alpha(1)-Adrenoceptor antagonists are now well established as the most common treatment for
lower urinary tract symptoms (LUTS) suggestive of bladder outflow obstruction associated with
benign prostatic hyperplasia. Both alpha(1)-adrenoceptor antagonists and 5alpha-reductase inhibitors are accepted treatments for LUTS, but with
finasteride this applies only to patients with clinically enlarged prostates, whereas alpha(1)-adrenoceptor antagonists are considered to be appropriate treatment for all patients, irrespective of prostate size. Systematic analyses of placebo-controlled studies show that commonly used alpha(1)-blockers are significantly superior to placebo in improving urinary flow and reducing symptoms. Efficacy of alpha-blockers appears to be well maintained over time, and there is no evidence of tolerance or tachyphylaxis to alpha(1)-blockade after 6-12 months' usage. Direct comparative trials show that, in the short term, alpha(1)-adrenoceptor antagonists are more effective than
finasteride in reducing symptom score. For alpha(1)-adrenoceptor antagonists, the most commonly reported adverse effects are
dizziness,
asthenia,
postural hypotension, and
syncope.
Alfuzosin has a more pronounced effect on blood pressure than does
tamsulosin, especially in elderly patients.
Tamsulosin is well tolerated and has minimal effects on blood pressure;
tamsulosin 0.4 mg has the lowest potential to reduce blood pressure and causes less symptomatic
orthostatic hypotension than
terazosin.