Available Drugs for Treating LUTS

    There are five groups of drugs to help improve lower urinary tract symptoms--LUTS.

    Group 1 is one of alpha-blockers to help relax the urinary sphincter (bladder neck and prostate urethra) like alfuzosin (Uroxatrol),
    doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), tamsulosin (Flomax), or terazosin (Hytrin); If effective, one may see
    urine flow improvement within 1-3 days after taking such drug.

    Group 2 is 5ARIs--5-alpha reductase inhibitors to help shrink the prostate like finasteride (Proscar) or dutasteride (Avodart).

    Group 3 is MRAs--muscarinic receptor antogonist to help suppress the over-activity of bladder muscle (detrusor).

    Group 4 is PDE-5 inhibitors primarily for erectile dysfunction, but somehow proved to help improve LUTS. Among sildenafil, vardenafil,
    and tadalafil, Tadalafil (Cialis) is the only one documented PDE-5 inhibitor to work for erectile dysfunction (ED) as well as for BPH /
    LUTS. But its high cost oftentimes may prohibit its regular use; instead, the combined daily use with one of alpha-blockers and on-
    demand use of one of PDE-5 inhibitors is preferred.

    Group 5 is combination of group 1--alpha-blocker and group 2--5ARI.  At times, the drugs in group 1 and 2 may be selected and used
    together to maximize the effect to improve urine flow and ease voiding symptoms; example - dutasteride + tamsulosin (Jalyn) . If
    working, urine flow may be improved within 1-3 days and optimized in 1-3 months after their combined use.

    If you tolerate these drugs well to help improve urination, make sure to take them indefinitely.

    Despite taking drugs, the voiding symptoms of LUTS may expectedly and slowly worsen because the drugs only help modify how
    bladder and urethra work and would not stop the continual accumulation of undesirable ill effects of aging.

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    Pharmacologic Treatment Options for BPH

    Class             Mechanism of Action      Drug (Brand)          Daily Dose      30-day       Adverse Effects*   
                          (MOA)                                                                (Oral)               AWP($)**
    ----------------------------------------------------------------------------------------------------------------------------------------------------------                                                                                                                                                                                                                   
                                Relax tension in the prostate      Alfuzosin (Uroxatroal)                10 mg             126.41        Erectile dysfunction
    1. Alpha-            smooth muscle by targeting       Doxazosin (Cardura)                1-8 mg               40.46        abnormal ejaculation              
        blockers        alpha-receptors                             Tamsulosin (Flomax)        0.4-0.8 mg             126.41        dizziness, headache                
                                                                                          Terazosin (Hytrin)                   1-10 mg                48.11        orthostatic hypotension           
                                                                                          Silodosin (Rapaflo)                   10 mg              249.47        fatique, infection,
                                                                                                                                                                                               QT interval prolongation,
                                                                                                                                                                                               polydipsia, IFIS
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                              Block the growth of prostate         Dutasteride (Avodart)               0.5 mg               181.50        Libido impairment,
    2. 5-ARIs         cells by targeting the                       Finasteride (Proscar)                 5 mg                  93.80        abnormal ejaculation,
                              5-alpha-reductase enzyme                                                                                                                 erectile dysfunction,
                              and decreasing concentrations                                                                                                         mastalgia, gynecomastia
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                             Decrease bladder smooth             Tolterodine (Detrol)            1-2 mg twice daily   198.55
    3. MRAs          muscle cell contractions by            Tolterodine (Detrol LA)          4 mg                       365.69      Xerostomia (dry mouth)
                             inhibiting muscarinic receptors     Fesoterodine (Toviaz)        4-8 mg                       287.36
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                             Decrease detrusor, prostate,         Tadalafil (Cialis)                         5 mg                   281.74      Back pain, dyspepsia,
    4. PDE-5         and urethra smooth muscle                                                                                                                 flushing, infection,
       inhibitors   tone via increase of                                                                                                                                myalgia, nausea,
                             intracellular cGMP                                                                                                                                  pharyngitis.
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    5.Combined  Combined MOA from 5ARI          Dutasteride-tamsulosin (Jalyn)  0.5 mg/0.4 mg   181.52      See monotherapy
      product      and alpha-blocker (see above)                                                                                                            agent above
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    * Most common adverse effects (>1%) per drug package insert.
    ** Based on least expensive available formulation (brand or generic) pricing for regular-release formulation of initial dosing
       from Lexicomp, calculated to 30-day supply based on per-unit pricing. http://online.lexi.com. Accessed April 23, 2016.
    5ARI: 5-alpha-reductase inhibitor;
    AWP: average wholesale price;
    BPH: benign prostatic hyperplasia;
    cGMP: cyclic guanosine monophosphate;
    DHT: dihydrotestosterone;
    IFIS: intraoperative floppy iris syndrome;
    LA: long-acting;
    MOA: mechanism of action;
    MRA: muscarinic receptor antagonist;
    PDE5: phosphodiesterase 5;
    LUTS: lower urinary tract symptom.