Choosing the Right BPH Treatment for Your Patients

Determining the right medication to prescribe for benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) can be a challenge, given the variety of pharmaceutical treatments available and potential adverse reactions. While BPH is not fatal, the condition can have a major impact on quality of life, due to heightened frequency of urination, urgency, and nocturia — and can even result in renal complications if left untreated. Choosing the right treatment is paramount to effectively address problematic symptoms and lower the risk of side effects. With more than half of men 50 years and older needing treatment for BPH, physicians should leverage a tailored therapeutic approach to successfully meet both patient and clinical needs.¹

Evaluating Treatment Options: A Clinical Comparison

Managing BPH requires a nuanced clinical approach, recognizing the complex relationship between symptom severity, prostate size, and individual patient factors and health goals. The most common medications used to treat BPH include:

1. Dutasteride
   As a 5-alpha-reductase inhibitor, dutasteride blocks the conversion of testosterone to dihydrotestosterone (DHT) to reduce prostate volume.¹ Compared to finasteride, another 5-alpha-reductase inhibitor, dutasteride administers a more powerful inhibition effect by targeting both type I and type II isoenzymes of 5-alpha-reductase.2 Due to the greater potency, dutasteride is ideal for patients with larger prostates and/or at higher risk of disease progression. Potential side effects of dutasteride include erectile dysfunction, decreased libido, and breast tissue enlargement.¹
2. Finasteride
   Finasteride is a 5-alpha-reductase inhibitor that only targets the type II isoenzyme.² As a result, finasteride does not suppress DHT production or, subsequently, reduce prostate size as significantly as dutasteride. As such, finasteride is suitable for patients with mild to moderate BPH symptoms and can even be effective for those with a smaller prostate size. The side effects of finasteride are similar to dutasteride but often less severe, especially sexual dysfunction and breast tissue enlargement.¹
3. Silodosin
   The selective alpha-1 blocker silodosin treats BPH by inducing smooth muscle relaxation in the prostate and bladder neck.¹ Silodosin has a very strong affinity for alpha-1a adrenergic receptors and, as a result, effectively minimizes the cardiovascular side effects associated with other alpha-1 blockers, including hypotension, weakness, and dizziness.¹ Silodosin is highly effective in treating voiding symptoms but is known to cause retrograde ejaculation, dizziness, and nasal congestion.¹
4. Tamsulosin
   Tamsulosin is an alternative alpha-1 blocker used to reduce prostate volume in patients with BPH. However, tamsulosin has a lower affinity for alpha-1a adrenergic receptors than silodosin, thereby increasing the risk of postural hypotension due to vasodilation in smooth muscle and endothelial cells.¹ Despite the increased cardiovascular effects, tamsulosin may be a more favorable choice for men who wish to avoid retrograde ejaculation — a common side effect of silodosin.1 Tamsulosin is also associated with a higher risk of intraoperative floppy iris syndrome (IFIS), which may impact treatment decisions for patients seeking cataract surgery.¹
5. Tadalafil
   Originally developed to treat erectile dysfunction, tadalafil is a phosphodiesterase type 5 inhibitor that is FDA approved to manage BPH — and may be the ideal treatment for patients struggling with both conditions. Tadalafil prevents the breakdown of cyclic guanosine monophosphate (cGMP), prolonging the action of nitric oxide, a vasodilation mediator that relaxes the smooth muscle in both the ureter and prostate.³ Phosphodiesterase type 5 inhibitors are known to cause indigestion, headache, and back pain, with headache being the most common side effect of tadalafil.¹

Help Patients Access The Right Treatment at Affordable Prices

Selecting the most appropriate treatment is just the first step to helping patients manage their BPH. If patients can’t consistently afford their medication, their condition may worsen and further impact their quality of life. With MediSuite, physicians can provide BPH treatments at the most affordable prices available to ensure the best possible treatment outcomes. MediSuite patients not only access competitively low prices but also benefit from fast and easy refills, prompt shipping, and discreet home delivery. Learn more about how MediSuite can help your patients find relief from BPH by reaching out to our team today.

Sources

1. Yu, Z. J., Yan, H. L., Xu, F. H., Chao, H. C., Deng, L. H., Xu, X. D., Huang, J. B., & Zeng, T. (2020). Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia. Frontiers in pharmacology, 11, 658.
2. Li, Y., Ma, J., Qin, X. H., & Hu, C. Y. (2022). The efficacy and safety of dutasteride and finasteride in patients with benign prostatic hyperplasia: a systematic review and meta-analysis. Translational andrology and urology, 11(3), 313–324.
3. Sun, X., Guan, W., Liu, H., Tang, K., Yan, L., Zhang, Y., Zeng, J., Chen, Z., Xu, H., & Ye, Z. (2018). Efficacy and safety of PDE5-Is and α-1 blockers for treating lower ureteric stones or LUTS: a meta-analysis of RCTs. BMC urology, 18(1), 30.