Best drugs to shrink prostate?

Asked: 29 Apr 2012 by warren123
Active: 22 Feb 2017
Topics: benign prostatic hyperplasia (bph), infections, tamsulosin, medical, prostate, urine

After a medical procedure i developed a blatter infection and my prostate squeezed off my urine flow. I am on a catheter and .4 mg of Tamsulosin per day. They took the catheter out after a week and had to put it back in. Is there a stronger drug that may help or maybe stronger Tamsulosin (Flowmax) dosage. I have just finished the doxycycline 100mg for 10 days. The infection is gone should my prostate shrink back? Before the procedure the prostate was weak but OK for my age. IE once or twice a night if i drank within 2-3 hours and occasionally I did not have to get up at all. Weak stream but ok I am 66.

Can i expect the prostate to go back down in size with time or should i be aggressive with my meds?

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kennyray 30 Apr 2012

Warren,
Your problems are serious enough to present them to your doctor. There is a stronger Flomax pill with 0.8 mg. I think that Flomax alone will not shrink the prostate. It works by relaxing the muscles in the prostate, thereby allowing a more normal urine flow. There is another med called Proscar which, over time, will shrink your prostate. It works for better urine flowby that shrinkage. It has less side effects than Flomax, but it takes a longer time to solve your problem. Do not change your dose of Flomax without your doctor's direction. I hope this helps you.
Kenison Ray
Houma,La.

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kaptnk228 2 Nov 2016

I am now 66 years old and was on Flomax for about 2 years. IMHO it is a terrible medication. Slowly I began getting tired sleeping 10-12 hrs per day and not really noticing it,
Then the abdominal and lower back pain started. Once I figured out what the cause was I stopped taking this med. I switched to Finasteride and will be changing avodart to shrink this thing. So far I haven't needed a replacement to Flomax. Flomax only treats the symptoms but does not reduce the size of your prostate. These two meds address the cause of prostate growth and both also just might help your hair to grow back.

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Sean Bhoy 22 Feb 2017

have you tried or heard of Preminal MenCare+ ,I have started using these and in my opinion they seem to work for me, my flow rate and pressure has become stronger and they certainly have improved on less trips to the toilet , and no longer have to get up through the night to go to the toilet , ,just thought I would mention these to you or anyone that might find this useful,,

Evaluating Drugs Used to Treat: Enlarged Prostate Comparing Effectiveness, Safety,

. . . . . . . . . . . . . . . . . . . • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 3 A man’s prostate becomes larger as he ages, a condition known as benign prostatic hypertrophy, or BPH. It’s usually not a serious or life-threatening condition, but it can cause problems with urinating, primarily in men age 50 and older. Many men with BPH will either have no symptoms or symptoms that are mild and not that bothersome. But for millions of others, the urinary problems caused by BPH can be burdensome and interfere with their quality of life. Some men with BPH, for example, feel the urge to get up several times throughout the night to urinate, which can interrupt their sleep and leave them tired and groggy the next day. Concerns about urinary problems can also lead some men with this condition to give up routine activities such as sports or going to the movies where it may be difficult to find or reach a restroom. You should see a doctor if you have urinary problems. The symptoms of BPH can be similar to the symptoms of prostate cancer, so it’s important to get an accurate diagnosis. You should also contact your doctor immediately if you have a fever or chills, pain in your back, side or abdomen, cloudy or bloody urine, or pain when urinating. Those could be signs of serious complications that require medical attention. If you have urinary problems due to BPH, lifestyle changes can often provide relief and should be tried first. These include going to the bathroom when you first feel the urge, reducing or eliminating your intake of alcohol, caffeine, antihistamines, and decongestants, and limiting your fluid intake before bedtime. If your symptoms persist or worsen, the next step is usually to consider medication. Two classes of drugs are commonly used to treat prostate enlargement: alpha-blockers and 5-alpha-reductase inhibitors. Alpha-blockers are generally used first because they act fast, relieving urination problems in a matter of days or weeks, while reductase inhibitors can take several months to provide relief. Sometimes the two types of drugs are used in combination. If you and your doctor decide that a drug is appropriate for your condition, we recommend the alpha-blocker doxazosin as your first option. We picked it as our Best Buy because it has a long track record of being both safe and effective. It’s also available as an inexpensive generic drug, costing $8 or less for a month’s supply. The savings would be significant compared to taking one of the costly brand-name alpha-blockers, which can run more than $100 per month. If doxazosin doesn’t work for you, you might try another alpha-blocker, terazosin, also available as a low-cost generic. Or you and your doctor might want to consider adding a reductase inhibitor to your regimen. In that case, we recommend adding finasteride. It is the only reductase inhibitor available as a generic, so it costs significantly less than a brand-name drug. In addition, the combination of finasteride and doxazosin has been proven to delay the progression of BPH symptoms. This report was updated in May 2012. Our Recommendations 4 • Consumer Reports Best Buy Drugs • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate This report compares the effectiveness, safety, and cost of medicines used to treat urination problems due to prostate enlargement, a condition also known as benign prostatic hyperplasia (or hypertrophy), or BPH. It is based on an analysis of the scientific evidence on drugs to treat BPH, including studies from the 1960s through late 2008. This report is part of a project by Consumers Union and Consumer Reports to help you find safe, effective medicines that give you the most value for your health-care dollar. To learn more about the project and other drugs we’ve evaluated for other diseases and conditions, go to www.CRBestBuyDrugs.org. Prostate enlargement, or BPH, affects millions of men in the U. S., mostly those ages 50 and older. While it can be a serious condition in some cases, it’s important to note that it is not prostate cancer, and that many men who have been diagnosed with BPH have no symptoms at all or symptoms that are minor and not very bothersome. It’s also important to emphasize that BPH does not raise your risk of prostate cancer. The prostate becomes larger in all men as they age, and how slowly or rapidly that occurs does not appear to be linked to one’s risk of prostate cancer. That said, BPH symptoms (see the list of symptoms on page 5) can be similar to the symptoms of prostate cancer. So it’s important to be checked by a physician if you notice changes in your typical urination patterns or have other BPH symptoms. It’s also possible to have BPH and prostate cancer at the same time, underscoring the need to get checked. Almost all men—once they reach a certain age—will develop BPH. The statistics are not precise, but by age 55 or so, about half of all men have an enlarged prostate. By age 65, the figure is up to nearly 75 percent, and by age 80, nine in 10 men have BPH. But only about half of men will have symptoms that warrant treatment. BPH symptoms, which usually involve problems with urinating, aren’t hard to detect. And why they occur is pretty well understood. The normal function of the prostate is to produce semen, the fluid that carries sperm during ejaculation. The prostate surrounds the urethra, the tube that carries urine from the bladder and out of the body. When the prostate becomes enlarged, it pinches the urethra. This partly—and sometimes completely—restricts the flow of urine or causes difficulty urinating. An enlarged prostate also triggers changes in your bladder. As the urethra becomes narrow, the bladder has to work harder, which can cause its walls to become thick. This can make your bladder contract when it contains only a small amount of urine. Your bladder can also become Welcome Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 5 distended and lose its muscular tone. This combination of factors results in incomplete bladder emptying, which can make you feel as though you have to urinate more often and lead to other problems. The symptoms of BPH include: ■ slowed or delayed start to urinating ■ needing to urinate more often ■ needing to urinate two or more times during the night ■ weak flow of urine ■ dribbling of urine after finishing ■ straining to urinate ■ strong and sudden urge to urinate ■ feeling that the bladder is not completely emptied after urinating ■ sudden inability to urinate ■ incontinence (urine leakage) Table 1. Classes of Drugs Used to Treat BPH Generic Name Brand Name Available as a Generic Drug? Alpha-blockers Alfuzosin extended-release Uroxatral Yes Doxazosin Cardura Yes Doxazosin sustained-release Cardura XL No Prazosin1 Minipress Yes Silodosin Rapaflo No Tamsulosin Flomax Yes Terazosin Hytrin Yes 5-alpha-reductase inhibitors Dutasteride Avodart No Finasteride Proscar Yes 1 Prazosin is prescribed off-label to treat BPH. These symptoms can have a negative impact on your quality of life depending on their severity. Men who get up three or four times at night to urinate, for example, can be tired the following day. BPH can also inhibit some men from engaging in routine activities like sports or going to the movies because of anxiety about the need to use the restroom. BPH symptoms are usually mild for most men. But when they become bothersome or even severe it’s important to seek help because, if left untreated, prostate enlargement can lead to such complications as urinary-tract infections and kidney damage. Also, contact your doctor immediately if you have fever or chills, pain in your back, side or abdomen, cloudy or bloody urine, or pain when urinating. These symptoms could be a sign of complications that require medical attention. What causes the prostate to enlarge as men become older and why it occurs in some men more than others is not well understood. A hormone related to testosterone, called dihyroxytestosterone, or DHT, is thought to play an important role. Some men prone to developing a more severely enlarged prostate may have higher than average DHT levels in their blood, or their prostates may become more sensitized to its effects after age 60. Family history also plays a role. Men whose fathers and/or grandfathers had BPH are more likely to develop it. Some studies have suggested that black and Hispanic men may be more prone to urination problems related to BPH than white men, but recent studies have found little, if any, difference in rates of the condition by race. There are several treatment strategies that can help provide relief. Lifestyle changes (which are discussed in the Treatment Options section starting on page 8) can often be enough, but if they fail to improve symptoms, then medication might be necessary. This report focuses on the two classes of drugs commonly used to treat prostate enlargement: alpha-blockers and 5-alpha-reductase inhibitors. Table 1, on page 5, lists the seven alpha-blockers and two alpha-reductase inhibitors used to treat BPH. (The differences between the two drug classes are discussed later.) The erectile dysfunction medication, tadalafil (Cialis), is approved for treating enlarged prostate symptoms, and a combination pill, Jalyn, which contains both dutasteride and tamsulosin, is also available. Neither of those were included in the analysis that forms the basis of this report, so we do not discuss them. However, the pros and cons of combination therapy with an alpha blocker and a 5-alpha-reductase inhibitor are discussed on page 13. This report was updated in May 2012. 6 • Consumer Reports Best Buy Drugs • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 7 As we have already mentioned, many men with BPH don’t have symptoms or their symptoms can be managed with lifestyle changes. About half of men of any age who have BPH will have symptoms that require attention and treatment that may involve taking one of the drugs we evaluate in this report. The percentage of men requiring treatment increases with age: ■ One in four men in their late 50s can expect to have symptoms that are bothersome enough to seek medical attention or treatment; ■ One in three men in their late 60s can expect to have symptoms that are bothersome enough for them to seek medical attention or treatment, and ■ One in two men in their late 70s and beyond can expect to have symptoms bothersome enough to seek medical attention or treatment. This means that millions of men are regularly taking drugs or using other treatment options to ease the symptoms of BPH. The first advice we’d give to any man bothered by problems when urinating is to see a doctor. Many men are reluctant to talk about urination problems with their doctor, but it’s important to get these issues evaluated as early as possible to prevent any complications that may be present, whether or not the patient is aware of them. It’s important to note that some men don’t notice any symptoms of BPH and their enlarged prostate is only discovered by their physician during a routine examination. Getting a diagnosis Doctors should regularly ask all men over age 50 about urination problems. But if you are experiencing problems, you should bring them to your physician’s attention even if he doesn’t specifically ask you about them. It’s important to note that the size of your prostate does not always correlate with the severity of BPH symptoms. That is, some men with only slightly enlarged prostates can have quite bothersome symptoms, while others with substantially enlarged prostates may have few or no symptoms. To gauge the severity of your symptoms, your doctor will likely ask you several questions about your urination problems (See Table 2, below). Those questions will include how often you feel the urge to urinate, how many times per night you wake up to use the restroom, and how much your urination problems affect the quality of your life. Your doctor will use your answers to these questions to determine how severe your problems are and the most appropriate treatment. In addition, your doctor will take your medical history into consideration, including whether you have any other conditions that may worsen your symptoms or that might affect your treatment options. Your doctor will likely also do some simWho Needs a Drug for BPH? Table 2. Questions your doctor will likely ask about your symptoms*: Over the past month: ■ How often have you had a sensation of not emptying your bladder completely after you finish urinating? ■ How frequently have you urinated again less than two hours after you finished urinating? ■ How difficult have you found it to postpone urination? ■ How often have you had a weak urinary stream? ■ How frequently have you had to push or strain to begin urination? ■ How many times did you typically get up to urinate from the time you went to bed until the time you got up for good? And finally: ■ If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? *List is adapted from the International Prostate Symptom Score questionnaire. 8 • Consumer Reports Best Buy Drugs • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate ple blood and urine tests to check for infection and make sure your kidneys are functioning normally. Your doctor might also perform a digital rectal exam (the insertion of a finger into the rectum) to assess the size and firmness of your prostate and to check for the presence of lumps that might be an indication of prostate cancer, and/or discuss doing a blood test for prostate cancer, called the prostate-specific antigen, or PSA test. But you should know that there is considerable disagreement not only about the usefulness of these procedures but also whether they should be performed at all. For example, the U.S. Preventive Services Task Force recently recommended against the PSA test for men of all ages because their view of the evidence is that the test is more likely to lead to substantial harms than to save lives. However, other groups, such as the American Urological Association and the American Cancer Society, do not recommend against the PSA test. A thorough discussion of the pros and cons of these procedures is beyond the scope of this report, but if you would like to learn more about them, you can read about PSA screening on our website: http://www.consumerreports.org/health/ conditions-and-treatments/prostate-cancer-screening/overview/index.htm. In some cases of urination problems, your doctor may want to do additional tests to establish the diagnosis. One is called a post-void residual volume test, which measures how much urine is left in the bladder after urinating. Ultrasound techniques can also be used to check the size and structure of the prostate. Treatment options If your doctor diagnoses BPH and you have only mild symptoms or they are not too bothersome, he or she is likely to suggest “watchful waiting” and some lifestyle adjustments. The term “watchful waiting” means that you won’t be offered any specific treatments, but that you and your doctor commit to closely monitoring your symptoms over time to see if they worsen. That may include keeping a diary of symptoms and urination patterns or problems. Lifestyle adjustments aren’t a treatment per se, but they have been shown to be highly effective at both reducing symptoms and improving one’s quality of life. Table 3, above, lists commonly used measures. They include going to the bathroom when you first feel the urge rather than waiting, and reducing or eliminating your intake of alcohol and caffeine. It’s also a good idea not to drink a lot of fluids in a short time-span or two hours before bedtime. Getting regular exercise is promoted as helpful for reducing BPH, but there’s no good evidence that this works consistently. Kegel exercises—contracting the muscles that regulate urine flow—are known to help build control over urination. While good evidence showing this improves urination problems due to BPH is lacking, it can be worth trying. If possible, you should avoid over-theTable 3. Lifestyle Changes That May Relieve Mild Symptoms of Prostate Enlargement These measures can be helpful: ■ Urinate when you first feel the urge; don’t wait. ■ Do not rush urination. Take your time and relax before, during, and after to give your bladder extra time to empty if the stream is slow or intermittent. ■ Practice “double-voiding”: Urinate as much as possible, relax for a moment, and then go again. ■ Urinate before car trips, meetings, or movies. ■ Spread fluid intake throughout the day and reduce it before bedtime, especially coffee, tea, or caffeinated beverages. Do not avoid fluid intake to reduce the need to urinate. That can cause dehydration. ■ Drink alcohol and caffeine in moderation. ■ Avoid antihistamines and decongestants when possible. ■ If you take a diuretic (a type of high blood pressure pill), ask your doctor if you can take a lower dose or a different drug. ■ If you have diabetes, controlling blood sugar can reduce frequent urination. There’s no clear evidence these work: ■ Exercise. ■ Kegel exercises. ■ Herbal supplements such as saw palmetto, Pygeum africanum, rye-pollen grass, and beta-sitosterol. Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 9 counter cold and sinus medications containing decongestants or antihistamines, since these drugs can worsen the symptoms of prostate enlargement. If you’re taking diuretic drugs, you should ask your doctor whether the dose can be reduced or if you can take a different medication, since doing either could potentially improve your symptoms. Men with diabetes should work with their doctor to make sure their blood sugar levels are kept in control because if they aren’t, it can lead to increased urination. If your symptoms don’t improve with lifestyle changes or if they worsen, medication is typically the next step. Other treatments Various herbal supplements are touted as a treatment for urination problems due to BPH. These include saw palmetto, beta-sitosterol, rye-grass pollen, and Pygeum africanum. Some studies have suggested that those herbs may be effective, but many of the studies were small and not well done. That makes the results unreliable. Also, most of the studies followed men for less than six months, so it’s not clear if the benefits of these products last longer than that. We would urge caution in using any herbal supplements and advise you to discuss them with your doctor to make sure they are not interacting with any other medicines you take. Surgery and other procedures Surgery is typically reserved for men with complications, including recurrent blood in the urine, recurrent urinary-tract infections, kidney failure, and bladder stones. Surgery will likely be necessary if your BPH becomes so bad that you cannot urinate at all. Surgery can also be an option for men who can’t take medications for other health reasons or in cases where prescription medications haven’t worked well. A number of surgical procedures are used to reduce prostate enlargement and the associated symptoms. These techniques remove tissue from the prostate that may be blocking urine flow. Your doctor will review the risks and benefits of the different procedures if you need surgery. There are also nonsurgical procedures, such as microwave therapy, that shrink or kill obstructing prostate tissue. Again, your doctor can give you more information about those options if they are right for your situation. 10 • Consumer Reports Best Buy Drugs • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate As mentioned earlier, there are two main groups of drugs commonly used to treat BPH: alpha-blockers and 5-alpha-reductase inhibitors. (See Tables 4 and 5 on pages 11 and 12, respectively, for the commonly used dosages and for a brief description of how they differ.) Your doctor is most likely to prescribe an alphablocker as the first line of treatment if you need a drug to treat your BPH. That’s primarily because those drugs take effect quickly and—for most men— help relieve urination problems and other symptoms in a matter of days or weeks. About 60 percent of men treated with alpha-blockers experience an improvement in their symptoms. Alpha-blockers are also less expensive than the 5- alpha-reductase inhibitors. The three oldest alphablockers—immediate-release doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin)—are available in lower-cost generic forms that typically cost less than $30 for a month’s supply. (See Table 6 on page 14.) Prazosin is generally not used to treat urinary problems due to prostate enlargement because it is not approved by the Food and Drug Administration (FDA) for the condition. It is also less convenient because it must be taken twice per day, whereas the other alphablockers are taken once daily. But prazosin, which is FDA-approved to treat high blood pressure, is sometimes an option if you have both urinary problems from an enlarged prostate and high blood pressure. Three newer alpha-blockers—alfuzosin (Uroxatrol), tamsulosin (Flomax), and doxazosin sustainedrelease (Cardura XL)—are available in extendedrelease or continuous-release forms designed to keep them working in your body all day long. That may have advantages for some patients, but our analysis found no compelling evidence to indicate that those three medicines were any better than the older, immediate-release alpha-blockers in terms of reducing symptoms or improving quality of life. Moreover, both the brand-name and generic versions of those longer-acting drugs are significantly more expensive than the immediate-release formulations. Flomax, which is one of the most expensive alphablockers, has a unique issue regarding cost. It is only available in one dosage strength, so if you need to increase your dose to get relief from your symptoms, you will need to take two pills, which doubles the cost. The other alpha-blockers are available in varying strengths for about the same price, so even if you need a stronger dose, it will cost you about the same. The generic version of tamsulosin has the same problem. Just like its brand name counterpart, the generic tamsulosin is only available in one dosage strength, so if you need to increase your dose, you will still have to pay double. Another point to keep in mind when it comes to cost is that you can save money by buying higher-dose tablets and splitting them in half with your doctor’s or pharmacist’s approval. (You can only split pills that are immediate-release tablets, such as doxazosin and terazosin. Splitting should not be done with extended-release or sustained-release tablets.) For example, if you are taking 4 mg of doxazosin per day, you could buy the 8 mg pill for about the same price and split it. You should use a pill-splitter to make certain that the two halves are the same size and provide you with the correct dose. These devices cost about $5 to $10 and are widely available. Be sure to check prices at online pharmacies and large discount stores, too. Those outlets often have significantly lower prices. Other options include the programs offered by large chains, such as CVS, Target, Walgreens and Wal-Mart, where a 30-day supply of certain generic drugs costs just $4 or even less. We note in the price chart on page 14 which of the medications discussed in this report are likely available through those programs. Studies indicate that all alpha-blockers yield about the same clinical results in controlling symptoms and improving quality of life. Unfortunately, only a few studies directly compare the different alphablockers head-to-head. But to date, they have found no advantage for one alpha-blocker over another. Also, little research has been done on whether race or age makes a difference in how men respond to the BPH drugs. Some major studies have included Choosing a BPH Drug—Our Best Buy Picks Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 11 very elderly men and black men, but so far there is no de finitive evidence that the effectiveness or side effects of treatment differ between black and white men or older men. Silodosin (Rapaflo) is the newest alpha-blocker. The FDA approved this medicine in late 2008. In two studies involving a total of 923 men, those receiving Rapaflo showed an improvement in their symptoms and urinary-flow rate compared with those who took a placebo pill over 12 weeks. But since the drug does not have the long track record of use of some of the other alpha-blockers, its safety profile is not yet firmly established. In addition, it’s more expensive. At $159-$163 per month, depending on dose, it is one of the most expensive alpha-blockers, and costs significantly more than generic doxazosin, which runs $8 or less per month. For those reasons, we’d advise it not be used as initial treatment at this time. How the drugs work The 5-alpha-reductase inhibitors work in a much different way than the alpha-blockers. While the alphablockers relax muscles in the bladder, the 5-alpha reductase inhibitors actually shrink the prostate by blocking the abnormal buildup of the hormone DHT— a testosterone derivative—that can cause it to swell and become enlarged. The 5-alpha-reductase inhibitors help relieve symptoms but can take as long as 6 to 12 months before they work. And studies show they are much more likely to be effective in men with more severely enlarged prostates. The two 5-alpha-reductase inhibitors are finasteride (Proscar and generic) and dutasteride (Avodart). Finasteride is also sold under the name Propecia as a treatment for male pattern baldness, but this is a lower-dose tablet that is not approved by the FDA for treating BPH. Generic finasteride costs less than Avodart but it’s still more expensive than the generic alpha-blockers. Studies don’t indicate any difference in the effectiveness or safety of finasteride and dutasteride, and, at the current time, neither is known to have any advantages over the other. The 5-alpha-reductase inhibitors are sometimes prescribed initially, before an alpha-blocker, but this is quite rare. They are more commonly prescribed if an alpha-blocker has failed to relieve your symptoms or as a second drug to augment an alpha-blocker if you are not getting enough relief. There’s more about this combination therapy on page 13. One potential benefit of the 5-alpha-reductase inhibitors is that they might reduce the risk of developing prostate cancer. However, you should be aware that there is debate among experts about whether those drugs actually increase the risk of cancers that are more difficult to treat. As this report goes to print, Table 4. Common Dosages of BPH Drugs Generic Name (Brand Name) Starting Dosage Maintenance Dosage Alfuzosin extended-release (Uroxatral) 10 mg daily 10 mg daily Doxazosin (Cardura) 1 mg daily 2 mg to 8 mg daily Doxazosin extended-release (Cardura XL) 4 mg daily 4 mg or 8 mg daily Prazosin (Minipress) 1 mg daily 2 mg to 10 mg daily Silodosin (Rapaflo) 4 mg to 8 mg daily 4 mg to 8 mg daily Tamsulosin (Flomax) 0.4 mg daily 0.4 mg or 0.8 mg daily Terazosin (Hytrin) 1 mg daily 2 mg to 10 mg daily Finasteride (Proscar) 5 mg daily 5 mg daily Dutasteride (Avodart) 0.5 mg daily 0.5 mg daily the controversy has not been fully resolved to our satisfaction. This is an issue you need to discuss with your doctor to make the best-informed decision you can. Side effects You and your doctor’s choice of a BPH drug may be based more on its side effect profile than effectiveness. The most common side effects of alpha-blockers are reduced semen during ejaculation, headache, upset stomach, and stuffy or runny nose. The drugs can also cause low blood pressure, dizziness, and fainting, especially when you first start taking them, so it’s important to take precautions to prevent any injuries that could result from this. That includes taking the drug before you go to sleep, so you’re already laying down if problems do occur, and not driving or operating machinery when you first start taking it. With the older drugs—doxazosin, terazosin, and prazosin—your doctor should start you on a low dose and build up to a higher dose over a period of a few weeks to give your body time to adjust to the medicine. That process is not necessary with the newer alpha-blockers (Flomax, Rapaflo, and Uroxatral). Low blood pressure caused by the alpha-blocker medicines can fall to dangerous levels if you’re also taking a high blood pressure drug or erectile dysfunction medicines such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). So don’t take an alpha-blocker with those other drugs without first discussing it with your doctor. Men with prostate enlargement who are planning to have cataract surgery should be aware that all alpha-blockers can cause a complication called intraoperative floppy iris syndrome, or IFIS. This condition causes the iris of the eye to become limp due to increases in fluid levels in the eye. This is a concern because it can raise the risk of a painful and extended recovery period from cataract surgery, and a reduction in visual acuity or sharpness after the surgery. You should alert your eye surgeon that you are taking alpha-blockers if you plan on having this surgery. In very rare cases, the alpha-blockers can cause painful erections that last for hours. If not treated, this can lead to a permanent inability to achieve erection, so you should seek immediate medical attention if you develop this condition. The side effects of the 5-alpha-reductase inhibitors may include a reduced sex drive and difficulty achieving and maintaining an erection. While these can be bothersome for many men, in clinical studies only around 2 percent of those who developed any sexual difficulties found them to be severe enough to stop taking the medicines. However, the FDA in April 2012 updated the label of finasteride (Proscar and Propecia) to note that men have reported decreased libido and problems with ejaculation and orgasms that continued for weeks to months after they stopped taking the medications. Although those sexual side effects have not been clearly linked to Propecia or Proscar, the FDA said they were added to the labels because the reports indicate the drugs could cause a broader range of side effects that men should be aware of if they consider taking one of these medications. 