Which medications can help?

Photo of medication
PantherMedia / Daniel Pettersson

Drugs that help to empty the bladder can relieve symptoms caused by an enlarged prostate. They are often used if the symptoms are such a problem that it is hard to get by in everyday life without treatment.

If you have to go to the toilet several times a night and constantly feel the urge to pee during the day too because your bladder no longer fully empties itself, various medications can help.

When deciding whether to take a certain medication, it is always a good idea to talk to your doctor about possible interactions with other drugs. Many older men who develop prostate problems are already taking medication for other conditions – such as high blood pressure (hypertension) or chronic illnesses.

Alpha blockers

Alpha blockers are commonly used in the treatment of enlarged prostate symptoms. They help the bladder to empty properly by relaxing the muscles in the prostate gland and bladder. Because alpha blockers also lower your blood pressure, they are particularly suitable for men who have high blood pressure too.

The alpha blockers that are most commonly used for the treatment of enlarged prostate symptoms are:

  • alfuzosin
  • doxazosin
  • silodosin
  • tamsulosin
  • terazosin

How effective are alpha blockers?

Studies have shown that alpha blockers can relieve the symptoms caused by an enlarged prostate gland:

  • The symptoms improved in about 50 out of 100 men who took a fake medication (placebo),
  • compared to about 70 out of 100 men who took alpha blockers.

In other words, the alpha blockers relieved the symptoms in about 20 out of 100 men.

There is usually a noticeable improvement after several days, and the full effect is reached within a month. But alpha blockers generally don't make the symptoms go away completely. If a man doesn't notice an improvement within eight weeks of starting to use a medication, that medication probably won't ever work in him.

What are the side effects?

Because alpha blockers reduce your blood pressure, they can lead to problems like dizziness too. They may also cause ejaculation problems, reducing the amount of semen released. It is possible to estimate how common these side effects are based on the results of studies:

  • Ejaculation problems: In about 1 out of 100 men overall, and about 20 out of 100 men who are using silodosin.
  • Dizziness: In about 4 out of 100 men.
  • Feeling sluggish and tired: About 2 out of 100 men.
  • Low blood pressure: About 2 out of 100 men.
  • Stuffy and/or runny nose: About 1 out of 100 men.

But these side effects don't necessarily last a long time and aren't always considered to be a big problem. Only 1 out of 100 men in the studies stopped their treatment because of side effects.

To try to avoid side effects when taking doxazosin and terazosin, it is important to start with a low dose, and then gradually increase it.

If men who are taking alpha blockers for their prostate problems are thinking of using erection pills too, they should talk about it with their doctor first because the drugs may interact, causing problems like a drop in blood pressure.

5-alpha reductase inhibitors

These drugs reduce the production of male sex that cause the prostate to grow. As a result, the prostate becomes smaller again, and no longer pushes against the bladder and urethra (the tube which urine passes through) as much.

Two of these medications have been approved for the treatment of benign enlarged prostate in Germany:

  • finasteride
  • dutasteride

In the vast majority of cases, either finasteride is used on its own, or a combination drug containing dutasteride and the alpha blocker tamsulosin is used.

5-alpha reductase inhibitors have been proven to relieve enlarged prostate symptoms. But it takes a very long time for them to start working. It can take several months for the symptoms to improve, and sometimes there is still no noticeable improvement even after a year.

5-alpha reductase inhibitors are a particularly suitable treatment option for men who have a very enlarged prostate gland. They can then reduce the risk of urinary retention (being unable to pee) and the need for surgery.

What are the side effects?

In 2 to 3 out of 100 men, 5-alpha reductase inhibitors cause side effects such as erection problems, ejaculation problems, reduced sexual desire, and tiredness. In 1 out of 100 men, they lead to enlarged mammary glands.

These medications also change the level of "prostate-specific antigens" (PSA) in the blood, also known as the PSA level. For this reason, people who are taking finasteride or dutasteride and have a PSA test must tell their doctor that they are taking it.

How effective is combining drugs?

Alpha blockers and 5-alpha reductase inhibitors are sometimes combined to try to relieve the symptoms as quickly as possible and at the same time prevent the prostate from growing further. This combination is considered for men who have severe symptoms and a very enlarged prostate gland. Their prostate gland is more likely to grow even larger.

Combining these drugs can lower the risk of the symptoms getting worse or complications arising. But these advantages only became apparent after one to two years of treatment, and only in men with very large prostate glands.

The disadvantage: Ejaculation problems and erection problems are more likely in people who use this combination than in people who only use alpha blockers.

Brasure M, MacDonald R, Dahm P, Olson CM, Nelson VA, Fink HA et al. Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Review. May 2016. (AHRQ Comparative Effectiveness Reviews; Volume 178).

Favilla V, Russo GI, Privitera S, Castelli T, Giardina R, Calogero AE et al. Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis. Aging Male 2016; 19(3): 175-181.

National Clinical Guideline Centre. The Management of Lower Urinary Tract Symptoms in Men. 2010. (NICE Clinical Guidelines; Volume 97).

Wu YJ, Dong Q, Liu LR, Wei Q. A meta-analysis of efficacy and safety of the new alpha1A-adrenoceptor-selective antagonist silodosin for treating lower urinary tract symptoms associated with BPH. Prostate Cancer Prostatic Dis 2013; 16(1): 79-84.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on January 25, 2018
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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