Related guidance:
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 Lower urinary tract symptoms in men patient information by The British Association of Urological Surgeons.
See NHS Somerset formulary Drugs for erectile dysfunction for Phosphodiesterase type-5 inhibitors in the treatment of benigh prostatic hyperplasia.
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Alpha-adrenoceptor blockers | |||
| Doxazosin | 1mg tablet: £0.78 | First line for lower urinary tract symptoms in men as per traffic light guidance. Benign prostatic hyperplasia: The recommended initial dosage of Doxazosin is 1mg given once daily to minimise the potential for postural hypotension and/or syncope. Depending on the individual patient's urodynamics and BPH symptomatology dosage may then be increased to 2 mg and thereafter to 4 mg and up to the maximum recommended dose of 8 mg. The recommended titration interval is 1-2 weeks. The usual recommended dose is 2-4 mg daily. Doxazosin prolonged release should NOT be initiated. Please prescribe immediate release. Doxazosin is also licenced for Hypertension. See Cardiovascular system in formulary. |
|
| 2mg tablet: £0.80 | |||
| 4mg tablet: £0.91 | |||
| Tamsulosin | 400mcg modified-release capsule: £1.16 (30) | Second line for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia, take one daily. Tamsulosin tablets are not cost effective |
|
| Alfuzosin as Fuzatal XL® | 10mg modified-release tablet: £12.76 (30) | ||
| 5α-reductase inhibitor | |||
| Finasteride | 5mg tablet: £1.58 | For the treatment and control of benign prostatic hyperplasia in patients with an enlarged prostate to cause regression of the enlarged prostate, improve urinary flow and improve the symptoms associated with benign prostatic hyperplasia, take one tablet daily. |
|
| Alpha-adrenoceptor blocker and 5α-reductase inhibitor | |||
| Tamsulosin and dutasteride | 400mcg and 500mcg capsule: £3.73 (30) | Treatment of moderate to severe symptoms of benign prostatic hyperplasia, take one once daily as per traffic light guidance. Prescribing combination packs reduces carbon footprint.  |
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