12 • Consumer Reports Best Buy Drugs • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate Table 5. Description of BPH Drugs and their Side Effects Type of medication Main action Common side effects Alpha-blockers (alfuzosin, doxazosin, prazosin, silodosin, tamsulosin, terazosin) Relaxes muscles in bladder ■ Dizziness ■ Headache ■ Stomach problems ■ Reduced semen during ejaculation 5-alpha-reductase inhibitors (finasteride, dutasteride) Shrinks prostate tissue by blocking a hormone ■ Decreased sex drive ■ Decreased ability to get and keep an erection ■ Ejaculation problems Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 13 The 5-alpha-reductase inhibitors can also cause birth defects in developing fetuses. So men should avoid using 5-alpha-reductase inhibitors when planning a pregnancy with their female partners, and the medicines should not be handled by women who are pregnant or planning to become pregnant. Finally, the 5-alpha-reductase inhibitors can reduce levels of prostate specific antigen, or PSA, that is used to screen for prostate cancer. Patients who are appropriate candidates for these drugs tend to have higher PSA levels, but if the medicines lower their PSA levels it could make it more difficult to detect prostate cancer. There are strategies that attempt to account for this issue when reading the results of PSA tests, so make sure your doctor is aware that you are taking one of these drugs if your PSA level is being tested. Our Best Buy Pick For initial treatment of BPH, we have ruled out two of the alpha-blockers: silodosin (Rapaflo) because it is very expensive and does not have the long track record of safety and effectiveness that other alphablockers do, and prazosin because it is not FDAapproved for treating BPH and its twice-per-day dosing makes it more inconvenient than the other alpha-blockers. We would also advise against alfuzosin (Uroxatral and generic) and Cardura XL, since they are more expensive and their extended-release formulation has not been proven to be safer or more effective than the older alpha-blockers. That leaves three generic alpha-blocker drugs for consideration: doxazosin, tamsulosin, and terazosin. Given that there is no evidence that any of these is more effective or safer than the others, we have chosen generic doxazosin as our Best Buy for initial treatment of BPH due largely to its lower cost. Doxazosin has been on the market for several decades, so its safety and effectiveness profile is well-established. And a month’s supply costs $8 or less, depending on dose. If doxazosin works for you, the savings would be significant over taking one of the costly brand-name alpha-blockers. If doxazosin does not bring enough relief, you could try terazosin next. Or you could also try adding finasteride. Generic tamsulosin may be an option to consider if you don’t respond well to doxazosin or terazosin. However, as we previously noted, tamsulosin is only available in one dosage strength, so if you need to increase your dose, you will have to pay double. Combination therapy? For men who do not get enough relief from an alphablocker, adding a 5-alpha-reductase inhibitor is an option. Again, your doctor is unlikely to recommend this unless your prostate is significantly enlarged and your symptoms are bothersome. But be warned: This may not bring immediate relief. Studies indicate that combination treatment with an alpha-blocker and a 5-alpha-reductase inhibitor doesn’t generally provide additional bene - fit over an alpha-blocker alone in the first 12 months of treatment. Over the long-term, however, combination therapy appears to help prevent the symptoms from becoming worse. And it can also prevent serious compli ca tions, such as not being able to urinate at all (called acute urinary retention), which often leads to prostate surgery. One study, for example, found that after four years of treatment with both the alpha-blocker doxazosin and the 5-alpha-reductase inhibitor finasteride, symptoms worsened in only 5.3% of the men compared with about 10% of those who received either drug alone. Men with the greatest prostate enlargement got the most benefit from the combination therapy. Another study involving the combination treatment of the alpha-blocker tamsulosin and the 5-alphareductase inhibitor dutasteride (Avodart) in men with very large prostates found that both drugs together provided greater improvement in symptoms after one and two years of treatment than either drug alone. However, due to the increased risk of side effects with combination therapy, this treatment strategy is typically limited to men with bothersome symptoms and very enlarged prostates. If you and your doctor decide that this stra te gy is appropriate, we recommend doxazosin plus finasteride. This is the only combination treatment prov en to have a longterm benefit of delaying pro gres sion of symptoms over four years. And, as previously noted, both drugs are available as less-expensive generics. 14 • Consumer Reports Best Buy Drugs • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate Table 6. BPH Drugs – Cost Comparison Note: If the price box contains a , that indicates the dose of that drug is likely available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered. $ Generic Name and Dose Brand name1 Number of pills per day2 Average monthly cost3 Alpha-blockers Alfuzosin 10 mg sustained-release tablet Generic One $82 Alfuzosin 10 mg sustained-release tablet Uroxatral One $161 Doxazosin 1 mg tablet Generic One $8 $ Doxazosin 1 mg tablet Cardura One $74 Doxazosin 2 mg tablet Generic One $8 $ Doxazosin 2 mg tablet Cardura One $75 Doxazosin 4 mg tablet Generic One $7 $ Doxazosin 4 mg tablet Cardura One $74 Doxazosin 8 mg tablet Generic One $7 $ Doxazosin 8 mg tablet Cardura One $73 Doxazosin 4 mg sustained-release tablet Cardura XL One $81 Doxazosin 8 mg sustained-release tablet Cardura XL One $86 Prazosin 1 mg capsule Generic Two $14 $ Prazosin 2 mg capsule Generic Two $16 $ Prazosin 5 mg capsule Generic Two $20 $ Silodosin 4 mg capsule Rapaflo One $163 Silodosin 8 mg capsule Rapaflo One $159 Tamsulosin continuous-delivery capsule 0.4 mg Generic One $78 Tamsulosin continuous-delivery capsule 0.4 mg Flomax One $183 Terazosin 1 mg capsule Generic One $26 $ Terazosin 2 mg capsule Generic One $24 $ Terazosin 5 mg capsule Generic One $24 $ Terazosin 10 mg capsule Generic One $29 $ 5-alpha-reductase inhibitors Dutasteride 0.5 mg capsule Avodart One $146 Finasteride 5 mg tablet Generic One $75 Finasteride 5 mg tablet Proscar One $134 1. ‘Generic’ indicates that it’s the generic version of the drug. 2. As typically prescribed. 3. Prices reflect nationwide retail average for March 2012, rounded to the nearest dollar if you were to pay the cash price. Information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions, which is not involved in our analysis or recommendations. We omit drugs with a low number of prescriptions (less than 20) because the prices are unreliable and these medications might be difficult to find because pharmacies often won't stock drugs if there is little or no demand for them. Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 15 Talking With Your Doctor The information we present here is not meant to substitute for a doctor’s judgment. But we hope it will help you and your doctor arrive at a decision about which medication and dose is best for you, if one is warranted at all, and which gives you the most value for your health-care dollar. Bear in mind that many people are reluctant to discuss the cost of medicines with their doctor, and that studies have found that doctors do not routinely take price into account when prescribing medicines. Unless you bring it up, your doctors might assume that cost is not a factor for you. Many people (including physicians) think that newer drugs are better. While that’s a natural assumption to make, it’s not necessarily true. Studies consistently find that many older medicines are as good as—and in some cases better than—newer medicines. Think of them as “tried and true,” particularly when it comes to their safety record. Newer drugs have not yet met the test of time, and unexpected problems can and do crop up once they hit the market. Of course, some newer prescription drugs are indeed more effective and safer. So talk with your doctor about the pluses and minuses of newer vs. older medicines, including generic drugs. Prescription medicines go “generic” when a company’s patents on them have lapsed, usually after 12 to 15 years. At that point, other companies can make and sell the drug. Generics are much less expensive than newer brand-name medicines, but they are not lesser-quality drugs. Indeed, most generics remain useful medicines even many years after first being marketed. That is why more than 60 percent of all prescriptions in the U.S. today are written for generics. Another important issue to talk with your doctor about is keeping a record of the drugs you are taking. There are several reasons: ■ First, if you see several doctors, each might not be aware of medicine the others have prescribed. ■ Second, since people differ in their response to medications, it’s common for doctors today to prescribe several medicines before finding one that works well or best. ■ Third, many people take several prescription medications, nonprescription drugs, and dietary supplements at the same time. They can interact in ways that can either reduce the benefit you get from the drug or be dangerous. ■ And fourth, the names of prescription drugs—both generic and brand—are often hard to pronounce and remember. For all those reasons, it’s important to keep a written list of all the drugs and supplements you are taking, and periodically review it with your doctors. And always be sure that you understand the dose of the medicine being prescribed for you and how many pills you are expected to take each day. Your doctor should tell you this information. When you fill a prescription at the pharmacy, or if you get it by mail, you may want to check to see that the dose and the number of pills per day on the pill bottle match the amounts that your doctor told you. 16 • Consumer Reports Best Buy Drugs • Evaluating Prescription Drugs Used to Treat: Enlarged Prostate Our evaluation of medicines used to treat urinary problems due to BPH is based primarily on a systematic review conducted by researchers at the U.S. Department of Veterans Affairs and Oregon Health & Science University Evidence-based Practice Center. Researchers screened studies conducted from 1966 through July 2006 and focused on 62 that were wellconducted, and closely examined the effectiveness and/or safety of the drugs. A consultant to Consumer Reports Best Buy Drugs is also a member of the Oregon-based research team, which has no financial interest in any pharmaceutical company or product. The full review of drugs for BPH is available at http://www.hsrd.research.va.gov/publications/esp/ BPH-2007.pdf (This is a long and technical document written for physicians and researchers.) In addition, we adapted material from Consumer Reports Health, an online subscription Web site presenting treatment options and Ratings (See www.ConsumerReportsHealth.org). Consumers Union and Consumer Reports is solely responsible for selecting the Best Buy Drugs. Our methodology is described in more detail in the Methods section at www.CRBestBuyDrugs.org. How We Picked the Best Buy Drugs for BPH This copyrighted report can be freely downloaded, reprinted, and disseminated for individual noncommercial use without permission from Consumer Reports as long as it is clearly attributed to Consumer Reports Best Buy Drugs™. We encourage its wide dissemination as well for the purpose of informing consumers. However, Consumer Reports does not authorize the use of its name or materials for commercial, marketing, or promotional purposes. Any organization interested in broader distribution of this report should contact us at wintwe@consumer.org. Consumer Reports Best Buy Drugs™ is a trademark of Consumers Union. All quotes from the material should cite Consumer Reports Best Buy Drugs™ as the source. ©2012 Consumers Union of United States, Inc. Sharing this Report Evaluating Prescription Drugs Used to Treat: Enlarged Prostate • Consumer Reports Best Buy Drugs • 17 Consumers Union, publisher of Consumer Reports® magazine, is an independent and nonprofit organization whose mission since 1936 has been to provide consumers with unbiased information on goods and services, and to create a fair marketplace. Its website is www.ConsumerReports.org. These materials were made possible by a grant from the states Attorney General Consumer and Pre - scriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin. The Engelberg Foundation provided a major grant to fund the creation of the project from 2004 to 2007. Additional initial funding came from the National Library of Medicine, part of the National Institutes of Health. A more detailed explanation of the project is available at www.CRBestBuyDrugs.org. We followed a rigorous editorial process to ensure that the information in this report and on the Consumer Reports Best Buy Drugs website is accurate and describes generally accepted clinical practices. If we find, or are alerted to, an error, we will correct it as quickly as possible. But Consumer Reports and its authors, editors, publishers, licenses, and suppliers cannot be responsible for medical errors or omissions, or any consequences from the use of the information on this site. Please refer to our user agreement at www.CRBestBuyDrugs.org for further information. Consumer Reports Best Buy Drugs should not be viewed as a substitute for a consultation with a medical or health professional. This report and the information on www.CRBestBuyDrugs.org are provided to enhance your communication with your doctor rather than to replace it. About Us Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol, April 1, 2009;181(4):1779-87. Barkin J, Roehrborn C, Siami P, Haillot O, Morrill B, Black L, et al. Effect of dutasteride, tamsulosin and the combination on patient-reported quality of life and treatment satisfaction in men with moderate-to-severe benign prostatic hyperplasia: 2-year data from the CombAT trial. BJU Int, April 1, 2009;103(7):919-26. Droller MJ. A guideline for discussion and some thoughts. J Urol, 2009;181(4):1530-1. Helfand M, Muzyk T, Garzatto M. Benign prostatic hyperplasia (BPH). Management in primary care—screening and therapy. Department of Veterans Affairs, Health Services Research & Development Service, Evidence Synthesis Pilot Program. February 2007. Kaplan S, Roehrborn C, Meehan A, Liu K, Carides A, Binkowitz B, et al. PCPT: Evidence that finasteride reduces risk of most frequently detected intermediate- and high-grade (Gleason Score 6 and 7) cancer. J Urol, March 26, 2009. Kramer BS, Hagerty KL, Justman S, Somerfield MR, Albertsen PC, Blot WJ, et al. Use of 5- {alpha}-reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol, March 20, 2009;27(9):1502-16. Kupelian V, Wei JT, O'Leary MP, Kusek JW, Litman HJ, Link CL, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: The Boston Area Community Health (BACH) survey. Arch Intern Med, November 27, 2006;166(21):2381-7. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Jr., Dixon CM, Kusek JW, et al. The Long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med, December 18, 2003;349(25):2387-98. Wilt T, Brawer M, Barry M, Jones K, Kwon Y, Gingrich J, et al. The Prostate Cancer Intervention Versus Observation Trial: VA/NCI/AHRQ Cooperative Studies Program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy to watchful waiting for men with clinically localized prostate cancer. Contemp Clin Trials, January 1, 2009;30(1):81-7. Wilt TJ, N'Dow J. Benign prostatic hyperplasia. Part 1—Diagnosis. BMJ, January 19, 2008;336(7636):146-9. Wilt TJ, N'Dow J. Benign prostatic hyperplasia. Part 2—Management. BMJ, January 26, 2008;336(7637):206-10. References

