If you are like many of the 14 million men in the United States who have been diagnosed with benign prostatic hyperplasia (BPH), you’ve probably been taking the same medication, at the same dose, for years. If so, consider the experiences of two patients, both of whom were taking some type of medication for BPH. Their names have been changed, but all other details are accurate (see “Jack Muriel” and “Henry Banks” below).
At 64, Jack was taking tamsulosin (Flomax) for moderate BPH but otherwise was in good health. Recently retired, he looked forward to a weekly round of golf with friends at a local country club. One evening, while driving home to meet his wife for dinner, Jack suddenly became lightheaded. He felt as if he were about to faint. He managed to pull the car over to the side of the road and call for help. While dialing, he thought, “Maybe I shouldn’t have taken the Viagra and Flomax at the same time.”
At 77, Henry was generally in good health, but had been taking terazosin (Hytrin) for his BPH for years. At one point, after Henry experienced a bout of unexplained abdominal pain, his internist ordered an abdominal CT scan to determine the problem. As instructed by the radiology department, Henry drank large quantities of water before the procedure. The CT scan itself went fine, but afterward, Henry found he could not urinate, even though his bladder was full. Instead of returning home after the CT scan, Henry wound up in the emergency room, where he had to have a catheter inserted.
Jack and Henry experienced unexpected consequences while taking a BPH medication. Fortunately none of these consequences had long-lasting health effects — and they could be avoided in the future by making some adjustments. In Jack’s case, the problem was mixing a BPH medication with one for erectile dysfunction. Although many men use both medications without difficulty, some may need to take precautions. Henry might have been able to avoid a visit to the emergency room if, before getting a computed tomography (CT) scan, he’d told the radiologist that he had been taking a medication for severe BPH.
Certainly some type of adverse event, such as these men experienced, might make you wonder if it’s time to adjust the dose of your medication or perhaps even change medications. But there are other considerations as well. Every man is different. In this article, you’ll learn about the types of issues many men with BPH have confronted, and what situations might indicate it’s time to consider a change in medication.
Issues to consider
The two classes of drugs currently approved to treat BPH — alpha-1 blockers and 5–alpha-reductase inhibitors — work in entirely different ways, and therefore raise different types of issues. So it’s important to understand these differences as you evaluate which medications might be right for you.
Simply put, alpha-1 blockers deal with the “going” problem by relaxing certain muscles in the prostate and urinary tract, while 5–alpha-reductase inhibitors deal with the “growing” problem by reducing the size of the prostate (see Figure 1).
Figure 1. How BPH medications work
The alpha-1 blockers are classed into two groups. The selective agents, alfuzosin (Uroxatral), silodosin (Rapaflo), and tamsulosin (Flomax, generic), work primarily on the tissues of the urinary tract. The nonselective agents, doxazosin (Cardura, generic) and terazosin (Hytrin, generic), affect both the urinary tract and other tissues elsewhere in the body. The 5–alpha-reductase inhibitors, which include dutasteride (Avodart) and finasteride (Proscar, generic), act directly on the prostate.
Other medications are in development (see “Anticholinergic drugs” and “PDE-5 inhibitors,” below), but are not yet available. So for now, you’ll have to weigh the relative risks and benefits of alpha-1 blockers and 5–alpha-reductase inhibitors.
These medications are used to quiet overactive bladder muscles, which can lead to urinary incontinence. Investigators have discovered in the past few years that more than half of men with BPH also suffer from overactive bladder, and that this may further exacerbate urinary difficulties. Researchers are now investigating whether taking anticholinergic drugs can ease BPH symptoms.
When it comes to recommending one drug or another, urologists often use some general guidelines: Alpha-1 blockers are better at relieving urinary symptoms such as difficult or frequent urination, and are best for men with smaller prostate glands. But 5–alpha-reductase inhibitors may be in order if you have a large prostate gland or have not obtained sufficient relief from alpha-1 blockers. And they have a stronger track record for reducing the chance that you’ll need surgery or will experience complications such as acute urinary retention. Sometimes the medications are prescribed in combination.
Time to change?
Any of the following suggests that you should re-evaluate your BPH medication:
- Your BPH symptoms worsen, even though you are taking your current medication.
- You notice side effects that weren’t affecting you before.
- You start taking a drug for some other medical condition — or add drugs to an existing regimen (for example, you add another medication to help control your high blood pressure).
- You start taking a drug for erectile dysfunction.
Speed of relief
The alpha-1 blockers work quickly, taking effect in days to weeks. But the nonselective agents may require some patience, as doses have to be increased slowly at first, to avoid lowering your blood pressure too much. Doctors usually start with 1 milligram (mg) at bedtime, then gradually increase it as needed to a maximum of 10 mg of terazosin or 8 mg of doxazosin. This process, known as titration, may be frustrating for you as well because you will need to wait to find the correct therapeutic dose.
Dosing is simpler for the selective alpha-1 blockers. For tamsulosin, you take 0.4 mg or 0.8 mg half an hour after dinner. Alfuzosin is a time-release formulation, so a single 10-mg tablet is taken once a day immediately after a meal.
With the 5–alpha-reductase inhibitors, it takes longer to feel the results. These drugs shrink the prostate by reducing levels of the male hormone dihydrotestosterone (DHT), which promotes prostate growth. Levels of DHT fall precipitously after several weeks of taking a 5–alpha-reductase inhibitor, but it may take at least three to six months, and perhaps even longer, before you notice any improvement in urine flow.
When it comes to BPH, are two drugs better than one? The Medical Therapy of Prostatic Symptoms (MTOPS) study indicated that the answer may be yes — at least for some men. In the study, 3,047 men with BPH were randomly assigned to take doxazosin (Cardura), finasteride (Proscar), a combination of the two, or a placebo. After roughly four and a half years of observation, the combination reduced the risk of BPH progression (symptoms getting worse) by 66% when compared with placebo, significantly more than either drug alone. Compared with placebo, doxazosin reduced BPH progression by 39%, and finasteride reduced it by 34%.
A 2006 reanalysis of the MTOPS data according to prostate gland size found that combination therapy provided the most benefit to men whose prostate glands were 25 grams or greater in size (see “MTOPS study and reanalysis,” below).
MTOPS study and reanalysis
McConnell JD, Roehrborn CG, Bautista OM, et al. The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia. New England Journal of Medicine 2003;349:2387–98. PMID: 14681504.
Marberger M. The MTOPS Study: New Findings, New Insights, and Clinical Implications for the Management of BPH. European Urology Supplements 2006;5:628–33.
Some men with large prostates try combination therapy to get fast relief for their symptoms from the alpha-1 blockers. In six months or so, when the 5–alpha-reductase inhibitors begin taking effect, these men may stop taking the alpha-1 blockers.
However, you should consider two additional pieces of information when contemplating whether to start combination therapy: cost and side effects. First, taking two pills is more expensive. If you have to pay for medications on your own, or if your insurance company requires some type of co-pay, you may want to figure cost into the equation. Second, although the MTOPS study found that side effects were similar whether men took one drug or the combination, many experts feel differently, based on the patients they see.
High blood pressure
The nonselective alpha-1 blockers block alpha receptors in the heart and blood vessels as well as in the prostate, lowering blood pressure in the process. While these agents are usually not the first choice for blood pressure control, they may be a good choice for men who have both BPH and high blood pressure. If you want to limit the number of different medications you are taking, ask your doctor whether using a nonselective alpha-1 blocker might enable you to control both your BPH and your blood pressure — and then monitor both your urinary symptoms and your blood pressure to make sure the medicine is really working for you.
If you are already on another medication to control your blood pressure, or are taking an erectile dysfunction drug, then taking a nonselective alpha-1 blocker carries the risk that you will experience lightheadedness, faintness, dizziness, or postural hypotension (a drop in blood pressure that occurs when you sit or stand quickly, as when getting up from a chair or out of bed). Although a panel of Harvard experts thought the risk of hypotension was minimal, it’s still worth knowing about. Sudden episodes of low blood pressure can be dangerous if you already have some type of vascular disease, because it increases your risk of suffering a heart attack or stroke.
Similarly, because of these side effects, the nonselective alpha-1 blockers may not be the best choice for you if your blood pressure is already on the low side.
The selective alpha-1 blockers, alfuzosin, silodosin, and tamsulosin, have less of an impact on blood pressure, so they may be good alternatives in these situations. (Men taking silodosin may notice a drop in blood pressure upon standing.) Or consider taking a 5–alpha-reductase inhibitor.
The nonselective alpha-1 blockers (doxazosin and terazosin) are available now in generic as well as brand name formulations, and so may save you some money (see Table 1). Of course this may also depend on what type of drug coverage is included in your health insurance plan, and how much of a co-pay you need to contribute.
