BPH Medication: Combination Therapy

BPH Medication: Combination Therapy 645d52cd219b5.png

BPH Medication: Combination Therapy

Of all of the medication-based treatments for an enlarged prostate, there is evidence to suggest that combination therapy of alpha-blockers and 5-alpha reductase inhibitors, is the most effective.

Alpha-blockers are medicines that are used to relax muscle tissue thereby helping to relieve pressure and urinary symptoms associated with an enlarged prostate, such as tamsulosin (Flomax) or terazosin (Hytrin).

While 5-Alpha Reductase Inhibitors such as dutasteride (Avodart) and finasteride (Proscar), are medications that can shrink the prostate.

One study, in particular, found that the combination therapy of alpha-blockers and 5-alpha reductase inhibitors reduced the risk of urinary retention and the need for prostate surgery by 66% when compared to the impact of the alpha-blocker tamsulosin alone.

Using a combination of alpha-blockers and 5-alpha reductase inhibitors in the treatment of an enlarged prostate has shown promising results, however, it is not without its own set of side effects and risks.

According to a meta-analysis study published in the medical journal Aging Male, entitled “Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: A systematic review with meta-analysis,” the overall prevalence of erectile dysfunction and reduced libido was found to be significantly greater for men treated with the combination therapy of alpha-blockers and 5-alpha reductase inhibitors.

In fact, they found that combination therapy not only increased the risk of erectile dysfunction significantly, compared to the prevalence of this side effect during monotherapy with just alpha blockers or 5-alpha inhibitors- but they also found that combination therapy resulted in more reported cases of reduced libido than monotherapy.

Other potential side effects of these medications are:

Dizziness, headache, and fatigue (most common)
Decrease in sex drive
Erectile dysfunction
Retrograde ejaculation
Decreased volume of ejaculate
Dry mouth, stuffy nose, and swelling of the ankles
Breast disorders (painful or enlarged breasts)
Low blood pressure

Both alpha-blockers and 5-alpha reductase inhibitors have their side effects, as well as their benefits.

The primary benefit of alpha-blockers is that they offer quick relief from BPH symptoms – usually in days to weeks. Whereas with 5-alpha reductase inhibitors, a benefit is that they can shrink the prostate and potentially avoid the need for prostate surgery, however, it can take anywhere from three to six months to experience any signs of improvement.

Even though combination therapy shows more promising results in the treatment of BPH, alpha-blockers are still the most commonly prescribed treatment. However, alpha-blockers are only effective in the short term, and symptoms will most likely return once the medication is stopped.

For men that wish to avoid taking medication for an enlarged prostate due to the risks and side effects of these drugs, they may wish to explore the option of a non-invasive surgical procedure that we specialize in here at MidAtlantic Vascular and Interventional called Prostate Artery Embolization.

In our next article, we will take a look at what the research says about the efficacy of Prostate Artery Embolization and compare it to the efficacy of medication therapy in the treatment of benign prostate hyperplasia.

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