Doxazosin in the Treatment of Benign Prostatic Hyperplasia in Normotensive Patients: A Multicenter Study

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia: latest update on alpha-adrenoceptor antagonists

An update of a systematic review of alpha1-adrenoceptor (AR) antagonists in the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) showed that these agents have comparable efficacy. The total symptom score is improved by 30-45% and maximum urinary flow rate by 15-30% vs baseline. alpha1-AR antagonists that can be started at their therapeutic dose have a more rapid onset of action than alpha1-AR antagonists that have to be titrated. alpha1-AR antagonists can be differentiated according to their tolerability. Alfuzosin (especially the 10 mg once daily dose) and tamsulosin (especially the 0.4 mg once daily dose) are better tolerated than doxazosin and terazosin. However, alfuzosin might induce more cardiovascular adverse events (AEs) in the elderly and/or patients with cardiovascular comorbidity and/or comedication. Tamsulosin tends to interfere less with blood pressure regulation and induce less vasodilatory AEs than alfuzosin, especially in the elderly, and is well tolerated in patients with cardiovascular comorbidity and/or comedication. Cardiovascular AEs might lead to potentially serious complications such as falls, fractures and institutionalization. Abnormal ejaculation has mainly been reported in placebo-controlled trials with tamsulosin but in direct comparative trials its rate with tamsulosin 0.4 mg was similar to, or only slightly higher than, the rate with alfuzosin. In addition, abnormal ejaculation is not reported as bothersome by the patient or associated with serious complications. It can be concluded that an alpha1-AR antagonist with a low potential to interfere with blood pressure regulation and to induce cardiovascular AEs, also in patients with cardiovascular comorbidity and/or comedication, can be considered a first-choice treatment option in LUTS/BPH.

Doxazosin for benign prostatic hyperplasia: An open-label, baseline-controlled study in Korean general practice

BACKGROUND

Few studies have reported the treatment of benign prostatic hyperplasia (BPH) in Asian patients. We assessed the safety and efficacy of doxazosin, a selective alpha1-adrenoceptor antagonist, in the treatment of Korean patients with symptomatic BPH.

METHODS

Two hundred and ninety-five men, aged 48 years or older with clinical BPH, were enrolled in a 12-week, open-label, baseline-controlled, dose-titration, multicenter study. A 2-week, single-blind, placebo run-in was followed by 10 weeks of doxazosin treatment, initially administered at 1 mg/day, with upward titrations (2, 4, or 8 mg/day) at 2-week intervals. The international prostate symptom score (IPSS) was used to assess efficacy after 4, 6, and 10 weeks of active treatment.

RESULTS

The intent-to-treat (ITT) population comprised 249 patients (mean age 63.6 years). Doxazosin significantly reduced the mean total IPSS by 48%; similarly, the obstructive and irritative subscores were reduced from baseline by 51% and 39%, respectively (P < 0.001 for all scores: Wilcoxon rank sum test). In a subset analysis of 170 normotensive and 78 hypertensive patients, significant reductions in mean systolic and diastolic blood pressures relative to baseline were observed only in the hypertensive subset (P < 0.01). Similar results in mean IPSS were observed in older (> or =65 years, n = 100) and younger (45-64 years, n = 140) patients, as well as between normotensive and hypertensive patients. Thirty-nine patients reported adverse events: The most frequent were dizziness, dyspepsia, asthenia, somnolence, and dry mouth.

CONCLUSIONS

The efficacy and safety of doxazosin treatment for BPH were confirmed in this Asian population. Significant improvements in total IPSS, as well as obstructive and irritative subscores, were observed.

The short-term effects of tamsulosin in Japanese men with benign prostatic hyperplasia

We evaluated the short-term effects of tamsulosin in treating benign prostatic hyperplasia. Twenty-seven patients, aged 57 to 86 years (mean 68.4); complaining of obstructive urinary symptoms who had received no previous treatment for such symptoms were orally administered 0.2 mg of tamsulosin for 4 weeks. Symptoms (total AUA symptom score and AUA symptom subscores) and objective parameters including peak and average flow rate, and post-void residual urine rate were evaluated before and after 1, 2 and 4 weeks of treatment. The mean total AUA symptom score and the mean AUA symptom subscores for incomplete emptying and weak stream were significantly decreased after only 1 week of treatment. The mean AUA symptom subscores for intermittency, urgency and nocturia were significantly decreased after 4 weeks of treatment. The mean AUA symptom subscores for frequency and hesitancy were unchanged after 4 weeks of treatment. The mean peak and average flow rate, and post-void residual urine rate were significantly improved after only 1 week of treatment. In conclusion, tamsulosin improved not only objective parameters but also symptoms only 1 week after the start of treatment.