Table 1. Cost of BPH drugs compared
The costs below are based on average wholesale prices to pharmacists and the lowest dosage; costs to patients may be more.
|Drug class||Generic name (brand name)||Estimated cost per month for generic, if available||Estimated cost per month for brand name medication|
|Nonselective alpha-1 blockers||doxazosin (Cardura), 1-mg tablets||$17.99||$51.67|
|terazosin (Hytrin), 10-mg tablets||$13.99||n/a|
|Selective alpha-1 blockers||alfuzosin (Uroxatral), 10-mg tablets||n/a||$129.16|
|silodosin (Rapaflo), 8-mg capsules||n/a||$124.99|
|tamsulosin (Flomax), 0.4-mg tablets||$120.99||$142.18|
|5–alpha-reductase inhibitors||dutasteride (Avodart), 0.5-mg capsules||n/a||$123.57|
|finasteride (Proscar), 5-mg tablets||$70.08||$112.99|
|Prices given are those charged by the online retailer drugstore.com as of Oct. 1, 2010 for a one-month supply (30 capsules or tablets). They do not take any discounts or insurance coverage into consideration. Drug prices may vary, and your pharmacy may charge more.|
Sexual side effects
Because they affect levels of the male hormone testosterone, the 5–alpha-reductase inhibitors may cause a variety of sexual side effects. In the original clinical trials, 3.7% of men taking these drugs (and 4%–6% by some other estimates) developed erectile dysfunction. Another 3.3% of men experienced a decline in libido, while 2.8% had problems ejaculating during an orgasm.
In addition, one of the selective alpha-1 blockers, tamsulosin, causes ejaculation problems in some men who take it. The other alpha-1 blockers may cause less of this problem.
Erectile dysfunction is treatable with three medications, and it is generally safe to take these drugs when you are taking your BPH medication, whether it is an alpha-1 blocker or a 5–alpha-reductase inhibitor; however, we offer some important cautionary advice.
If you develop problems with ejaculation during sex, the solution depends on what medication you are taking. If you are taking a 5–alpha-reductase inhibitor, the only way to resolve the ejaculation difficulties is to stop taking the BPH medication, so you may need to decide on another medication (or surgery) to deal with your urinary difficulties. However, if you are taking tamsulosin, you may be able to alleviate ejaculation problems by taking the drug every other day (see “Alternate days,” below).
Investigators asked 140 men with BPH to take 0.4 mg of tamsulosin (Flomax) daily for three months. If the men responded to tamsulosin, they were randomized to one of three groups. One group continued taking the medication daily, the second took the same dose every other day, and the third stopped taking the drug. Men taking tamsulosin every other day did just as well as those taking it daily, and experienced fewer side effects such as ejaculation problems.
Source: Yanardag H, Goktas S, Kibar Y, et al. Intermittent Tamsulosin Therapy in Men with Lower Urinary Tract Symptoms. Journal of Urology 2005;173:155–7. PMID: 15592062.
Gynecomastia (breast enlargement), another possible side effect of the 5–alpha-reductase inhibitors, is rare but is distressing when it occurs. Stopping the medication may reverse the problem. But not always: Some men have had to undergo breast reduction surgery — or learn to live with the changes.
Medications for erectile dysfunction
Three medications have been approved for the treatment of erectile dysfunction: sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These medications are all PDE-5 inhibitors, which generate nitric oxide, a chemical that enables arteries to widen. The increased blood flow to the penis helps to produce an erection. The problem is that arteries elsewhere in the body widen as well, causing a slight drop in blood pressure.
If you are considering an erectile dysfunction medication, you don’t have to worry if you are also on one of the 5–alpha-reductase inhibitors for your BPH: The drugs can be taken together without adverse effects. However, if you are currently using, or considering, an alpha-1 blocker, you may want to take some precautions when adding one of the PDE-5 inhibitors.
Here’s why: Because the PDE-5 inhibitors cause a system-wide drop in blood pressure, theoretically they can exacerbate the blood pressure–lowering action of the nonselective alpha-1 blockers doxazosin and terazosin. This seems especially to be a problem when taking sildenafil (Viagra) and vardenafil (Levitra); tadalafil (Cialis) is a longer-acting PDE-5 inhibitor, and the risks are less clear.
As a result, some doctors recommend that if you are using a nonselective alpha-1 blocker for BPH, you should avoid taking an erectile dysfunction medication altogether. However, our panel of Harvard experts think the concerns are overblown. If you don’t want to stop using a nonselective alpha-1 blocker for your BPH, you can make sure you take the PDE-5 inhibitor at different times of the day (take one medication after lunch, say, and the other in the evening) to avoid problems.
Or you can lower the dose of your alpha-1 blocker or PDE-5 inhibitor. That is what Jack Muriel eventually decided to do. He’d taken his BPH medication, Flomax, along with Viagra before heading home to have dinner with his wife. The combination created the dizziness that caused him nearly to run off the road. His doctor suggested he try lowering his dose of Viagra in the future, to 25 mg (from the 100–200 mg he’d been taking), because that would lessen the chance of dizziness if he took it along with the Flomax. Or, if that dose was not sufficient, he could try 50 mg of Viagra. But to prevent problems, he needed to make sure that he took it at least four hours before (or after) he took the Flomax.
Could these medications, already approved to treat erectile dysfunction, also alleviate BPH symptoms? The answer may be yes, according to early studies of sildenafil (Viagra) and tadalafil (Cialis) — although the dosing is different than for erectile dysfunction. The medications may help by relaxing smooth muscle within the prostate, thereby improving the flow of urine. However, more research is needed.
The Prostate Cancer Prevention Trial showed that taking one of the 5–alpha-reductase inhibitors, finasteride, reduced the risk of developing prostate cancer by 24.8% — an astounding amount, and a result that would normally change the practice of medicine.
But here’s the bad news — and why you need to consider your choice of finasteride carefully: Men in the study who took finasteride were more likely to develop high-grade cancer (the type more likely to spread and become life-threatening) than those taking a placebo. In the PCPT study, high-grade prostate cancers developed in 37% of the men taking finasteride who developed tumors (6.4% of all the men taking finasteride), compared with 22% of the men taking placebo who developed tumors (5.1% of all men taking placebo).
So what’s going on? It’s not clear. The PCPT study has generated heated discussion, and one leading theory is that because finasteride shrank the prostate gland, doctors had a smaller target to sample, and were therefore more likely to find cancer. It is unclear whether the findings also apply to dutasteride, but because the drug is in the same class, most researchers think it does. For now, check with your own urologist for advice about what you should do.
Pay attention to PSA levels. If you decide to take a 5–alpha-reductase inhibitor, whether it’s only for your BPH symptoms or because you also want to reduce your overall risk of prostate cancer, you’ll need to understand how these medications will affect your PSA levels. In general, 5–alpha-reductase inhibitors tend to reduce PSA levels by about 50%, although the actual reduction varies from man to man. It is important to obtain a baseline PSA value before beginning treatment with one of these medications, and then have another after 6–12 months, to see how much the PSA has gone down after treatment. This follow-up PSA then becomes your new baseline.
You’ll need to figure this new baseline into your calculations as you monitor your PSA in the future. So, for example, if you start taking a 5–alpha-reductase inhibitor, and your PSA falls from 3 to 1.5, that’s to be expected. But if it should double over the course of a year, say from 1.5 back to 3, talk with your doctor about whether to have a prostate biopsy. Even though a value of 3 is considered “normal” in men not taking a 5–alpha-reductase inhibitor, a PSA value that doubles within a year of beginning one of these medications could indicate that cancer is present.
Acute urinary retention
Henry Banks developed acute urinary retention after drinking large quantities of water for a CT scan. This is a medical emergency, because if someone is unable to urinate and excrete urine, over time pressure that builds up in the bladder can adversely affect the kidneys, possibly leading to kidney failure — which is life-threatening.
For most men, of course, the most tangible worry about acute urinary retention is that they may have to have a catheter inserted to relieve pressure on their bladder — which is simply uncomfortable, bothersome, and potentially embarrassing (the catheter can sometimes leak, causing accidents). Sometimes a man can be weaned from the catheter and return to taking a BPH medication, but not always. A man who has developed acute urinary retention may need to consider surgical options to alleviate his symptoms.
Although BPH symptoms often remain stable, one study found that progression was likely in men with the following clinical profile:
- Age 62 years or older
- Prostate size of 31 grams or greater
- PSA of 1.6 ng/ml or greater
- Urine flow less than 10.6 ml per second
- Post-void residual of 39 ml or greater
Source: Crawford ED, Wilson SS, McConnell JD, et al. Baseline Factors as Predictors of Clinical Progression of Benign Prostatic Hyperplasia in Men Treated with Placebo. Journal of Urology 2006;175:1422–7. PMID: 16516013
To reduce your risk of developing acute urinary retention, you have two options. The first is to take some common-sense precautions, no matter what BPH medication you are on. Watch your intake of fluids, especially if you will be unable to urinate for a while (such as when you’re at a sporting event or on a long airplane trip). If your doctor recommends a medical test that requires you to drink fluids ahead of time, as Henry did, mention that you are taking a BPH medication and ask what your doctor advises.
