Benign Prostatic Hyperplasia Treatments

BENIGN PROSTATIC HYPERPLASIA TREATMENTS
Generic	Brand	Strength	Form	Dose	Note
5 ALPHA-REDUCTASE INHIBITORS¹
dutasteride	Avodart	0.5mg	caps	Monotherapy: 0.5mg once daily. Combination: 0.5mg once daily with tamsulosin 0.4mg once daily.	• Swallow whole • Inhibits type I (liver, skin) and II (genitourinary) 5 alpha-reductase • >90% suppression of baseline serum DHT
finasteride	Proscar	5mg	tabs	Monotherapy: 5mg once daily. Combination: 5mg once daily with doxazosin.	• Inhibits type II (genitourinary) 5 alpha-reductase • 70% suppression of baseline serum DHT
ALPHA₁-BLOCKERS^2,3
alfuzosin	Uroxatral	10mg	ext‑rel tabs	10mg once daily	• Swallow whole • Take with food and the same meal each day
doxazosin	Cardura	1mg, 2mg, 4mg, 8mg	scored tabs	Initially 1mg daily; may double dose every 1−2wks; max 8mg daily
doxazosin	Cardura XL	4mg, 8mg	ext‑rel tabs	Initially 4mg daily; may titrate after 3−4wks; max 8mg daily	• Swallow whole • Take with breakfast
silodosin	Rapaflo	4mg, 8mg	caps	8mg once daily	• Take with a meal • Renal impairment (CrCl 30−50mL/min): 4mg
tamsulosin	Flomax	0.4mg	caps	Initially 0.4mg daily; may increase to 0.8mg daily after 2−4wks	• Swallow whole • Take ½ hr after same meal each day
terazosin	—	1mg, 2mg, 5mg, 10mg	caps	Initially 1mg once daily. Titrate to 10mg once daily; usual max 20mg/day. Reevaluate if no response after 6wks.	• Give at bedtime
PHOSPHODIESTERASE TYPE 5 INHIBITOR²
tadalafil	Cialis³	2.5mg, 5mg, 10mg, 20mg	tabs	Monotherapy: 5mg once daily at the same time each day. Combination: 5mg once daily with finasteride for up to 26wks.	• Also indicated for erectile dysfunction + BPH: take without regard to timing of sexual activity. • Moderate renal dysfunction (CrCl 30−50mL/min): Initially 2.5mg, may increase to 5mg. • Concomitant potent CYP3A4 inhibitors: max 2.5mg. • Not recommended for CrCl <30mL/min, hemodialysis, or severe hepatic impairment. Caution in mild or moderate hepatic impairment.
TYPE I and II 5 ALPHA-REDUCTASE INHIBITORS¹ & ALPHA₁‑BLOCKER^2,3
dutasteride + tamsulosin	Jalyn	0.5mg + 0.4mg	caps	1 cap once daily	• Swallow whole • Take ½ hr after same meal each day
TYPE II 5 ALPHA-REDUCTASE INHIBITOR¹ + PHOSPHODIESTERASE TYPE 5 INHIBITOR
finasteride/ tadalafil	Entadfi³	5mg/5mg	caps	1 cap once daily at the same time each day for up to 26wks	• Take on empty stomach
NOTES
* These strengths are not indicated for use in BPH. ¹ 5AR inhibitors lower prostate specific antigen (PSA) levels in a predictable fashion, adjust interpretation of PSA levels accordingly. ² α₁-blockers may cause orthostatic hypotension; titrate dose slowly. When therapy has been interrupted for several days or longer, patients should be retitrated from the initial dose. Symptomatic hypotension can occur with concomitant α1-blockers and PDE5 inhibitors. ³ Although rare, priapism and subsequent permanent impotence has been associated with use and patients should be fully informed of this risk. Not an inclusive list of medications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 1/2024)

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