Management
- Non-pharmacologic management:
- Avoid fluids before bedtime or going out
- Decrease caffeine and alcohol intake
- Double voiding to empty the bladder more completely
- First-line medications are alpha-1 blockers
- Tamsulosin 0.4 mg p.o. daily, 30 minutes after a meal
- Can be increased to 0.8 mg p.o. daily if no response after 2 to 4 weeks
- Silodosin 8 mg p.o. daily
- Alfuzosin 10 mg p.o. daily
- Second-line medications include:
- 5-alpha-reductase inhibitors (5-ARIs):
- PDE-5 inhibitors: tadalafil 5 mg p.o. daily
- Beta-3 adrenergic agonists: mirabegron 25 mg p.o daily, can increase to 50 mg after 4 weeks
- Anticholinergics:
- Tolterodine IR 1 to 2 mg p.o. twice daily or ER 2 to 4 mg p.o. daily
- Oxybutynin IR 5 mg p.o. bid to tid, or ER 5 to 10 mg p.o. daily
- Solifenacin 5 mg p.o. daily, can increase to 10 mg after 2 weeks