Second, if you are at risk for acute urinary retention, it means your symptoms have progressed so that your urinary difficulties are moderate to severe in intensity (see “BPH progression,” above). It may be time to consider switching to a 5–alpha-reductase inhibitor. Because these medications reduce the size of the prostate and thus ease constriction of the urethra, they also reduce the risk of developing acute urinary retention and having to undergo surgery (see “Two additional benefits,” below).
Two additional benefits
A clinical trial involving more than 3,000 men, comparing finasteride (Proscar) with placebo, found that only 3% of men taking finasteride developed acute urinary retention (versus 7% taking placebo), and 5% eventually required surgery (versus 10% taking placebo).
Source: McConnell JD, Bruskewitz R, Walsh P, et al. The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment Among Men with Benign Prostatic Hyperplasia. New England Journal of Medicine 1998;338:557–63. PMID: 9475762.
Making a decision
Obviously the decision about whether to make some change in your medication regimen for BPH — whether it involves changing the dose or switching medications — is a complex one. You alone know how bad your urinary symptoms are, and what other health issues and trade-offs you need to consider.
Table 2 summarizes the salient information by drug and suggests the type of men who might want to consider taking one drug rather than another. Ultimately, of course, you are the authority when it comes to your own body, and different people metabolize drugs in different ways, so these general guidelines should be viewed as just that — general.
Even so, the information in this table, and in the rest of this article, may help you clearly evaluate your medication options. And if you ultimately decide that medications are not providing you with sufficient relief, it may be time to look into surgical options.
Table 2. General guidelines for BPH medications
|Medication and mechanism of action||Potential side effects||You might want to consider using if||You may not want to use if|
|Alpha-1 blockers (nonselective)|
doxazosin (Cardura, generic)
terazosin (Hytrin, generic)
How they work
|Alpha-1 blockers (selective)|
tamsulosin (Flomax, generic)
How they work
finasteride (Proscar, generic)
How they work
Originally published Jan. 1, 2007; last reviewed April 22, 2011.
June 25, 2018
You can write to the editorial person regarding questions going unanswered here as well as for expressing concern that the article has not been updated since 2011.
Email address is: firstname.lastname@example.org
May 11, 2018
Hello, further to my Post of November 17; I have maintained a near Vegan diet, other than occasional fish and to my surprise the health benefits are significant. I no longer need any Omeprazole, I have lost 14lbs and Cholesterol reduced from 7 to 4.1. Most impressive is that I reduced Tamsulosin to alternate days and now enjoy undisturbed sleep and my sinuses are clear most of the time. Hope this helps someone. Best wishes.
April 30, 2018
My doctor discussed the use of 5 mg per day of cialis for bph. I currently take viagra 100 mg as needed which is rarely effective recently. If I start cialis 5 mg per day for bph, what do patients do when they need something for ed? Also, are there surgical procedures for bph that have minimal side effects on ed?
April 27, 2018
I am 63 with BPH with PSA of 9. On alfuzosin for about 4 months. Stopped working and had acute urinary retention and have had indwelling catheter for about 3 weeks and soon to have urodynamic study to see if TURP would help. Considering trying to do self catheter for a few months and switch to flowmax and/or other meds to see if condition improves. Is this trial with the self catheter worth it or is it best just move quickly with TURP?
April 25, 2018
Excellent advice! Thank you. I will certainly pass on the info to my husband and we’ll be able to make an informed decision.
April 15, 2018
I am 62 and have suffered from severe BPH for a while now. Anyone ever try Floxman and doxazosin together? Meaning alternating doses of each every other day. Each works a little differently, I have been curious about this. The literature warns against it. Also says we should not take PE medication, but many do.
mir ali khan
March 26, 2018
I too am taking 0.4 mg Flomax and 5 mg Finnastride for 2years……want to stop Finnastride as bad side effects….70 years now…any advice?
March 14, 2018
Hi my name’s Bill and I am 63 years old. I had my first PSA level test 2 months ago and the reading was 4.1. My GP told me that I had a BPH and prescribed me Tamsulosin 0.4 mg taken daily. After taking it for 3 weeks, I went for another PSA test and the reading was 3.17. Does Tamsulosin help lower the PSA level? I stopped using it since after my second PSA test because I noticed that I had trouble sleeping at night and I had to wake up two times to pee. One of the side effects of Tamsulosin is sleeplessness. Should I stop using this medicine and ask my GP to give me another similar prescription to treat my BPH? Are there any serious problems in the future if BPH is not treated?
Any people with same experience please share. Greatly appreciate any help.
February 6, 2018
I am a 66 year old male, recently retired. I had the Green Laser surgery about 5 years ago to treat my BPH and acute urinary retention. Last week, I had a repeat procedure, but this time it was the TURP. My Urologist had recommended that I start taking Finasteride (5mg) after the surgery. I am concerned with the risk of developing a aggressive type of cancer, is someone in a similar situation? My urologist doesn’t seem to be that much concern with the cancer risk. Thanks for any feedback.
January 13, 2018
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December 28, 2017
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November 24, 2017
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November 23, 2017
I am 72. I was diagnosed with BPH about 5 years ago and have been taking avodart since. About 2 yrs ago I was diagnosed with sleep apnea (fairly severe) and began using a cpap machine. Looking back I’ve probably had it for more than 30 years.
I understand that there is a fairly well established co-morbidity between sleep apnea and BPH.
Is there any research which would suggest that using cpap might ‘cure’ BPH and eliminate the need for the avodart?
I have had no significant side effects from the avodart but I know that any drug that inhibits anything in the hormonal system affects all kinds of things even if they aren’t obvious.
My experience with the cpap has been life changing – very positive on many fronts – presumably due to hormonal changes that have occurred because I’m now getting deep sleep.
November 16, 2017
Please update this article – the table has information that is over 7 years old.
November 16, 2017
I was diagnosed with chronic bacterial prostatitis, bph, and chronic pelvic pain syndrome at only 34 yrs old back in May. He started me immediately on daily Flomax .4mg and I also had a 6 wk course of Cipro followed by 6 wks of doxycycline. The stuffy nose effect of Flomax .4 is so bad for me that I’ve switched to taking it in the morning. I use Flonase sometimes to combat the stuffiness, but when it gets really bothersome for 3 or 4 days in a row then I temporarily switch to every other day dosing. Lately I’m back to getting up 2-4 times during the night to go pee. And I continue having twitching/spasm pains deep inside. I understand with the CPPS diagnosis that it’s a chronic pain issue, but I was surprised at my followup last week the urologist STILL WON’T check my PSA! He tells me I’m too young, etc but my prostate is already almost triple in size and prostate cancer runs rampant on both sides of my family! But since all my tests show I’m thoroughly voiding and my stream is strong, he thinks it’s just my bladder so I’ve now started a trial of 25mg Myrbetriq, will titrate up to 50mg next week if my BP doesn’t spike. The first couple days I could barely pee a dribble and it BURNED…nervous that the main risks are high BP, acute urinary retention, and UTI, but so far so good…
November 15, 2017
Hello, my name is Nic aged 64 and live in England. 3 months ago I changed my diet to almost Vegan; I eat some oily fish, in order to address digestion issues relating to a minor Hiatus Hernia. I achieved my goal in that after 8 years daily prescription I no longer need Omeprazole but do take half tsp Bicarbonate of Soda before bed. I also have an enlarged Prostate and for about 6 years have taken daily Tamsulosin. An unexpected development is that recently I have improved urine Flow and longer periods of undisturbed sleep. As a consequence I am about to reduce Tamsulosin 400 to alternate days and hope to improve my constant blocked sinuses. If I note reduced Flow or increased urgency I will resume daily Tam; blocked sinus is price I am prepared to pay. Hope this is of some help to someone. Best wishes to you all.
November 15, 2017
Hello, my name is Nic aged 64 and live in England. 3 months ago I changed my diet to almost Vegan (I eat some oily fish) in order to address digestion issues relating to a minor Hiatus Hernia. I achieved my goal in that after 8 years daily prescription I no longer need Omeprazole but do take half tsp Bicarbonate of Soda before bed. I also have an enlarged Prostate and for about 6 years have taken daily Tamsulosin. An unexpected development is that recently I have improved urine Flow and longer periods of undisturbed sleep. As a consequence I am about to reduce Tamsulosin 400 to alternate days and hope to improve my blocked sinuses. If I note reduced urine Flow or increased urgency I will resume daily Tam; blocked sinus is price I am prepared to pay. Hope this is of some help to someone. Best wishes to you all.