What Medicines Treat BPH?

Not too long ago, men who wanted relief from BPH had one main option: surgery. In recent years, that’s changed. Drugmakers have come out with a number of medicines that give you more choices to treat your symptoms.

Benign prostatic hyperplasia (you’ve probably heard it called enlarged prostate) can cause problems such as a weak urine stream or having to pee a lot all day. Some medicines ease these symptoms by calming the muscles in the bladder and prostate. Others stop prostate growth and shrink the size of the prostate.

Medicine is now the most common way to treat men with mild to moderate BPH. Researchers are still learning about long-term effects and when drugs can be most helpful. Talk to your doctor to find out which medicine may be best for you.

Alpha Blockers

These work by relaxing muscles in your bladder and prostate, which makes it easier to pee. They don’t change the size of your prostate, but they do help with urine flow, waking at night to pee, and other symptoms. And you won’t have to wait long to see results; they usually work right away.

If you have high blood pressure and BPH, alpha blockers may be a good option for you because they treat both conditions.

If you are planning to have cataract surgery, it’s best to avoid them. They can lead to problems during the procedure.

Side effects: Since alpha blockers affect your blood pressure, they can make you feel very tired and cause these other things as well:

Dizziness
Fainting
Headaches
Lightheadedness
Low blood pressure

They may also lead to what you may hear a doctor call “retrograde ejaculation.” This is when sperm go backward into your bladder instead of out through your penis. It doesn’t cause any harm, but it means you may not have any sperm when you ejaculate. Men who still want to have children should keep this in mind.

Names: Your doctor might suggest one of these alpha blockers:

5-Alpha Reductase Inhibitors

These stop your body from creating one of the hormones that makes your prostate larger. They prevent growth and in some cases even shrink it. This can improve your urine flow and ease other BPH symptoms as well. They seem to be most helpful to men with very large prostates.

These drugs have two other benefits as well. They may:

Lower the odds that BPH will lead to other problems, such bladder damage
Make you less likely to need surgery

It can take up to 6 months to see the full effects of 5-ARIs, and you have to keep taking them to get results.

Side effects: This medication is not for use by women. Pregnant women should not be exposed to itbecause it can lead to birth defects in male babies.

