunction. These drugs can also improve symptoms associated with BPH. There are 3 types of PDE5I: sildenafil, tadalafil, vardenafil

In addition to men with erectile dysfunction, men with symptoms of prostate enlargement can also benefit from treatment with PDE5Is.

PDE5Is can cause side effects such as headache, dizziness and indigestion. PDE5Is should not be used with certain alpha-blockers such as doxazosin or terazosin. Their use can also cause serious problems, especially in men with heart problems.

They should not be used by men with uncontrolled blood pressure or kidney failure. If you experience vision loss after using a PDE5I, consult your doctor.

Be sure to consult your doctor about any concerns you have regarding the side effects of PDE5Is and the situations in which they should not be used.

Drug Combinations
Your doctor may recommend a combination of drugs. The most commonly used combinations are:
An alpha-blocker with a 5ARI
An alpha-blocker with an MRA
The aim of these treatments is to combine the benefits of both drugs. When used together, these drugs can be more effective. However, they can often cause more side effects. The side effects of each drug have been mentioned in the previous sections. Combination therapy is recommended for men with moderate or severe symptoms.