November 12, 2017
Has anyone been prescribed to take a double dose of Uroxatral (alfuzosin)? My urologist has me taking two 10 mg pills a day and it was working well – good flow and no urgency. I cut back to one dose a day and not working as well – more frequency and less flow. I am concerned about the double dose and was wondering if anyone else uses a double dose. Thanks.
November 11, 2017
This site is so very informative. Me I’m 65 I was taking Flomaxtra for a benign enlarged prostate they worked well enabling a better flow rate I stopped taking them for a short period whilst I undertook various tests after which the consultant advised I start taking it again but my GP advised me the type I was taking had changed to Flomaxtra XL 400 mg however they did not give me the same relief he then prescribed Alfuzosin 10mg but having read many reviews I have refrained from taking them or any other medication however things have deteriorated like poor flow resulting in taking up to 4 minutes to urinate, frequent visits to the toilet getting out of bed two to three times a night. So now I’m thinking of going back to the Flomaxtra XL 400 mg even though they stopped working. I don’t fancy the Finasteride due to the side effects. Is there another medication or a herbal remedy to help the flow? Thanks.
October 17, 2017
I am 60 years old and have been on finasteride for 4 years and Rapaflo for almost 3. Both have helped though their effectiveness are declining and now having ED issues and retrograde ejaculation as well as a significant lost of sexual desire. I now have esophageal spasms and one doctor recommended Cialis for that. But I don’t believe I can take Cialis and Rapaflo together. Should I consider switching to Cialis? That might help with a several other issues? Otherwise I’m in great shape but Rapaflo seems to also be zapping my energy much.
September 17, 2017
I’m a 78 year old male who has been afflicted with BPH and its associated luts for several years. My primary concern was nocturia as I was having to get 6-8 times each night to void. I have tried all the drugs therapies to include doxazosin, tamsulosin, finisteride, cialis, myrbetric, desmopressin, etc., both individually and in combination. None produced any significant improvement in my urinary issues. Finally, after much research, I elected to submit to surgery. In mid July, 2017, I underwent the PVP (Green Light photoselective vaporization of the prostate) procedure. All went well with no apparent complications. I had a Foley catheter for four days. For about two weeks after the surgery everything was perfect. I had a robust stream and felt I could put out a forest fire. Then I noticed a gradual decrease in my flow rate (Q). The decline in my flow rate continued to decline until at my four week post-op follow-up with my urologist/surgeon, my output velocity was less than before the surgery. My urologist attributed the decline to swelling of the prostate and urethra resulting from the surgery. Her plan was to wait an additional two months and re-evaluate. Unfortunately, my flow rate continued to decline to the point that by the first week in September (50 days post op) I had no stream at all and could only drip urine one drop at a time. I had a non-prostate related surgery on the 11th of September and for reasons unknown, I regained some improvement in my stream velocity after that surgery. My output is currently what I would characterize as a minimal dribbling intermittent steam. My urologist has scheduled a flow rate test and a cystoscope exam in the forthcoming weeks. I suspect there is a blockage somewhere and that the current voiding problem is not caused by swelling.
My conclusion is that the PVP procedure itself is safe and effective and I would consider it again. I think something was not done correctly by the surgeon during the procedure. I’m sure I’ll need another surgery to correct whatever is wrong. Meanwhile, as long as I can void by whatever means and avoid acute retention, I will fight on and try to attain a better quality of life by eliminating these troubling BPH issues.
September 17, 2017
Hi ,I just had TURP procedure done inside my prostate 16 days ago and in ok but I don’t see why I have to take BOTH Tamsulosin AND Finasteride since the prostate tissues blocking my urethra were removed and I can pee again already .I tried to not go the surgery route But as I tried with the Tamsulosin and Finasteride for 3 and half months to be able pee again without a catheter but to no avail was I able to urinate .Everytime the catheter was removed monthly to see if I could urinate normally it wouldn’t happen and another catheter would have to be inserted so after 4 tries of catheter removal to see if I could pee again over the 3 1/2 months catheterized I gave in to the operation.i just don’t think I need to be on the BPH Medications anymore or at least not both of the them.i think if one I have to take maybe Finasteride because it would continue to shrink my prostate and keep it shrunk and so there should be no future problem of prostate blockage ,thanks ,I feel for you guys , especially the guys who have experienced complete urinary retention and catheterization,aside from the really I’m formative article you guys helped too with information on BPH MEDS and processes
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July 17, 2017
Great article when written. But it badly needs updating. For example, generic Viagra is now available. I get it for 50 cents a pill (20mg). Yes, the pills are made here in the USofA. These pills can help with enlarged prostate problems. And to use them for ED you simply increase your dose on whoopee day.
June 26, 2017
If you can get away with not taking Finisteride and only using Tamulosulin that is about as good as it gets for me. Finisteride really crushes your t-levels and some docs will prescribe both in combination which is not needed. Very helpful information regarding BP levels and Tam. I do experience a bit less energy while taking it and found this article very helpful in understanding the medicine. I was considering testosterone therapy but will probably just adjust to the new normal. Bummer:)
April 4, 2017
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April 3, 2017
I was dx with Prostate CA somewhere around 2003-2008 (5% of 1 of 6 cores) and Gleason of 3+3. After 8-10 years and a 12-Core it was still confined to 1 core and increased from 5% to 10% of 1 core and no rise in the Gleason. I’ve been taking Finasteride for almost 10 years and latest PSA was 1.4 so I’m happy with the results and my Urologist is even happier. From my research, and more importantly with discussion with my urologist, I give a lot of credit to Finasteride’s 5-alpha reductase inhibitor’s ability for this achievement.
March 15, 2017
I see a lot of questions by guys who have posted above, but no answers…why is that? There are some very good questions that I would have liked to answers to….like, once you start taking Tamulosin, if you stop taking it, do you develop urinary retention or other problems? That would seem to indicate that once you start it, you become dependent/hooked on it!
March 11, 2017
I am in my 70s, Finasteride seems to work too well for me, in terms of promoting urination. However, frequency and urgency continue to be a problem. Also, I seem to bruise easily — like someone taking a blood thinner. Why is Finasteride not produced in a dosage below the 5 mg pill? I should add that I also take Tamsulosin 0.4 mg.
March 5, 2017
This is one of many high-quality articles by the Harvard prostate team and I really appreciate it! But…it was written over a decade ago, and only updated six years ago. Much has happened since then medically and so this piece DOES need to be rewritten or at least updated. 🙂
February 17, 2017
One of the best articles on the current state of medication for BPH. It says it was last reviewed in 2011, so an update seems to be in order. Perhaps you can add something about Free PSA too. Thank you.
February 12, 2017
Many thanks indeed to the Harvard writers, it is the best article of its scope that I have seen. And thanks too to the many who have written, may I join you now. I am 76 and have had enlarged prostate problems for many years. 3 years ago I was put on Duodart, the two component pill. My prostate was in excess of 120 cc, I made 30 or so trips to void the bladder each day. etc. Now my prostate is greatly reduced in size and depending on the amount of coffee, well the trips are greatly reduced. Downside – large boobs, smaller balls, body hair greatly reduced. weight increase, plus possibly other side effects.Now I am considering ceasing the Duodart medication.
February 6, 2017
I am 44 and I take Alfuzosin and Dutasteteride in the evening. I was hoping this medication is short term but I have since found out it’s long-term. I have pain when trying to get an erection and when I do retrograde ejaculation is frustrating.
Most people I tell ie dentist and so on say I’m far too young for an enlarged prostate.
Gerald h. Lewis
February 5, 2017
READ YOUR ARTICLE AND FOuND IT VERY INFORMATIVE. tHANKS FOR HAVING IT AVAILABLE.
December 23, 2016
My last post was 29 August:
Had the TURP (rotor rooter) procedure. Chose this one over microwave or hot wire material removal as it enables the doctor to recover material to send away (other procedures burn it all away) for pathology analysis = results NO signs of Cancer!!
Recovery required Cather in for three days and then all was great. No pain encountered. Strict rule is NO sex for 6 weeks. It has been three months now and I am doing great. If it snows I can now write my name in that snow from 5 ft away = lots of velocity!!! Most Urination urges have gone away and I sleep through the night Only draw back is when I urinate the volume is around 200 ML (regular) each time (yes – test indicate badder is empty after urination).
Sexual climax is different with no fluid out the penis but rather it goes backwards into the bladder and eventually out through normal urination. This sort of reduces the SUPER PEAK climax experienced before but still very satisfying — Also no mess!
I am very happy with the path I took!!!!
December 16, 2016
I am a 68 year old man who developed a problem of night time dribbling. Saw Urologist who put me on daily tamulosin and finasteride. Went for flow test and found out I was retaining urine. Started self catherisation x3 times a day. Been doing that for almost a year. Seems to be OK but wonder where it is all going?
Saw urologist last week, he was only interested in whether I wanted an op to assist in placing catheter.
