Class
Drug
MoA
Efficacy &
Dose, admin,
Side
Drug Interactions &
Safety, etc.
Cost &
place in Tx
onset
Effects
precautions
conv
α 1Aalfuzosin - relax prostatic - Tx should be 10 mg daily po Vertigo Possible additive
Maximal response seen in weeks.
$
adrenergi Xatral, smooth muscle initiated w/ this, after the same (2%).
hypotension when
c
generics by acting as
if possible.
meal each day
combined with beta
May rarely cause intraoperative floppy
Antagoni
antagonists at
effective in
blockers. Monitor blood iris syndrome. Patients undergoing
sts
α1A receptors
reducing LUTS
pressure.
cataract surgery should inform their
(α 1AAA)
independent of
ophthalmologist if they are or were
prostate
Avoid combination with using an α1-adrenergic antagonist.5
size, has no
potent CYP3A4
effect on PSA,
inhibitors, e.g.,
and are
ketoconazole, ritonavir.
associated with
Excessive hypotension Shown to have a role in management of
less sexual
may occur.
acute urinary retention.
dysfunction
than are 5 α reductase
inhibitors
“”
silodosin
8 mg daily po Diarrhea ↑ silodosin blood levels Maximal response seen in weeks.
$$$
after the same (2.6%), by potent CYP3A4
meal each day. ↓ dizziness inhibitors (e.g.,
May rarely cause intraoperative floppy
Rapaflo
to 4 mg daily in (3.2%), clarithromycin,
iris syndrome. Patients undergoing
patients with
headache itraconazole,
cataract surgery should inform their
moderate renal (2.4%), ketoconazole, ritonavir). ophthalmologist if they are or were
impairment
nasal
No dose adjustment is using an α1-adrenergic antagonist.5
(ClCr 30–50
congestion required if combined
mL/min)
(2.1%), with moderate CYP3A4
orthostatic inhibitors (e.g.,
hypotensio diltiazem). ↑ silodosin Contraindicated in patients with severe
n (2.6%), blood levels when
renal impairment (ClCr <30 mL/min).
retrograde combined with PNot recommended in severe hepatic
Class
“”
Drug
MoA
Efficacy &
place in Tx
tamsulos
in
controlle
d-release
Flomax
CR,
generics
Dose, admin,
onset
Side
Drug Interactions &
Safety, etc.
Effects
precautions
ejaculation glycoprotein inhibitors insufficiency or if also using potent
(28%)
(e.g., cyclosporine).
CYP3A4 inhibitors.
0.4 mg daily po Retrograd No known clinically
at the same time e
significant drug
each day, with or ejaculation interactions.
without food
(5–10%).
Maximal response seen in weeks.
Cost &
conv
$
May rarely cause intraoperative floppy
iris syndrome. Patients undergoing
cataract surgery should inform their
ophthalmologist if they are or were
using an α1-adrenergic antagonist.5
Swallow pills whole; do not crush or
chew.
5αdutasteri Interferes w/ test 1st line for
reductase de
’s stimulatory patients with a
Inhibitor Avodart effect on prostate significantly
enlarged
s
growth by
prostate (>40 g)
(5αRI)
blocking 5αwho can not
reductase (type IItolerate the
5αR converts test cardiovascular
adverse
&
effects of α 1androstenedione adrenergic
=> DHT in
antagonists
prostate,
0.5 mg daily po Sexual
Combination with
Blocks types I and II isoenzymes.
dysfunctio strong CYP3A4
n (3–4%). inhibitors (e.g.,
↓ prostate-specific antigen. Early
ketoconazole, ritonavir) response seen in 6 mo.
may increase serum
concentration of
dutasteride. Monitor for
increased adverse
reactions, e.g.,
impotence, decreased
libido.
$$$
Class
Drug
MoA
Efficacy &
place in Tx
Dose, admin,
onset
Side
Effects
Drug Interactions &
precautions
Safety, etc.
Cost &
conv
genitals, scalp
hair follicles)
“”
finasteri
de
Proscar,
generics
5αRI/
dutasteri
α1AAA de/tamsu
combos losin
modified
release
Jalyn
5 mg daily po
Sexual
No known clinically
dysfunctio significant drug
n (3–4%). interactions.
