Section 15. Urology

Nonselective α-Adrenergic Antagonists

Alfuzosin (Uroxatral)

10 mg QD

1 week

• 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

Doxazosin (Cardura)

1–8 mg QD

2–6 weeks

Doxazosin GTS (Cardura XL)

4–8 mg QD

1 week

Prazosin (Minipress)

0.5–2 mg BID

2–6 weeks

Terazosin (Hytrin)

1–10 mg QD

2–6 weeks

Selective α-Adrenergic Antagonists

Silodosin (Rapaflo)

8 mg QD

1 week

• Tamsulosin and silodosin have low incidence of cardiovascular side effects
• Common side effects include flu-like illness, fatigue, nasal congestion, and ejaculatory dysfunction

Tamsulosin (Flomax)

0.4–0.8 mg QD

1 week

5α-Reductase Inhibitors

Dutasteride (Avodart)

0.5 mg QD

3–6 months

• 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)

Finasteride (Proscar)

5 mg QD

3–6 months

Antimuscarinic Agents

Darifenacin (Enablex)

Urge 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 and gel and solifenacin
• Patients with dementia taking ...