Unfortunately, I have been on various antibiotics for last 4 months which initially shift infection but which returns days after course finishes. Now starting three month palliative antibiotic course.
I have a very enlarged prostate and an atonic bladder, not sure if the drugs will improve my situation. No ejaculate at all but no loss of libido.
December 10, 2016
I am 54 years old and was taking flomax and found it gave me an erection lasting 4 hours uncomfortable. Can I take flow max on an as needed basis.
November 27, 2016
I am 64 and taking Duodart. I have noticed decreased libido, impotence, Gynecomastia and runny nose. Sounds like Viaga can work for the occasions it is necessary and this dose can vary, as required
September 26, 2016
I am a 73 old male with diagnosed IC and OAB For the last 3 years i have received a Botox intraversical operation each year in my detrusor muscles to eleviate the problem of excessive wetting accidents Just recently my urologist also suggested i needed to take Duodart for the in between very limited urine flow. however it has been determined for some years ago that I cannot take any medication with anticholenergic conternt – like Flomax and Doudart since it makes me non responsive to anything. So is a prostate reduction operation now the only alternative or whar di “we” do?
September 21, 2016
Anyone on here have the 4K Score test done or there’s a new procedure called Rezum, anyone have this done ?
September 6, 2016
Has anyone here used or know of Trospium Chloride?
Trospium Chloride tablets USP are a muscarinic antagonist indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency.
September 3, 2016
I have had BPH for several years now and have taken several medications mentioned in this article, all to no avail. Currently, my urologist put me on oxybutynin chloride 5mg, twice a day. I have had no results from that either.
This medication is not mentioned in this article. Why not?
This article has been one of the better articles I have read but noticed, as one poster above stated, that there are no answers to questions from knowledgeable doctors.
August 29, 2016
My last post was 26 July 2016
Stopped the Cather process and am still on those pills, and NOT real happy with the pill consequence. #1 sex libido is down a lot. #2 Sex climax results in no fluid released which really diminishes the act of sex enjoyment.
Talked to the doctor and looked into Cialis as as an alternate to Finasteride, but found even though my medical plan would cover Cialis (once a day) for BPH, but the deductible cost was still close to $200 a month.
Really want to get off of these pill requirements, so I am going with the rotor router process, which my doctor noted (from experience) will relieve the prostrate restriction to flow problem for a good 8-10 years; where after that time estimate the process will be required again.
While waiting for the rotor rooter appointment (and still on both pills) I started to have to get up at night 3-4 times (this is after 4 months on the pills), so I started to use the Cather again but only just before bedtime (on average releasing about 300-400 ML) and thus being able to sleep through the night.
August 9, 2016
Very useful article. I am 86 and have BPH since I was 63. Now I take tamsulosin .4 mnd and finasteride 5 mg. I am happy with the result except I do have to Pee three times each night every 2.5 hours. I am on this regimen for the last two years. My concern is will i develop aggressive prostate cancer?
I read in this article that this was a possibility. So, should I drop Finasteride? What can happen if I do so. Please help.
July 28, 2016
Sure wish there were some answers posted to all these comments / Questions!!!!!
Prior to going to China I went my Urologist (noted to my General Practictinser during annual physical of frequent low volume urination issues) and he said PAS #’s looked OK over my last five years of Annual physicals and prostrate is slightly enlarged (I am 71 and very active), and come back and see him in 6 months.
Went to China for 20 days half way through the trip developed this sharp pain in my lowere left back. Everyone on the trip (including the chinees doctor on the riverboat) noted it sounded like a kidney stone symptom and that I should drink lots of water —
—–After 2 days of pain a trip to the emergency room identified a full bladder and a Cather was installed (1,250 ML of liquid came out within a 5 minute period).
A new Urologist back home removed the fixed cath installed in China and put me on daily self caturizations 3 X a day and prescribed .6 MG Tamsulosin (Generic Flow Max to relax prostrate). After one month she added 5 MG Finasteride (shrink prostrate) noting there would be side effects of Lowering my Libido. She also noted after two month to try reducing my self cath to daily (before bed) = and that worked out well. She noted to try and stop the once a day cath after one additional month.
That month is now over and I am into day 2 with no cath. Urination is like all this was before all this started (9-10 X daily with low volumes of around 100 – 150 ML) and a once or two time night trip urinate.
Draw back is low to no volume in sex ejaculations and a reduced libido.
Doctor (at last visit) did note Calais is another option to talk about before a surgical approach and I have found our insurance will cover Calais for BPH.
Will Cialis help and can it get me off the other medication that appears to be dampening my life enjoyment of sex?
I am very apprehensive of taking the approach of the surgery direction of enlarging (sapping out) the inside of the urethra!
July 17, 2016
Very clear explanation of the overall subject. I’m approaching a healthy 87, had X-ray and hormone therapy for Prostate cancer, stopped Flomax years ago but continue with PROSCAR. My “very large” prostate still allows tolerable urination cycles. Post radiation moderate ED issues are being addressed with trials of 100mg Viagra or 20mg Cialis to some satisfaction. I suggested an 8 week trial of 5mg Cialis daily and no Proscar followed by PSA and Testosterone tests which was agreed upon. I’ll be patiently waiting for the truckload delivery of the 5mg Cialis just ordered. Things could be looking up for wife and I.
July 14, 2016
Good article. Needs the review and update. Very helpful.
June 30, 2016
Thanks for the enlightenment! Needed it badly. Considering another PSA test shortly. Results will provide progression clue! And the way forward.
May 2, 2016
Tamsulosin is not an anticholinergic drug (like atropine, oxybutynin…), tamsulosin does not block the muscarinic receptor. Tamsulosin specific blocks the prostate alfa-adrenereceptors with Kd 0.04nM (Urol Res, 1994,22,273-278).
April 24, 2016
I have read your many reviews, my husband has been on Tamslosin for about 3 yr.s now,, since he started taking the pill, he had been having fogging thinking..
now it is worse and we are seeing a neaurologis , he is 77 yr.s i just read in an article that it is an anticholinergic drug. and could cause demensia…excuse my spelling..
need an answer..
April 21, 2016
Thanks for article helped me .
April 10, 2016
This was a good article. It’s time to revise and update it now. For example, Avodart IS now available in generic, and the cost is reasonable. You’ve done a beneficial service for your readers. Keep it up.
Basil C. Samaras, mech.engineer
March 14, 2016
In my case of BPH, the drug AVODART raised the liver enzyme γ-GT, that is gamma-glutamyltransferase, to the (double checked) value of 116 U/L . After discontinuing it, the γ-GT returned to normal values of 11-50 U/L. The size or volume of the prostate gland is measured by the ultrasonographing apparatus in cubic centimeters and not in grams.
Question: when a drug shrinks the outer dimensions of the prostate (the only thing seen on ultrasonography display), who knows what happens to the unseen internal diameter of the gland? Does it shrink too (which worsens the urine flow) or it is being enlarged? In other words, which is the three- dimensional displacement of the shrinking gland cells?
March 6, 2016
My Name Is Ron I Take Flomax Twice za Day Sometimes Not Always Pee Comes Out By Itself And I Get Burning What Do You Suggest Thank You
February 7, 2016
I’m a healthy, fit, active 53 year old, who has been taking tamsulosin, avodart, and daily cialis for the past two years. I’ve had three episodes of acute urinary retention over the past years, with a trip to the ER and a catheter for a day or two in each case. Each time it involved alcohol use. I also have retrograde ejaculation during nearly every orgasm.
I would like to begin taking a daily multivitamin or supplement pack. A friend has had good success with Mega Men 50 Plus from GNC. Any thoughts on whether adding this would have any effect on my prostate issues?
December 31, 2015
Does Cialis for daily use contain finasteride?
December 13, 2015
I just read Norms post about coming off of Tamsulosin and ending up in ER unable to void his bladder. I have just started taking this medicine so I have been surfing the web looking for information about it. My symptoms have all cleared up but I have developed retrograde ejaculation. I have my first follow up in a few weeks and was going to ask about stopping the drug because I don’t want to be on any drug long term. Is this bladder retention common when coming off this drug and am I going to be stuck on it for life?
February 6, 2016
Kevin, I hope you decided to stay on Tamsulosin. The day I was prescribed it a few years ago, I went to dinner and drank several glasses of water thinking that taking the Tamsulosin before I went to bed would cause no urinary issues. How wrong I was! I couldn’t urinate all night and I finally had to drive myself to the ER with Acute Urinary Retention. The pain was unbearable! If I had a gun I probably would have used it on myself. The ER Doctor inserted a cathader and the problem was solved. I’ve been on Tamsulosin for a few years and it just takes a little bit of time for your body to accept the medication. A fact of life for a lot of us guys. Good luck and accept fate.
December 3, 2015
Thank you very much!