For patients at
0.5 mg
Breast
Combination with
risk for
dutasteride/ 0.4 disorders strong CYP3A4
developing
mg tamsulosin (1 (1%), ↓ inhibitors (e.g.,
complications of
libido
ketoconazole, ritonavir)
BPH (specifically capsule) po 30
may increase serum
patients with an minutes after the (5%),
enlarged
same meal each dizziness concentration of
prostate gland
day
(1%),
dutasteride. Monitor for
greater than 40 g 6
ejaculation increased adverse
, 17 and an elevated
disorders reactions, e.g.,
PSA ≥1.4 ng/
(8%),
impotence, decreased
mL (1.4 mcg/L))
impotence libido.
(5%). All
are most
pronounce
d within
first 6
months of
treatment.
Blocks type II isoenzyme.
$$
↓ prostate-specific antigen. Early
response seen in 6 mo.
Blocks types I and II isoenzymes.
↓ prostate-specific antigen. Early
response seen in 6 mo.
Maximal response seen in weeks.
May rarely cause intraoperative floppy
iris syndrome. Patients undergoing
cataract surgery should inform their
ophthalmologist if they are or were
using an α1-adrenergic antagonist.5
Swallow pills whole; do not crush or
chew.
$$$
Class
Drug
MoA
Efficacy &
place in Tx
Dose, admin,
onset
Side
Effects
Drug Interactions &
precautions
Safety, etc.
Cost &
conv
Contact with the contents of the
dutasteride soft gelatin capsule
contained within the hard-shell capsule
may irritate the oropharyngeal mucosa.
Indicated for the treatment of moderate
to severe symptomatic benign prostatic
hyperplasia in men with enlarged
prostates.
The clinical benefit
of combination therapy is that it quickly
relieves symptoms, delays
disease progression and reduces the need
for surgical intervention.
α1doxazosi - relax prostatic
adrenergi n
smooth muscle
c
Cardura, by acting as
Antagoni generics antagonists at
sts
α1A receptors
(nonsele
ctive)
(α1AA)
1–12 mg QHS
po
Dizziness, Possible additive
Maximal response seen in weeks.
$-$$
headaches, hypotension when
asthenia combined with betaMay rarely cause intraoperative floppy
and nasal blockers. Monitor blood iris syndrome. Patients undergoing
Dose titrated
congestion pressure.
weekly to
cataract surgery should inform their
desired response (5–20%);
ophthalmologist if they are or were
syncope May precipitate
using an α1-adrenergic antagonist.5
(<1%).
hypotension in
conjunction with
phosphodiesterase type
5 inhibitors (e.g.,
Class
“”
Drug
MoA
Efficacy &
place in Tx
terazosin
Hytrin,
generics
phenoxyben Blocks α1αadrenergi zamine
adrenergic
c
receptors =>
Antagoni
relaxation of
sts
smooth muscle
(nonsele
ctive/1st
gen
αAA)
Leuprolide Blocks pituitary
LH
release of
superago ,
goserelin luteinizing hormone
nists
Dose, admin,
onset
Side
Effects
Drug Interactions &
precautions
sildenafil).
Safety, etc.
1–10 mg QHS
po
Cost &
conv
Dizziness, Possible additive
Maximal response seen in weeks.
$-$$
headaches, hypotension when
asthenia combined with betaMay rarely cause intraoperative floppy
and nasal blockers. Monitor blood iris syndrome. Patients undergoing
Dose titrated
congestion pressure.
weekly to
cataract surgery should inform their
desired response (5–20%);
ophthalmologist if they are or were
syncope May precipitate
using an α1-adrenergic antagonist.5
(<1%).
hypotension in
conjunction with
phosphodiesterase type
5 inhibitors (e.g.,
sildenafil).
Blocks α2 as
well; not very
specific
…
No longer used
due to sides.
Not FDA
approved
antagonism of presynaptic α 2-adrenergic
receptors that results in tachycardia and
arrhythmias
decrease
libido
and can
Class
Drug
MoA
Antiandrog bicalutami Blocks
dihydrotestosterone
ens
de,
flutamide at
Efficacy &
place in Tx
Dose, admin,
onset
“”
its intracellular
receptor
Megestrol
acetate
(Megace
a.
Blocks pituitary
release of
luteinizing hormone
and
blocks androgen
receptor
“”
Cost of 30-day supply; includes drug cost only.
Legend: $ <$25 $-$$ <$25–50 $$ $25–50 $$$ $50–75
Side
Effects
cause
erectile
dysfunction
,
gynecomasti
a, and hot
flashes.
nausea,
diarrhea,
and
hepatotoxic
ity
Drug Interactions &
precautions
Safety, etc.
Cost &
conv