Other side effects when men take it may include:

Erectile dysfunction
Lower sex drive
Retrograde ejaculation

Some of these side effects may get better as your body gets used to the medicine.

5-ARIs may also lower your PSA (prostate-specific antigen), which affects one way that doctors look for prostate cancer. That isn’t harmful, but it may help to get a PSA test before starting these drugs. Also, the FDA now requires labels on 5-ARIs to include a warning that they may be linked to an increased chance of high-grade (or aggressive) prostate cancer.

Names: There are two main 5-alpha reductase inhibitors:

Finasteride (Propecia, Proscar)
Dutasteride (Avodart)

Phosphodiesterase-5 Inhibitors

These are the same medicines used to treat erectile dysfunction. They smooth muscles in the bladder and prostate, which can help ease BPH symptoms.

There are several kinds of phosphodiesterase-5 inhibitors, but the Food and Drug Administration has approved only Tadalafil (Cialis) to treat BPH.

It’s not used as often as other drugs, but if you have ED and BPH, it’s another option.

Side effects: When you take Cialis, you might get:

Back and muscle pain
Headaches
Redness and warmth or burning on the face, neck, and upper body
A stuffy nose
An upset stomach after eating
Vision problems

Drug Combinations

If one medication on its own doesn’t help with symptoms, your doctor may suggest taking two. Common combinations include:

Finasteride and doxazosin
Dutasteride and tamsulosin -- this comes in a single pill (Jalyn)
Alpha blockers and antimuscarinics (drugs used to treat overactive bladder)

While these combos can be more helpful than a single drug, they may also result in more side effects, since you’re taking two medications instead of one.

Enlarged Prostate

· Overview

o Alternative Names

o Causes

o Symptoms

o Treatment

o Support Groups

o References

· In-Depth Report

· News & Features

· Reporter's File

· Expert Q & A

· Questions for Your Doctor

· Clinical Trials

· 5 Things to Know

Multimedia

· Prostatectomy

· TURP

· Enlarged Prostate

Web Links

· National Institute of Diabetes and Digestive and Kidney Diseases

· American Urological Association

Times Essentials

Recent findings and perspectives on medical research.

REPORTER'S FILE

Rethinking an Old Ailment: Enlarged Prostate

By GERALD SECOR COUZENS

Doctors are now urging early action and revised treatment for men with B.P.H.

· EXPERT Q & A

· New Therapies in the B.P.H. Pipeline

· QUESTIONS FOR YOUR DOCTOR

· What to Ask About B.P.H.

· CLINICAL TRIALS

· Selected Studies: B.P.H.

See All »NEWS & FEATURES

· It Was Benign, but Almost Killed Him

· Cataract Surgery Complications Are Linked to a Urinary Drug

· Urology Field Slowly Altered, by Women

· For Men, Relief in Sight

· Selected Studies: B.P.H.

· What to Ask About B.P.H.

· What You Need to Know About an Enlarged Prostate

· Rethinking an Old Ailment: Enlarged Prostate

· New Therapies in the B.P.H. Pipeline

· Prostate Tests and Obese Are Studied

REFERENCE FROM A.D.A.M.

Back to TopAlternative Names

BPH; Benign prostatic hyperplasia (hypertrophy); Prostate - enlarged

Back to Top Causes »

The actual cause of prostate enlargement is unknown. Factors linked to aging and changes in the cells of the testicles may have a role in the growth of the gland. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.

Also, if the testicles are removed after a man develops BPH the prostate begins to shrink in size.

Some facts about prostate enlargement:

· The likelihood of developing an enlarged prostate increases with age.

· BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.

· A small amount of prostate enlargement is present in many men over age 40. More than 90% of men over age 80 have the condition.

· No risk factors have been identified other than having normally functioning testicles.

In-Depth Causes »

Back to Top Symptoms »

Less than half of all men with BPH have symptoms of the disease. Symptoms may include:

· Dribbling at the end of urinating

· Inability to urinate (urinary retention)

· Incomplete emptying of your bladder

· Incontinence

· Needing to urinate two or more times per night

· Pain with urination or bloody urine (these may indicate infection)

· Slowed or delayed start of the urinary stream

· Straining to urinate

· Strong and sudden urge to urinate

· Weak urine stream

In-Depth Symptoms »

Back to Top Treatment »

The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your doctor will also take into account other medical problems you may have.

Treatment options include "watchful waiting," lifestyle changes, medicines, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.

SELF-CARE

For mild symptoms:

· Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.

· Avoid alcohol and caffeine, especially after dinner.

· Don't drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.

· Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.

· Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.

· Learn and perform Kegel exercises (pelvic strengthening exercises).

· Reduce stress. Nervousness and tension can lead to more frequent urination.

MEDICINES

Alpha 1-blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha 1-blockers notice improvement in their symptoms. .

Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.

Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.

SAW PALMETTO

Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown that it may help with symptoms, but results are mixed and more research is needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

· Incontinence

· Recurrent blood in the urine

· Inability to fully empty the bladder (urinary retention)

· Recurrent urinary tract infections

· Decreasing kidney function

· Bladder stones

The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.

Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

Simple prostatectomy: An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed. The outer portion is left behind. This is a long procedure. Most people need to stay in the hospital for 5 to 10 days. This treatment is most often done on men who have very large prostate glands.

Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Other, less-invasive procedures use heat to destroy prostate tissue. None have been proven to be better than TURP. Patients who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

· Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)

· Elderly patients

· Patients with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease

· Men who are taking blood-thinning drugs

In-Depth Treatment »

Back to TopSupport Groups

Some men may find it helpful to take part in a BPH support groups.

Back to TopReferences

Roehrborn CG. Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin North Am. 2011 Jan;95(1):87-100.

McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011 May;185(5):1793-803. Epub 2011 Mar 21.

McNicholas TA, Kirby RS, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 91.

Enlarged Prostate: A Complex Problem

There are many treatments for enlarged prostates (BPH), but all have side effects and possible complications. Learn what to expect -- and how to decide.

By Jeanie Lerche Davis

Listen

FROM THE WEBMD ARCHIVES

All his life, he slept like a stone. But now, there's an annoying trip to the bathroom every night, sometimes once or twice a night.

For most men, these nightly bathroom runs may be the first sign of an enlarged prostate. Other symptoms may include trouble starting a stream of urine, leaking, or dribbling. And, like gray hair, an enlarged prostate is a natural by-product of getting older, doctors say. Trouble is, the nightly bathroom runs become more frequent -- eventually edging their way into the daytime routine.

"They can't sit through a meeting or a plane flight without getting up," says Kevin Slawin, MD, a professor of urology at Baylor School of Medicine in Houston. "It's very annoying … and when they have to go, they really have to go."

It's a problem that has several names -- enlarged prostate, benign prostate hyperplasia, or simply BPH. According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, over one-half of men have BPH; by age 85, the number climbs to 90%, according to the American Urological Association (AUA).

Enlarged Prostate Symptoms and Causes

In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra -- the "chute" through which urine and semen exit the body.

As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.

Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.

Symptoms of enlarged prostate can include:

A weak or slow urinary stream
A feeling of incomplete bladder emptying
Difficulty starting urination
Frequent urination
Urgency to urinate
Getting up frequently at night to urinate
A urinary stream that starts and stops
Straining to urinate
Continued dribbling of urine
Returning to urinate again minutes after finishing

When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.

Time to Do Something About Your Enlarged Prostate?

Most men put up with an enlarged prostate for months, even years, before seeing a doctor, says Slawin. "When they're getting up several times a night, and have trouble falling asleep again, that's when they come in," he tells WebMD.

It's not always obvious what's going on, Slawin adds. "When men start having urinary problems, it's hard to know the reason. They should see a doctor when anything changes, because there can be bladder cancer, stones, prostate cancer. BPH is often a diagnosis of exclusion … after we make sure nothing more serious is going on."

Urologists use the BPH Impact Index, a symptom questionnaire developed by the American Urological Association to determine if a man's symptoms from BPH require treatment. "It helps us understand how severe the problem is," says Slawin. Higher scores indicate more severe symptoms.

Prostate growth -- and the trouble it causes -- varies greatly from person to person, says O. Lenaine Westney, MD, division director of urology at The University of Texas Medical School at Houston. "Some people have more growth than others. Some people with very large prostates don't have trouble with voiding. It's a very individual thing."

Watchful Waiting With an Enlarged Prostate

When the symptoms of an enlarged prostate gland are mild, with low scores on the BPH Impact Index (less than 8), it may be best to wait before starting any treatment -- what's known as "watchful waiting."