November 23, 2015
Maurice H. If you have breathing problems, i dont know if it is because of the tamsulosin. What i do know is that i went off
tamsulosin thinking i was ok. Well, i gradually was not fine.
Eventually, no drops came out. So had to go to emergency and
install a catheter for relief. \my advice is stay and do not
stop tamsulosin, it is not good. After having the indwelling
catheter for 1 month, i reverted to a temporary catheter and
used tamsulosin and finasteride. And improvement has risen
where i can void , albeit slowly gradually, but that was
an improvement from 0 drops 1.5 months ago.
my advice is do not come off tamsulosin, keep on taking it
and try finasteride as well , they both work together fine,
one relaxes the muscles, the other ..finasteride.. shrinks
I made the mistake of getting off tamsulosin for 2 months
and suffered for it, having to go to emergency.
so my advice do not stop taking it.. regards
October 11, 2015
Recently, I was diagnosed with BPH of .5. My PSA is okay at1.3, and the DRE also showed no cancer. But after two days of Tamsulosin I started having breathing problems and went off the tamsulosin. I also do not want to have retrograde ejaculation, as I am sexually active with my lady. I am going to wait and see how much urine flow is obstructed. I am getting a pretty good stream now, but that may because of the two days I took the tamsulosin. There is pain though in the penis and rectum when I urinate, and it seems to stay there indefinitely. I am wondering if going off the Tamsulosin will have an adverse effect.
August 8, 2015
Just over two years ago, my gradually but steadily worsening BPH symptoms suddenly spiked to the point where I ended up in the hospital with acute urinary retention. This led to being on a full time indwelling catheter while I started taking tamsulosin to if it could improve my condition enough to atop needing a catheter and start planning for green laser (or other) surgery.
The medication ended up giving effectivly ZERO relief, and it was clear that I needed the laser procedure sooner rather than later. Being an uninsured self pay patient at the time, I struggled to be financially able to afford the cost of this treatment plan.
I quickly adapt to having an indwelling catheter, and I learned how to become a “self cath” patient, replacing my catheter every 4-8 weeks.
Over these now two plus yers, I always tried to go as long as possible between old catheter removals and swapping in a new one. After removal I could typically have some poor degree of bladder control and flow, but within 24-48 hours I would revert to the acute retention status.
My observations of what happens with the progression of BPH to the severe level over time, and what doctors never clearly explain, is that as the prostate steadily pinches tighter around the urethra, the minimum level of bladder PRESSURE needed to initiate flow gets steadily higher, and the bladder muscles start having difficulty producing this level of flow starting pressure by themselves.
The result is that the bladder gets stretched further, and this extra stretching raises the PRESSURE inside the bladder to the level where the combination of BOTH the bladder muscles AND the stretching induced extra pressure, together allow for reaching a high enough pressure level to overcome urethra pinching and initiate flow.
However, when flow does finally start, is only at enough pressure establish weak flow, and after only a fairly small per cent of the bladder’s total urine “inflation” has emptied, the subsequent reduction of pressure from the loss of bladder stretch drops it below the point where flow can be maintained, choking it down to a sporadic dribble level.
How, as a result of the bladder’s PARTIAL urine evacuation lowering pressure in the bladder, the previously backed up kidneys jump for joy and immediately resume sending some of their excess urine accumulation down into the bladder, causing pressure there to rise again, and to reach the point where flow from the kidneys drops off. This fresh and rapid rise in bladder pressure from backed up kidneys’ unloading into a NON-EMPTIED bladder, is what gives the urge to pee again so soon after just having peed, and the boost of bladder pressure is just enough to trigger the urgent need for another PARTIAL voiding of the bladder to needed, often just a few minutes after the prior urination ended. This vicious cycle of weak and partial urination only gets worse with time unless treated.
This summarizes my view of what happens at the more severe stages of the BPH condition.
It certainly is no good for the kidneys to keep having to “inflate” the balloon size of the bladder to higher and higher pressure levels, in order to sufficiently assist the bladder muscles to reach the high enough levels of EXCESS PRESSURE needed to allow some limited amount of urine flow starting to pass through a thoroughly pinched urethra, but only lasting long enough to give a partial bladder evacuation. -RRLedford
June 1, 2015
Been taking Alfuzosin for the past 5 years… Starting to wonder if the extreme fatigue I am feeling is from this med???… stuffy nose and a very dry mouth …
April 26, 2015
At 87 and having never taken these drugs before and not having ED, I started on tamsulosin 10 days before a hernia repair operation. Reason is to offset the shock to the bladder because of the operation and it might otherwise shut down. Prior to this I regularly take zinc, magnesium and L-argenine. The L-argnine produces the nitric oxide that viagra would produce and much cheaper. Have had reduced urine flow and frequent night trips to bathroom. With 2 doses of the tamsulosin 0.4 mg, already the stream is like a fire hose. Doc says I may want to continue it after the operation. It appears that a half dose probably will be plenty.
April 11, 2015
In the column to the far right it states that “you may not want to use it” for the very reason it was prescribed?! Alpha- one blockers are prescribed for BPH so if you have frequent UTIs one shouldn’t take the meds? Or am I interpreting this all wrong?!
March 12, 2015
200 mg of Ibuprofen at bedtime has eliminated my nightime
urination problem…I am 84 years old and take no prescription drugs although all those mentioned in the article have been prescribed. I choose not to deal with
side effects. Why don’t doctors tell male patients to try
this first??? It works for me and my urologist admits it
works for other patients of his?
March 9, 2015
Great article. I am 64 yo. After taking Avodart daily for several years I experienced ED. I got off the Avodart and erection returned. I now only take Avodart as needed, approx one pill every 10 days. When I have to urinate more than once a night it is time for a pill. This strategy was approved by my doctor. Your comments please.
February 24, 2015
Many thanks for such an informative easy-to-read article. I am 63 and have been taking Avodart and Xatral for several years due to BPH. I was concerned about taking Viagra in combination with the BPH meds but after reading your article I am clear about the precautions to take.
Thank you again.
February 16, 2015
I was given Tamsulosin 0.4mg by a Urologist because I have 2 kidney stones. He said that the Tamsulosin will relax the ureters and bladder to help the stones pass better.
I noticed on everything I have seen including the information sheet that comes with the prescription regarding side effects that one possible side effect is that you could get an erection that lasts longer than 4 hours. I have not seen this side effect mentioned in your article. This side effect worries me as I’m drinking a lot of water to flush the stones out and if I get this side effect I will not be able to urinate making my situation worse. Is the lengthy erection a possible side effect?
Also can I take Tamsulosin if I have a heart murmur?
February 10, 2015
Nice and highly educative article on BPH. I am 72 years old and on Tamsulosin .4 mg for the last five years. My flow of urine has reduced from 15 ml/sec to 7ml/sec and my PSA has increased from 1.7 ng to 2.08 ng in these five years Wt of prostate is 36gms. At times I have difficulty in passing the urine and I feel pain and tenderness in my Hypogastrium. My urine exam reports show 3-4 pus cells. Pl. advise how to overcome this problem and for how long I can take Tamsulosin safely.
February 3, 2015
This is all great information but my question is:
I am 68 yrs old and have been taking Flomac and Finisteride daily, I would like to switch to more of an herbal remedy such as Zinc, Pommagranite juice, Saw Palmetto etc. for an enlarged prostate, although the Doc, after last exam, said it was at a normal size for my age
What would be the side effects to stopping the Flomac and Finisteride? My PSA is 12 and has been consistant for over a yr. I have been on Flomac and Finisteride for a year also.
mir ali khan
March 26, 2018
I too am taking 0.4 mg Flomax and 5 mg Finnastride for 2years……want to stop Finnastride as bad side effects….70 years now…any advice?
S. J. Goodman
February 2, 2015
Thanks very much for this article. My Urologist started me on Tamsulosin about a year ago. I had some side effects such as ED. He swithced me to Uroxatral which I have been taking for several months. Last week he had me start taking Cialis with the Uroxitral.
In you opinion is the combination safe and should I be taking them both at the same time?
Thank you for your help.
January 31, 2015
ANY FACTUAL BENEFIT BETWE EN AVADART AND FINISTRIDE . pLEASE COMMENT. sb
January 28, 2015
Thanks for providing such incredible information.
R E Reeves
January 17, 2015
A very well written, easily understood article – thank you. I am a 63 yr old male taking both Tamsulosin and Avodart for the past 2-3 years. This has helped my urinary symptoms considerably. A new insurance plan is no longer covering the Avodart so I am contemplating asking my urologist about switching to Finasteride which is a covered drug. This article has helped that decision process.
Donald L. Parsons
October 29, 2014
I have been taking 0.4mg of Tamsulosin every morning for over two years with good results except that I frequently could not sleep through the night with out urinating. About a year ago I experience a pulled muscle in my lower back from lifting a heavy object. To help with the discomfort I began taking two  200 mg of ibuprofen each evening prior to going to bed.
