α1-adenoceptor antagonists for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH):: State of the art

An update of an analysis of placebo-controlled and direct-comparative studies with alpha(1)-AR antagonists in LUTS/ BPH was performed to assess whether the alpha(1)-adrenoceptor (AR) antagonists currently available for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) (alfuzosin, terazosin, doxazosin and tamsulosin) can be differentiated with regard to efficacy and/or tolerability. It appears that all alpha(1)-AR antagonists have a comparable efficacy. Total symptom score is improved by 30-45% and maximum flow rate (Q(max)) by 15-30% versus baseline. alpha(1)-AR antagonists that can be started at their full therapeutic dose seem to have a more rapid onset of action than alpha-AR antagonists that have to be titrated. The difference between alpha(1)-AR antagonists is related to their tolerability, with alfuzosin (especially the prolonged release (XL) once daily formulation) and tamsulosin (especially the 0.4 mg once daily dose) being better tolerated than terazosin and doxazosin. Abnormal ejaculation has mainly been reported in placebo-controlled trials with tamsulosin. However in direct-comparative trials its incidence with tamsulosin was comparable or slightly higher than that with alfuzosin. Furthermore, few patients (<1%) discontinue treatment due to abnormal ejaculation and overall sexual function is slightly improved by both alfuzosin and tamsulosin. Tamsulosin tends to interfere less with blood pressure control and to induce less vasodilatory adverse events (AEs) than alfuzosin, especially in the elderly and patients with cardiovascular disease and/or co-medication. Vasodilatory AEs may, especially in patients who are more prone to these AEs such as the elderly and/or patients with cardiovascular/hypertensive co-morbidity and/or co-medication, lead to serious complications such as falls, fractures and even institutionalisation. Therefore an alpha(1)-AR antagonist which has a low potential to induce vasodilatory AEs, also in the elderly and/or patients with cardiovascular comorbidity and/or co-medication, is a first choice treatment in patients with LUTS/BPH. (C) 2004 Published by Elsevier B.V.