prostatic hyperplasia (BPH) is a condition where the prostate enlarges and
compresses the urinary outlet or urethra
. The prostate is a gland in males that surrounds
the upper part of the urethra. Increase in size of the prostate often occurs in
older ages resulting in obstruction to the flow of urine. The patient complains
of symptoms like increased frequency of urination during the day as well as
night, weak or interrupted stream, increased urgency and need to strain to
begin urination. He may feel that he has not emptied his bladder completely
after urinating. Untreated BPH could give rise to complications like repeated
infections, bladder stone formation and kidney damage.
A recent article published in the US Pharmacist
reviewed the use of drugs in treatment of BPH.
According to the authors, treatment
of mild-to moderate BPH can be delayed and the patient observed for some time.
If symptoms progress, the patient should be prescribed drugs
the selective alpha-1 adrenergic
(also known as selective alpha-1 blockers) group. These include alfuzosin, doxazosin,
silodosin, tamsulosin, and terazosin.
These drugs relax the smooth
muscles of the prostate and relieve obstruction.
terazosin could cause a decrease in blood pressure as a side effect. Alfuzosin,
tamsulosin and silodosin have been associated with abnormal ejaculation. All
the drugs from this group cause dizziness. Tamsulosin is associated with a rare
complication during cataract surgery called intraoperative floppy iris
syndrome. The alpha blockers could interact with the patient's current
medications; this should be taken into consideration before prescribing the
symptoms continue to progresses despite treatment with an alpha blocker or the
patient does not tolerate the drug, drugs belonging to 5 - alpha reductase
inhibitor group like dutasteride and finasteride may be added or substituted
. These drugs act at the
level of hormone production and reduce the proliferative action of androgens on
the prostate. They require a longer time to show an effect; thus treatment
should be continued at least for 6 months before reassessing the effect on the
patient. Side effects include decreased libido, decreased semen quantity during
ejaculation, impotence and rarely gynecomastia or development of breasts in
Good results have been noted when alpha blockers
have been combined with 5-alpha reductase inhibitors to treat BPH.
indicate that tolterodine belonging to the anticholinergic group of drugs
provides good results when used in combination with alpha blockers
. This drug acts by relaxing
the bladder and thus reducing spasm. It causes side effects like dry mouth and
Though complementary and alternative medicine (CAM)
remedies are not recommended, one product called saw palmetto has shown some promise
in initial studies. Further studies are required to establish its role in BPH.
The costs of treatment which includes the costs of
the medications as well as managing the side effects of the drugs should also
be taken into consideration before a patient is prescribed a drug for BPH.
1. Knezevich EL, Knezevich JT, Spangler ML. Benign Prostatic Hyperplasia
and the Medication Management of Associated Lower Urinary Tract Symptoms. US
Pharm. 2011; 36(6):20-24.