I noticed that I was no longer having to go to the bathroom during the night. Is it possible that the ibuprofen help relax the smooth muscles in the prostate to alleviate the problem of nightly needing to urinate?
February 22, 2016
I have noticed the same results.Can you share more since this observation?
October 24, 2014
Thanks for your article.I need some help. My age is 83 Currently have 8MG of Terazoni at bed time. Get up 2 time every night. Have enlarge prostate. PSA reading is 12.5 to 13. Have readings done every year and the numbers remais about the same. Whay is your advise. Thanks. HE.
October 22, 2014
Very informative article. I wanted to know when to consider taking Proscar as recommended by my urologist. I do not have acute urinary retention yet. I am 69 and have been on Flomax for 10+ years. I increased from 0.4mg to 0.8mg but still get weak stream at times. Those times are; after sitting for 2 hours at a movie, after waking up during sleep once or twice at night. I mentioned that to my doc and he suggested taking proscar. I would think flomax would also be taken at the same time until the prostate shrinks. I am not sure at this time what size I have but recall the doc saying about the size of an apple. Not a good comparison IMHO…apples vary in size. I also have ED but my med plan only allows for Levitra and at full price. I have not found Levitra to work very well. Viagra has worked well in the past but not available to me. I am uncertain if proscar is right for me at this time.
R I Layard
October 13, 2014
Seems that nothing is ever told to patient about side effects or long term use of drugs. Very little information is given about dangers of surgical interventions. Thanks for good article. Most informative.
October 2, 2014
Very informative article. I am 63 and taking both thamsolin and avadit for the last two years. How long one can have and when should I stop taking these.
January 16, 2017
Thanks for a very wide information. I am 64, enjoyed warm water therapy for three months and notice improvement but not as I observed when my Dr recommend Doudart, But I noticed also headache nose blockage and low libido/erectile dysfunction just after 3 weeks dosage but the swelling of my lower belly due to my (BPH) prostate problem reduced drastically. Please advise.
September 25, 2014
Excellent write-up, very informative. I am 60 and have been taking Cardura (4mg/daily) for approx. 5 yrs. for BPH, my PSA has risen from 4 to10 over this period of time, I have had 4 biopsies, all negative for cancer. However, around the time of my last biopsy, I had started experiencing pressure on my stomach and bladder, the biopsy was negative and I have since had an endoscope, which was normal and a colonoscopy which was fine. I am not getting any answers from my urologist. I feel like something abnormal is happening but i dont know what. Do you have any suggestions for my next step? Many Thanks .
September 25, 2014
My PSAwas on 2.2 and taking Avodart the dr. prescribe Cardura because of erectyle.disfunction and know after a year taking this medication my PSA is up to 3.1, could it be the cardura. Please help me because I dont see my urologist until the middle of October an I worry too much. Thank you.
August 21, 2014
I am a 64 year old man in good health (PSA .5) with the exception of some prostate issues. I am told that my prostate is not very enlarged. However, I have been on all of the typical medications mentioned here with nothing but detriment side effects. My problems: For about 2 years, the rate of my urination has reduced. This is not a significant because a few more seconds of urination does not adversely affect my life. However, having to wake to urinate once or twice a night has had a huge detrimental effect on life. Now my issue, there are lots of discussions, but none address my question. During a nightly urination, the volume of urine seems to be about half of a full bladder. If urine is collected for the entire night, it seems to be of a normal volume. With enlargement of the prostate, why has the volume of the bladder been cut in half requiring multiple urinations? The reason I usually read is that the prostate protrudes into the region of the base of the bladder. For the prostate to decrease the volume of the bladder by a half, it would have to be approximately half the size of the bladder and be in the perfect upward position which I never see in drawings or, push only the bladder opening (to the prostate) up approximately to half its height. I am wondering if the problem is actually coelomic adipose tissue in the region just protruding against the bladder wall instead of the prostate. Your comments please.
November 17, 2017
Richard: Your bladder has become more muscular and when you relax at night it takes half the force to make you need the loo. During the adrenaline stops this.
August 20, 2014
Great summary (I wish my urogists provided this info). Tha nk you!
How does the supplemental testosterone therapy relate to BPH treatment?
At ~65, over a year ago, I was put on supplemental testosterone (injection, 1ml/2weeks) to cope with fatigue due to lower T-levels (no sexual problems).
Now I developed (after an episode of prostatitis) a BPH (30-40mg), and I am contemplating a proper course of threapy. It seems that perhaps I should quit supplementary T (which may contribute to BPH). On the other hand, I know that lower T-levels (extending my 2-week period) result in unpleasant physical weakness.
August 19, 2014
This is a very good article and covers all the bases. I take both Flomax and Avodart (for only 6 months). The Avodart hasn’t made any difference so far, but apparently that is normal. I’ve been taking Flomax for about 10 years and recently have started having more problems than usual with light headedness and fatigue. I’m going to try the “every other day” Flomax regimen discussed in the article.
August 16, 2014
Great write-up.Simple precise and comforting.
mir ali khan
March 26, 2018
I m taking 5 mg Finnastride and 0.4 mg Flomax….thinking of stopping the 5 mg…now……after 2 years….rsvp
August 11, 2014
Thorough and easy to comprehend. Lots of information provided in a short, easy to digest format. Thank you.
Bernard Olu Adefope
July 4, 2014
The information have been very helpful to me thank you so much.
March 6, 2014
There are ample web resources that help understanding the probable causes and treatment of breast enhancement in males, which is commonly known as gynecomastia, so you can seek more information about the topic, and try finding out the best medical aid.
February 11, 2014
I presently take both Tamsulosin and Finasteride and was wondering if I should quit taking the Finasteride because the increased risk of getting prostate cancer plus the cost of my
generic meds increased by 5.00 a month this year which isn’t a whole lot though. But my doc said that the chances of getting prostate cancer from taking finasteride are very minimal and I think it is shrinking my prostate. Although, I don’t notice any difference by taking it!
July 21, 2013
Very informative. Thank you!
Commenting has been closed for this post.
When should I stop taking tamsulosin? ›
For enlarged prostate – if tamsulosin is helping your symptoms, you can continue to take it long term. Your doctor may check every few months that you're still having relief from symptoms. For kidney stones – your doctor may tell you to stop taking it if your stones have gone or if the medicine is not helping you.How long should a man take tamsulosin? ›
The subsequent pivotal double-blind tamsulosin studies have shown the efficacy and safety of 0.4 mg tamsulosin once daily for up to 1 year,5–7 and a recently published extension study by Narayan and Lepor demonstrated similar results for up to 2 years.What happens when you stop taking tamsulosin? ›
If you stop taking the drug suddenly or don't take it at all: Your BPH symptoms won't improve. If you stop taking this drug for several days, talk to your doctor before starting again. If you miss doses or don't take the drug on schedule: Your medication may not work as well or may stop working completely.How long does benign prostatic hyperplasia last? ›
Painful or frequent urination should go away within about two to three weeks. Sexual side effects, such as erectile dysfunction, are unlikely. Studies currently suggest that symptom improvement lasts for at least five years.How long tamsulosin can be taken? ›
No clinically significant changes in blood pressure or pulse rate occurred during the study. Conclusions: Long-term treatment with tamsulosin is safe and well tolerated in patients with lower urinary tract symptoms/benign prostatic hyperplasia. Improved efficacy was sustained during 4 years of followup.Does Flomax keep you from ejaculating? ›
Like all medications, Flomax comes with the potential for side effects. The most common side effects include dizziness, runny nose, and abnormal ejaculation, including: failure to ejaculate. decreased ease of ejaculation.Is tamsulosin linked to dementia in the elderly? ›
Recent findings: Duan et al. have recently shown that men taking tamsulosin have a higher risk of developing dementia when compared to men taking other α-adrenergic antagonists or no α-adrenergic antagonists at all (HR 1.17; 95% CI 1.14-1.21).How long does it take tamsulosin to shrink the prostate? ›
Flomax may take up to 2-6 weeks to provide benefit. Call your healthcare provider if your urination doesn't improve within two weeks or you experience any severe, persistent, or worsening side effects, including rash, priapism, or fainting.Does tamsulosin make you pee more at night? ›
Tamsulosin reduces nighttime urine production in benign prostatic hyperplasia patients with nocturnal polyuria: a prospective open-label long-term study using frequency-volume chart. Neurourol Urodyn.Does tamsulosin affect the kidneys? ›
Your kidneys and liver clear tamsulosin from your body after you take a dose. If you have severe kidney or liver problems, your body might not be able to properly clear the drug. This can cause levels of it to build up, increasing your risk for side effects.
