Alpha blockers--specifically selective alpha blockers such as tamsulosin (Flomax) and alfuzosin (Uroxatral)--have become the front-line treatments for many people with benign prostatic hyperplasia (BPH), or enlarged prostate, according to Eric Klein, M.D., head of the Section of Urologic Oncology at The Cleveland Clinic's Glickman Urologic Institute. However, since BPH and prostate cancer share symptoms, your doctor should evaluate you for prostate cancer before prescribing any BPH medication.
BPH, more common with advancing age, occurs when the prostate enlarges and affects the flow of urine from the bladder. Selective alpha blockers specifically relax the smooth muscles in the bladder neck and prostate to improve urinary flow. Nonselective alpha blockers--doxazosin (Cardura) and terazosin (Hytrin)--relax not only the prostate muscles but also muscles surrounding blood vessels, and they double as treatments for high blood pressure (hypertension).
The alpha blockers work quickly, and most BPH patients see improvements in symptoms within a few days with the selective alpha blockers and within days to weeks with the nonselective versions. For patients with more serious BPH symptoms and selected patients with urinary retention, doctors may prescribe an alpha blocker in combination with a 5-alpha reductase inhibitor--dutasteride (Avodart) or finasteride (Proscar)--which shrinks the enlarged prostate.
SIDE EFFECTS AND PRECAUTIONS
The most common side effects of alpha blockers are nasal congestion, dizziness and ejaculation problems.
In some patients, use of the nonselective alpha blockers may dramatically reduce blood pressure (hypotension), especially after starting treatment, and increase the risk of fainting (syncope) and falls. To negate the effects of dizziness, Dr. Klein recommends that his patients take alpha blockers at bedtime. You also can take selective alpha blockers after the same meal each day.
Men taking erectile dysfunction drugs such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) should use alpha blockers with caution, as the combination may trigger hypotension. Use of cimetidine (Tagamet) may increase the levels of alfuzosin and tamsulosin in your system. Patients taking antifungal drugs such as ketoconazole, HIV drugs such as protease inhibitors (Norvir), or other alpha blockers should avoid using alfuzosin. If you suffer from BPH, ask your doctor if an alpha blocker is right for you.
SEEK AN EVALUATION
The symptoms of BPH and prostate cancer are indistinguishable, so Dr Klein recommends that patients with lower urinary tract symptoms undergo a prostate-specific antigen exam (a blood test) and a digital rectal exam to feel for abnormalities in the prostate. "It's the standard of care that if someone comes in with urinary symptoms like that, they should be screened for prostate cancer," he said.
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|Title Annotation:||drug therapy of benign prostatic hyperplasia|
|Publication:||Men's Health Advisor|
|Date:||Aug 1, 2006|
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