Figure 15.1.1 Treatment Algorithm for BPH
Reproduced with permission from Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC. Benign Prostatic Hyperplasia. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: McGraw-Hill; 2011:chap 93
Table 15.1.2 Pharmacotherapy for BPH |Favorite Table|Download (.pdf)
Table 15.1.2 Pharmacotherapy for BPH
Nonselective α-Adrenergic Antagonists
10 mg QD
- Orthostatic hypotension, syncope and dizziness common with doxazosin, prazosin and terazosin; in particular with the first few doses; 10% of patients will stop taking due to side effects (Int J Clin Pract. 2008;62:1547); start with low dose and titrate up as tolerated over the course of 4–6 weeks
- Prazosin not recommended due to more side effects (J Urol. 2003;170:530)
- Alfuzosin has a low incidence of cardiovascular side effects due to its low serum and high prostate concentration; dose titration is not needed
- These agents will not effect PSA, prostate size, or alter disease progression
1–8 mg QD
Doxazosin GTS (Cardura XL)
4–8 mg QD
0.5–2 mg BID
1–10 mg QD
Selective α-Adrenergic Antagonists
8 mg QD
- Tamsulosin and silodosin have low incidence of cardiovascular side effects
- Common side effects include flu-like illness, fatigue, nasal congestion, and ejaculatory dysfunction
0.4–0.8 mg QD
0.5 mg QD
- Sexual side effects occur in approximately 10% of patients and include erectile dysfunction, ejaculatory dysfunction, and decreased libido
- Will reduce prostate size and PSA; measured PSA should be doubled to reflect true value in patients taking these agents (J Urol. 2003;170:530)
- Finasteride and dutasteride reduced prostate cancer incidence by ˜25% over 7 and 4 years, respectively (N Engl J Med. 2003;349:215; N Engl J Med. 2010;362:1192)
5 mg QD
Table 15.2.1 Pharmacotherapy of Urinary Incontinence |Favorite Table|Download (.pdf)
Table 15.2.1 Pharmacotherapy of Urinary Incontinence
7.5–15 mg QD
- Antimuscarinics are first-line therapy for urge incontinence
- A systematic review of comparative trials found that tolterodine IR was better tolerated than oxybutynin IR; solifenacin and fesoterodine had better efficacy than tolteridine XR, but fesoterodine had higher incidence of adverse effects (Cochrane Database Syst Rev. 2012;1:CD005429)
- Dry mouth, constipation, dizziness, and visual disturbances are common, highest incidence with oxybutynin IR and tolterodine IR, lowest incidence with oxybutynin patch ...
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