With regular checkups once a year or more often, doctors can watch for early problems and signs that the condition is posing a health risk or a major inconvenience. That's where the BPH Index is especially helpful, Westney tells WebMD. "It lets us know how high the symptom score is … when to start treatment."

The "driving force in treatment," she explains, is whether the symptoms are affecting your quality of life -- and whether a blockage is causing serious complications, such as inability to urinate, blood in the urine, bladder stones, kidney failure, or other bladder problems.

A few questions to ask yourself:

How severe are your symptoms?
Do symptoms prevent you from doing things you enjoy?
Do they seriously affect your quality of life?
Are they getting worse?
Are you ready to accept some small risks to get rid of your symptoms?
Do you know the risks associated with each treatment?
Is it time to do something?

Deciding on Treatment for an Enlarged Prostate

A range of treatments can relieve enlarged prostate symptoms -- medications, minimally-invasive office procedures, and surgery. The best one for you depends on your symptoms, how severe they are, and whether you have other medical conditions.

The size of your prostate gland, your age, and your overall health will also factor into treatment decisions. What's best for a man in his 50s might not be optimal for an 80-year-old. An older man may want immediate symptom relief through drugs or surgery, whereas a younger man may lean toward a minimally invasive treatment. According to the American Urological Association, surgery often does the best job of relieving symptoms, but it also has more risks than other treatments.

Consider the options carefully with your doctor, says Westney. "We can start with medications, and if there's no improvement, we look at minimally invasive therapy to reduce a portion of the prostate," she tells WebMD. "These procedures are very effective, and side effects are very rare."

If symptoms are really bothersome -- or if you have complications like urine retention -- it may be best to bypass medication. The minimally invasive treatments have benefits over surgery, like quick recovery time; however, you may need a second procedure later on. There is also less risk of serious side effects like long-term incontinence or erection problems -- which can occur rarely with surgery.

Medications for an Enlarged Prostate

Several drugs are FDA-approved to relieve common symptoms of an enlarged prostate. Each works differently, says Westney. They either shrink the enlarged prostate or stop the prostate cell growth, she explains. "For many men, medications are very effective," Westney tells WebMD. "They have a significant change in symptoms, and side effects are very uncommon … so medications are an attractive treatment."

Doctors use the BPH Index to gauge how the patient responds to medication, Westney adds. "We see how symptoms are progressing … if they've stabilized or not."

Alpha blockers: These drugs don't reduce the size of the prostate, but they are very effective at relieving symptoms. They work by relaxing the muscles around the prostate and bladder neck, so urine can flow more easily. These drugs work quickly, so symptoms improve within a day or two. They are most effective for men with normal to moderately enlarged prostate glands.

The drugs: Flomax (tamsulosin), Uroxatral (alfuzosin), Hytrin (terazosin), Cardura (doxazosin), and Rapaflo (silodosin).

Alpha blockers were originally created to treat high blood pressure; dizziness is the most common side effect; other side effects are generally mild and controllable. Possible side effects include headache, stomach irritation, and stuffy nose. These drugs are not for men with significant urine retention and frequent urinary tract infections.

5-Alpha reductase inhibitors: These drugs can partially shrink the prostate by reducing levels of a male hormone -- dihydrotestosterone (DHT) -- which is involved in prostate growth. These drugs take longer to work than alpha blockers, but there is urine flow improvement after three months. These drugs can reduce risk of acute retention (inability to urinate) -- and also reduce the need for prostate surgery. You may need to take them for 6 to 12 months to see if they work.

The drugs: Proscar (finasteride) and Avodart (dutasteride).

Possible side effects include erection problems, decreased sexual desire, and reduced amount of semen. These side effects are generally mild and may go away when you stop taking the drugs -- or after the first year of taking the drugs.

There is also drug combination therapy, which may be effective against symptoms associated with BPH. Some examples of combined drugs include an alpha-blocker and a 5-alpha-reductase inhibitor; or an alpha-blocker and an anticholinergic.

Minimally Invasive Treatments for an Enlarged Prostate

When medications don't help your enlarged prostate, several procedures can relieve symptoms -- without surgery. They are performed in a doctor's office. "These procedures use various types of heat energy to shrink a portion of the prostate," explains Westney. "They are very effective."

TUMT (transurethral microwave thermotherapy): This therapy for mild to moderate blockage reduces urinary frequency, urgency, straining, and intermittent flow -- but does not correct any bladder-emptying problems. In this procedure, computer-regulated microwaves are used to heat portions within the prostate to destroy select tissue. A cooling system protects the wall of the urethra during the procedure. TUMT is performed in a doctor's office and requires only topical anesthesia and pain medications.

Possible side effects include painful urination for several weeks. Temporary urgency and frequency of urination is also possible. There may be less semen ejaculated. Many men must have this procedure repeated, either because symptoms return or do not improve.

TUNA (transurethral radio frequency needle ablation): This procedure also destroys prostate tissue to improve urine flow and relieve symptoms. It involves heating the tissue with high-frequency radiowaves transmitted by needles inserted directly into the prostate (some anesthesia is used). The procedure does not require a hospital stay. Possible side effects include painful, urgent, or frequent urination for a few weeks.

Prostatic stents: In some cases, a tiny metal coil called a stent can be inserted in the urethra to widen it and keep it open. Stenting is done on an outpatient basis under local or spinal anesthesia. Usually, stents are only for men who are unwilling or unable to take medications -- or who are reluctant or unable to have surgery. The majority of doctors don't consider stents a good option for most men.

There could be serious side effects, and some men find that stents don't improve their symptoms. Sometimes a stent shifts position, which can worsen the symptoms. In some cases, men experience painful urination or have frequent urinary tract infections. Stents are expensive, and there can be difficulty in removing them.

Surgery for an Enlarged Prostate

For most men with very enlarged prostates, surgery can relieve symptoms -- but there are both risks and benefits with each type of operation. Discuss them with your doctor. After a careful evaluation of your situation and your general medical condition, your doctor will recommend which is best for you.

TURP (transurethral resection of the prostate): This is the most common surgery for an enlarged prostate, and considered to bring the greatest reduction in symptoms. Only the tissue growth that is pressing against the urethra is removed to allow urine to flow easily. The procedure involves an electrical loop that cuts tissue and seals blood vessels. Most doctors suggest using TURP whenever surgery is required, as it is less traumatic than open surgery and requires shorter recovery time.

With the TURP procedure, patients can expect to have retrograde ejaculation afterwards, says Westney. This is a condition in which a man ejaculates backward into the bladder instead of through the urethra. "Retrograde ejaculation generally isn't painful," she tells WebMD. "It shouldn't be an issue unless fertility is a concern." Other possible side effects include blood loss requiring transfusion (rare), painful urination, recurring urinary tract infections, bladder neck narrowing, and blood in the urine.

After TURP, the odds of erection problems range from 5% to 35%. However, this is often temporary -- and the ability to have an erection and an orgasm returns after a few months.

TUIP (transurethral incision of the prostate): This procedure involves making cuts in the prostate instead of removing prostate tissue. These cuts reduce pressure on the urethra, making urination easier. Patients go home the same day, and wear a catheter for a day or two.

Symptom relief is slower with TUIP, compared with TURP. However, most men are satisfied with their ultimate symptom relief from this. Also, retrograde ejaculation is less common and less severe than after TURP. Risk of erection problems is similar to TURP.

Laser Surgery: This procedure uses a high energy vaporizing laser to destroy prostate tissue. It is done under general anesthesia and may require an overnight stay at the hospital. It provides immediate relief of symptoms, yet men may suffer from painful urination for a few weeks. In general this procedure causes less blood loss, and side effects can include retrograde ejaculation. These procedures include:

Transurethral holmium laser ablation of the prostate (HoLAP)
Transurethral holmium laser enucleation of the prostate (HoLEP)
Holmium laser resection of the prostate (HoLRP)
Photoselective vaporization of the prostate (PVP)

Open Prostate Surgery (Prostatectomy): When a transurethral procedure cannot be used, open surgery (which requires an incision in the abdomen) may be used. This allows the surgeon to remove tissue in the prostate. Open prostatectomy is typically done when the prostate gland is greatly enlarged, when there is bladder damage, if there are bladder stones, or if the urethra is narrowed. The inner part of the prostate is removed. This surgery is done under general or spinal anesthesia, and recovery can take a few weeks to several months.

Side effects are similar to TURP, including blood loss requiring a transfusion, urinary incontinence, erection problems, and retrograde ejaculation.

