Benign prostatic hypertrophy

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):
    • Dutasteride 0.5 mg p.o. daily
    • Finasteride 5 mg p.o. daily
  • 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