Medications for an Enlarged Prostate: Treatment Options

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Medications for an Enlarged Prostate: Treatment Options

By Your Health Magazine Health Information Team

The main medications for an enlarged prostate are alpha blockers, 5-alpha reductase inhibitors, and tadalafil. Alpha blockers usually provide faster relief by relaxing muscles around the prostate and bladder outlet. Five-alpha reductase inhibitors gradually shrink the prostate, while tadalafil can improve urinary symptoms and erectile dysfunction. The best enlarged prostate medication depends on symptom severity, prostate size, other health conditions, and potential side effects.

How Enlarged Prostate Medicines Compare

Benign prostatic hyperplasia, or BPH, can cause a weak urine stream, difficulty starting urination, incomplete bladder emptying, urgency, frequent urination, and nighttime bathroom trips. Medication may help when symptoms are bothersome but do not require a procedure.

Alpha Blockers for Faster Symptom Relief

Alpha blockers are commonly prescribed when the immediate goal is to improve urine flow. These drugs relax smooth muscle in the prostate and bladder neck, reducing resistance as urine leaves the bladder. They do not make the prostate smaller or prevent it from continuing to grow.

Common drugs for an enlarged prostate in this class include tamsulosin, alfuzosin, silodosin, doxazosin, and terazosin. Their side-effect profiles differ. Possible effects include dizziness, lightheadedness when standing, low blood pressure, fatigue, nasal congestion, and changes in ejaculation. Doxazosin and terazosin generally have more effect on blood pressure than prostate-selective options.

Anyone taking or considering tamsulosin should tell an ophthalmologist before cataract or glaucoma surgery, even if the medicine was used in the past. Its official prescribing information describes an eye-surgery complication known as intraoperative floppy iris syndrome. People with balance problems, low blood pressure, or a history of falls should also discuss these issues with their prescriber.

Medicines That Gradually Shrink the Prostate

Finasteride and dutasteride are 5-alpha reductase inhibitors. They reduce the production of dihydrotestosterone, a hormone involved in prostate growth. These medicines are generally most useful when the prostate is demonstrably enlarged rather than when urinary symptoms are primarily caused by bladder dysfunction.

Unlike alpha blockers, these medications work gradually. Improvement may take three to six months or longer. Over time, they may improve urine flow and reduce the likelihood of acute urinary retention or the need for BPH surgery in appropriately selected patients.

Possible side effects include reduced sexual desire, erectile difficulties, decreased semen volume, and ejaculation problems. These drugs also lower prostate-specific antigen, or PSA. A clinician needs to account for that effect when interpreting PSA test results. Prostate cancer and BPH can occur together, so new urinary symptoms should be evaluated rather than assumed to be benign.

Finasteride and dutasteride are not interchangeable with every similarly named product. Finasteride is marketed in different strengths and indications for BPH and hair loss, while dutasteride is also available in a combination prescription containing tamsulosin. Patients can use MedlinePlus drug information to review the active ingredient and patient safety information for a specific prescription.

Tadalafil for BPH and Erectile Dysfunction

Tadalafil is a phosphodiesterase-5 inhibitor that can treat urinary symptoms associated with BPH. It may be particularly relevant when a person has both bothersome urinary symptoms and erectile dysfunction. Tadalafil improves symptoms but does not substantially shrink the prostate.

Potential side effects include headache, indigestion, flushing, nasal congestion, muscle aches, back pain, and low blood pressure. Tadalafil must not be taken with nitrate medicines, including nitroglycerin and isosorbide, because the combination can cause a dangerous blood pressure drop. Its current DailyMed prescribing information also warns about interactions with certain blood pressure medicines and alpha blockers.

A prescriber should review cardiovascular health and all prescription, nonprescription, and recreational substances before selecting tadalafil. Patients should not combine tadalafil with an alpha blocker or change either medicine without medical guidance.

Combination Treatment and Bladder-Directed Medicines

For someone with bothersome symptoms and a clearly enlarged prostate, a clinician may prescribe an alpha blocker together with finasteride or dutasteride. The alpha blocker may provide earlier relief while the 5-alpha reductase inhibitor works gradually. Combination therapy can produce more side effects, so follow-up is important.

Some people continue to experience urgency, frequent urination, or urge leakage even after treatment of the prostate outlet. After checking how well the bladder empties, a urologist may consider:

• Antimuscarinic medicines, such as solifenacin, tolterodine, or oxybutynin. Possible effects include dry mouth, constipation, blurred vision, confusion, and urinary retention.
• Beta-3 agonists, such as mirabegron or vibegron. These relax the bladder muscle but may not be appropriate for everyone; blood pressure and medication interactions may require review.

These are medicines for bladder symptoms, not drugs that shrink an enlarged prostate. They require careful selection when a person already has difficulty emptying the bladder.

Are Over-the-Counter BPH Medicines Effective?

Dietary supplements are often marketed as medicine for an enlarged prostate, but they are not equivalent to FDA-approved prescription drugs. Saw palmetto is one of the best-known ingredients. However, the National Center for Complementary and Integrative Health reports that saw palmetto alone probably provides little or no benefit for BPH symptoms.

Supplement ingredients and concentrations can vary, and herbal products may interact with medications. Readers considering nonprescription products can learn more about natural alternatives to Flomax and over-the-counter options, but should discuss supplements with a clinician or pharmacist.

Some over-the-counter cold and allergy products can actually worsen urination. Decongestants and certain antihistamines may tighten the bladder outlet or make bladder emptying more difficult. Check product labels and ask a pharmacist before using them if you have BPH or urinary retention.

Choosing the Right BPH Medicine

A primary care clinician or urologist may consider several factors before recommending BPH medicine:

• The most troublesome urinary symptoms
• Prostate size and evidence of blockage
• How well the bladder empties
• Blood pressure, fall risk, and cardiovascular health
• Erectile or ejaculation concerns
• PSA results and prostate cancer risk
• Kidney or liver function
• Planned cataract or glaucoma surgery
• Other prescriptions, supplements, and nonprescription products

Medication is not always necessary for mild symptoms, and medicine is not the only treatment. Minimally invasive procedures or surgery may be considered when symptoms remain severe, complications develop, or medication is ineffective or poorly tolerated.

When to Seek Care

Arrange an evaluation for new, persistent, or worsening urinary symptoms. Seek prompt medical care for blood in the urine, painful urination, recurrent urinary infections, significant lower abdominal discomfort, or urinary symptoms accompanied by fever and chills. Being completely unable to urinate is an emergency and requires immediate treatment.

This information is for general education and does not replace an evaluation by a qualified healthcare professional. Do not start, stop, combine, or change a prescription BPH medication without guidance from the prescribing clinician.