Herbal Therapies for an Enlarged Prostate

Several herbal supplements are marketed for enlarged prostates. Saw palmetto, beta-sitosterol, and pygeum are all are widely used in Europe. They are available in the U.S. and don't require a prescription.

However, researchers and doctors are cautious about advising patients to try herbal supplements. Because they are not FDA-regulated, there are concerns about a product's quality from batch to batch, according to the NIH's Office of Dietary Supplements. Also, the safety of an herbal product depends on many things -- the chemical makeup, how it works in the body, how it is prepared, and the dosage.

Something else to consider: Like any drug, a herbal remedy can affect how other medications or treatments work, or interact dangerously with your other medications. They can also have side effects. And, the AUA points out, they have not been well-studied for effectiveness or safety.

Before trying any alternative treatment, learn as much as you can about it, the AUA says. Most importantly -- talk to your doctor before you try an herbal remedy. Many doctors consider alternative therapies like saw palmetto to "have no effect on symptoms, except as expensive placebos," Slawin tells WebMD.

Saw palmetto: Saw palmetto is one of the most popular herbal supplements taken for BPH. The extract comes from ripened berries of the saw palmetto shrub. Extracts are thought to prevent testosterone from breaking down and triggering prostate tissue growth, similar to the 5-alpha reductase inhibitor medications. Studies of this supplement have had varied results.

"Saw palmetto does not work," Slawin tells WebMD. He points to a recent "very nicely done" randomized study that found palmetto was no more effective than a placebo in relieving BPH symptoms. However, other studies have found it to be as effective as Proscar, a BPH medication. Varying quality of herbal products (dosages, ingredients, or purity) may account for the conflicting results, researchers say. Also, many studies of herbals have not been well-controlled.

Beta-sitosterol: This compound is extracted from pollen of rye grass. There has been some evidence that it provides relief from urinary symptoms. However, in four studies the supplement did not increase urinary flow rates, shrink the prostate, or improve bladder emptying.

Pygeum: This extract comes from the bark of the African plum tree. Numerous studies have found positive results for pygeum. In 18 studies, this extract relieved BPH symptoms twice as often as the placebo; it also increased urinary flow by nearly 25%.

Enlarged Prostate Treatments in the Pipeline

Researchers continue to investigate new therapies for enlarged prostates. "Another category of drugs is under development," says Slawin. "We've come a long way in treating BPH. It's no longer the life-threatening disease it once was. Now, in treatment, we're working on quality of life issues… reducing side effects of treatment."

Also being studied is a procedure called water-induced thermotherapy (WIT), an experimental procedure that involves destroying excess prostate tissue utilizing heated water and an air-filled balloon, which protects normal prostate tissue. The procedure is performed with only local anesthesia. Results may not be fully apparent for three to four months. However, preliminary studies examining WIT have shown positive results, with a near doubling in urine flow. However, the American Urological Association has not thus far endorsed WIT as a viable treatment option for symptoms of BPH.

Considering taking medication to treat Enlarged Prostate? Below is a list of common medications used to treat or reduce the symptoms of Enlarged Prostate. Follow the links to read common uses, side effects, dosage details and read user reviews for the drugs listed below.

Your search for Enlarged Prostate returned the following treatments.

DRUG NAME	INDICATION	TYPE	USER REVIEWS

Flomax oral			582 User Reviews
Cialis oral			399 User Reviews
Avodart oral			215 User Reviews
tamsulosin oral			191 User Reviews
finasteride oral			168 User Reviews
Rapaflo oral			163 User Reviews
terazosin oral			136 User Reviews
Uroxatral oral			125 User Reviews
doxazosin oral			92 User Reviews
prazosin oral			76 User Reviews
Jalyn oral			57 User Reviews
Cardura oral			53 User Reviews
Proscar oral			47 User Reviews
alfuzosin oral			42 User Reviews
tadalafil oral			35 User Reviews
Minipress oral			26 User Reviews
silodosin oral			9 User Reviews
Adcirca oral			7 User Reviews
dutasteride oral			7 User Reviews
Cardura XL oral			7 User Reviews
dutasteride-tamsulosin oral			3 User Reviews
tadalafil oral (antihypertensive)			Be the first to review it

Learn about User Reviews and read IMPORTANT information about user generated content

Proscar Side Effects

Proscar

Pronunciation

Generic Name: finasteride (fih NAH steh ride)
Brand Names: Propecia, Proscar

What is Proscar?

Proscar prevents the conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is involved in the development of benign prostatic hyperplasia (BPH).

Proscar is used to treat symptoms of benign prostatic hyperplasia (BPH) in men with an enlarged prostate.

Proscar may also be used for purposes not listed in this medication guide.

Important information

Proscar should never be taken by a woman or a child. Finasteride can be absorbed through the skin, and women or children should not be permitted to handle Proscar tablets.

Although Proscar is not for use by women, this medication can cause birth defects if a woman is exposed to it during pregnancy. Proscar tablets should not be handled by a woman who is pregnant or who may become pregnant. If a woman accidentally comes into contact with this medication from a broken or crushed tablet, wash the area with soap and water right away.

SLIDESHOW

View Frightful (But Dead Serious) Drug Side Effects

Before taking Proscar, tell your doctor if you have ever had an allergic reaction to finasteride, or to a similar medicine called dutasteride (Avodart).

Using Proscar may increase your risk of developing prostate cancer. Your doctor will perform tests to make sure you do not have other conditions that would prevent you from safely using Proscar.

Call your doctor at once if you notice any breast lumps, pain, nipple discharge, or other breast changes. These may be signs of male breast cancer.

Before taking this medicine

Proscar should never be taken by a woman or a child. Finasteride can be absorbed through the skin, and women or children should not be permitted to handle Proscar tablets.

To make sure you can safely take Proscar, tell your doctor if you have any of these other conditions:

· liver disease, or abnormal liver enzyme tests;

· prostate cancer;

· a bladder muscle disorder;

· stricture of your urethra;

· if you are unable to urinate; or/p>

· if you have ever had an allergic reaction to a similar medicine called dutasteride (Avodart).

Using Proscar may increase your risk of developing prostate cancer. Your doctor will perform tests to make sure you do not have other conditions that would prevent you from safely using finasteride.

How should I take Proscar?

Take Proscar exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Take this medicine with a full glass of water.

Proscar can be taken with or without food. Take the medicine at the same time each day.

To be sure Proscar is helping your condition and not causing harmful effects, your blood may need to be tested often. Your doctor will also test your prostate specific antigen (PSA) to check for prostate cancer. Visit your doctor regularly.

Use Proscar regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store Proscar at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid?

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Proscar side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Proscar: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you notice any breast lumps, pain, nipple discharge, or other breast changes. These may be signs of male breast cancer.

Less serious Proscar side effects may include:

· impotence, loss of interest in sex, or trouble having an orgasm;

· abnormal ejaculation;

· swelling in your hands or feet;

· swelling or tenderness in your breasts;

· dizziness, weakness;

· feeling like you might pass out;

· headache;

· runny nose; or

· skin rash.

The sexual side effects of Proscar (decreased libido, trouble having an erection, ejaculation problems) may continue after you stop taking this medication. Talk to your doctor if you have concerns about these side effects.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Proscar?

There may be other drugs that can interact with Proscar Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

In Summary

Common side effects of Proscar include: impotence and decreased libido. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to finasteride: oral tablet

As well as its needed effects, finasteride (the active ingredient contained in Proscar) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking finasteride, check with your doctor immediately:

More common:

· Chills

· cold sweats

· confusion

· dizziness, faintness, or lightheadedness when getting up from a lying or sitting position

Less common:

· Bloating or swelling of the face, arms, hands, lower legs, or feet

· breast enlargement and tenderness

· hives or welts

· itchy skin

· rapid weight gain

· redness of the skin

· skin rash

· swelling of the lips and face

· tingling of the hands or feet

· unusual weight gain or loss

Incidence not known:

· Clear or bloody discharge from the nipple

· dimpling of the breast skin

· inverted nipple

· lump in the breast or under the arm

· persistent crusting or scaling of the nipple

· redness or swelling of the breast

· sore on the skin of the breast that does not heal

Minor Side Effects

Some finasteride side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:

· Decreased interest in sexual intercourse

· inability to have or keep an erection

· loss in sexual ability, desire, drive, or performance

Less common:

· Runny nose

· sleepiness or unusual drowsiness

· sneezing

· stuffy nose

Less common or rare:

· Abdominal or stomach pain

· back pain

· decreased amount of semen

· diarrhea

· dizziness

· headache