Related guidance: Lower urinary tract symptoms in men: management Clinical guideline (CG97 May 2010 updated June 2015)

Urinary retention due to benign prostatic Hyperplasia

The recommended treatment of benign prostatic hyperplasia is usually an alpha-adrenoceptor blocker. The alpha1-selective adrenoceptor blockers relax smooth muscle in benign prostatic hyperplasia producing an increase in urinary flow-rate and an improvement in obstructive symptoms.

In patients with an enlarged prostate, a raised prostate specific antigen concentration, and who are considered to be at high risk of progression (such as the elderly), a 5α-reductase inhibitor (such as finasteride or dutasteride) should be used. A combination of an alpha-adrenoceptor blocker and a 5α-reductase inhibitor can be offered if symptoms remain a problem. See 5α-reductase inhibitor in formulary.

Lower urinary tract symptoms in men patient information by The British Association of Urological Surgeons

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Doxazosin immediate release
4mg tablets: £0.95 (28)

Doxazosin prolonged release should NOT be initiated. Please prescribe immediate release.
Doxazosin is also licenced for Hypertension. See Cardiovascular system in formulary.
Second line:Tamsulosin MR capsules
400mcg m/r capsules: £1.13 (30)
Tamsulosin MR tablets are not included in the formulary due to cost
Alpha-blocker and 5α-reductase inhibitor Tamsulosin 400 mcg and Dutasteride 500 mcg capsules400mcg and 500mcg capsules: £2.03 (30)
Phosphodiesterase type-5 inhibitorsTadalafil 5mg tablets5mg tablets: £2.20 (28)