Therapeutic Class Overview Benign Prostatic Hyperplasia (BPH) Treatments

Therapeutic Class  Overview/Summary: The agents approved for the treatment of signs and symptoms of benign prostatic hyperplasia (BPH) will be the focus of this review. The α-adrenergic blockers including, alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin, reduce smooth-muscle tone in the prostate and bladder neck decreasing lower urinary tract symptoms (LUTS) secondary to BPH. Alfuzosin, silodosin and tamsulosin are selective to the α-adrenergic receptors located in the prostate and therefore are only Food and Drug Administration (FDA) approved for BPH, whereas doxazosin and terazosin also inhibit α-adrenergic receptors found in the vascular smooth muscle and are additionally indicated for hypertension.1-6 The 5-α reductase inhibitors, dutasteride and finasteride, act by blocking the conversion of testosterone to dihydrotestosterone and in turn suppress the growth of the prostate. making them appropriate treatment options for LUTS associated with overall prostatic enlargement.7,8 Jalyn® (dutasteride/tamsulosin) is a combination of both an α-adrenergic blocker and a 5-α reductase inhibitors.9 The final drug approved for use in BPH is the phosphodiesterase-5 inhibitor, tadalafil. The exact mechanism for reducing BPH symptoms is unknown.10 Note that even though doxazosin and terazosin are FDA-approved for use in the treatment of hypertension, tadalafil is FDA-approved for use in the treatment of erectile dysfunction and pulmonary arterial hypertension, and finasteride is FDA-approved for alopecia, they are not included in this review. Jalyn® (dutasteride/tamsulosin) is a combination of both an α-adrenergic blocker and a 5-α reductase inhibitors.9 Another drug approved for use in BPH is the phosphodiesterase-5 inhibitor, tadalafil. The exact mechanism for reducing BPH symptoms is unknown.10 Although doxazosin and terazosin are FDA-approved for use in the treatment of hypertension, tadalafil is FDA-approved for use in the treatment of erectile dysfunction and pulmonary arterial hypertension, and finasteride is FDA-approved for alopecia, they are not included in this review.