What is the new treatment for enlarged prostate? ›
The UroLift System is a straightforward procedure that utilizes tiny implants to lift and hold the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue.Does tamsulosin affect blood pressure? ›
Tamsulosin may cause a sudden drop in your blood pressure, which could lead to dizziness or fainting. This risk is higher when you first start taking this drug, after your doctor increases your dose, or if you restart treatment after you stop taking it.Can an enlarged prostate go back to normal? ›
Can an Enlarged Prostate Be Cured? For most patients, BPH (enlarged prostate) is curable. Some people see a significant reduction in symptoms with medication alone. If medicine does not work, or your prostate is too large, surgery will often remove enough of the prostate to provide you with relief.What medications should I avoid with an enlarged prostate? ›
All men with BPH should avoid medicines that can worsen symptoms or cause urinary retention. These include certain antihistamines (such as diphenhydramine [Benadryl]) and decongestants (eg, pseudoephedrine, found in some cold medicines).What is the best medication for enlarged prostate? ›
Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue. 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate. A combination of the two, which, when used long-term, may help your symptoms more than either medicine alone.Is it better to take tamsulosin in the morning or at night? ›
Your first dose of tamsulosin may make you feel dizzy or faint, so it is important that you take it just before you go to bed. If you feel dizzy or weary, or if you start sweating, remain lying down until these symptoms have completely gone. Take one tablet/capsule every day.Is there an alternative to tamsulosin? ›
Doctors also prescribe four other drugs in this class to treat the symptoms of BPH: alfuzosin (Uroxatral) doxazosin (Cardura) silodosin (Rapaflo)Is it OK to take tamsulosin every other day? ›
Conclusions: Tamsulosin at a dose of 0.4 mg once daily and 0.4 mg once daily every other day for lower urinary tract symptoms provide comparable improvements in urinary flow and symptoms. Each treatment was well tolerated.Can prostatitis be caused by not ejaculating? ›
Prostatitis can develop into a chronic (ongoing) problem: Possible causes include repeated bacterial infections, stress, not ejaculating often enough, and unknown causes. Symptoms may include frequent urination, burning with urination, and lower abdomen or back pain.
Dizziness, lightheadedness, drowsiness, runny/stuffy nose, or ejaculation problems may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.
Does tamsulosin affect memory? ›
Since tamsulosin has a strong affinity for all neurotransmitter receptors (α 1A-adrenergic, dopaminergic, and serotonergic) that regulate and modulate important central nervous system functions, including mood, affect, attention, learning, and memory, previous investigators hypothesized that tamsulosin may increase the ...Does BPH cause dementia? ›
Interpretation. During up to 21 years of follow-up, men with BPH had persistently higher risk of AD and all-cause dementia compared with men in the general population. Our results identify BPH as a common, potentially remediable disorder associated with dementia risk.Does tamsulosin affect sleep? ›
Examples: alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), terazosin (Hytrin) and tamsulosin (Flomax). How they can cause insomnia: Alpha-blockers are linked to decreased REM (rapid eye movement) sleep — the stage of sleep when people dream — and daytime sedation or sleepiness.What is the fastest way to shrink an enlarged prostate? ›
5-alpha reductase inhibitors.
These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective.
Tamsulosin HCl capsules showed a significant statistical improvement in the erectile function, sexual desire, and intercourse satisfaction score with significant improvement in total IIEF in patients with lower urinary tract symptoms because of benign prostatic hyperplasia.Why is Flomax taken at night? ›
Dosage for Flomax
Take the first dose at bedtime to minimize the chances of getting dizzy or fainting.
The reported frequency of diarrhea with tamsulosin is 0.1–1%3 is lower compared with prazosin (<4%),4 terazosin (4%)5 and doxazosin (1–3%). Clinicians favor tamsulosin in the treatment of benign prostatic hyperplasia due to its uroselective action as well as the reduced cardiovascular and gastrointestinal side effects.What foods interact with tamsulosin? ›
Pharmacokinetics of extended-release forms of alfuzosin, doxazosin, tamsulosin and silodosin is well known to be food-sensitive. Alfuzosin, tamsulosin and silodosin due to their likely interaction with grapefruit juice and citrus fruits, may intensify adverse effects of the drugs.Can you drink alcohol while taking tamsulosin? ›
Alcohol (Ethanol) tamsulosin
Using ethanol with tamsulosin can lower your blood pressure. This can cause dizziness or feeling like you might pass out, especially when getting up from a sitting or lying position. This may be more likely to occur when you first start taking either of these medications.
Tamsulosin therapy is associated with a low rate of serum aminotransferase elevations, but clinically apparent acute liver injury due to tamsulosin is very rare.
Why is tamsulosin taken 30 minutes after a meal? ›
Take tamsulosin (Flomax) 30 minutes after the same meal every day. This will help your body absorb the medication. Don't crush, chew, or open tamsulosin (Flomax) capsules.What drugs should not be taken with Flomax? ›
Do not take tamsulosin with other similar medicines such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), or terazosin (Hytrin). Flomax may cause dizziness or fainting, especially when you first start taking it or when you start taking it again.What is the latest treatment for enlarged prostate 2021? ›
Physicians at UC San Diego Health are now offering prostate artery embolization (PAE) as a new treatment option for men with benign prostatic hyperplasia (BPH), or an enlarged prostate. The minimally invasive procedure is an alternative to surgery, with no hospital stay, little operative pain and lower cost.What is the safest procedure for enlarged prostate? ›
TURP is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication. While TURP has been considered the most effective treatment for an enlarged prostate, a number of other, minimally invasive procedures are becoming more effective.Is an MRI of the prostate better than a biopsy? ›
Conclusions. MRI with targeted and standard biopsy in men with MRI results suggestive of prostate cancer was noninferior to standard biopsy for detecting clinically significant prostate cancer in a population-based screening-by-invitation trial and resulted in less detection of clinically insignificant cancer.Can you take tamsulosin with blood pressure medication? ›
Taking tamsulosin along with blood pressure medications can increase the risk of orthostatic hypotension (OH), which is dizziness or fainting upon standing; these symptoms are due to a sudden drop in blood pressure (Biaggioni, 2018).What are the side effects of tamsulosin 0.4 mg? ›
- difficulty falling asleep or staying asleep.
- back pain.
- runny or stuffy nose.
- pain or pressure in the face.
- sore throat, cough, fever, chills, or other signs of infection.
An improvement in peak urinary flow of more than 30% was seen in 31% and 36% of the 0.4 mg- and 0.8 mg- tamsulosin-treated patients, respectively, but in only 21% of the placebo-treated patients.What will a urologist do for enlarged prostate? ›
The urologist can remove all or part of the prostate through the incision. This surgery is used most often when the prostate is greatly enlarged, complications occur, or the bladder is damaged and needs repair.What foods can irritate prostate? ›
- red and processed meat.
- high-fat dairy.
- saturated fat.
At what size of prostate requires surgery? ›
TURP developed itself to become the gold standard of surgical treatment for medium sized prostates. The EAU guidelines, based on grade A evidence, recommends TURP for prostates between 35 and 80 ml. Over that limit, open surgery seems to remain the only option for treating BPH, according to available clinical evidence.When should I stop taking tamsulosin? ›
For enlarged prostate – if tamsulosin is helping your symptoms, you can continue to take it long term. Your doctor may check every few months that you're still having relief from symptoms. For kidney stones – your doctor may tell you to stop taking it if your stones have gone or if the medicine is not helping you.What drug shrinks the prostate? ›
5-alpha reductase inhibitors shrink the prostate gland if it's enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.What makes BPH worse? ›
Some symptoms may get worse because of cold weather or as a result of physical or emotional stress. Some over-the-counter medicines also can make BPH worse, such as diphenhydramine (e.g., Benadryl), pseudoephedrine (e.g., Sudafed) and oxymetazoline spray (e.g., Afrin).How can I shrink my prostate without medication? ›
It's been used in alternative medicine for centuries to relieve urinary symptoms, including those caused by an enlarged prostate. According to the National Institutes of Health (NIH) , a few small-scale studies have suggested that saw palmetto might be effective for relieving BPH symptoms.
If you stop taking the drug suddenly or don't take it at all: Your BPH symptoms won't improve. If you stop taking this drug for several days, talk to your doctor before starting again. If you miss doses or don't take the drug on schedule: Your medication may not work as well or may stop working completely.Are prostate supplements worth taking? ›
Overall, evidence supporting the effectiveness of supplements for prostate health is weak. However, limited studies suggest that some ingredients may help lessen some of the uncomfortable symptoms associated with prostate issues.How long does it take tamsulosin to shrink the prostate? ›
Flomax may take up to 2-6 weeks to provide benefit. Call your healthcare provider if your urination doesn't improve within two weeks or you experience any severe, persistent, or worsening side effects, including rash, priapism, or fainting.Is it OK to take tamsulosin every other day? ›
Conclusions: Tamsulosin at a dose of 0.4 mg once daily and 0.4 mg once daily every other day for lower urinary tract symptoms provide comparable improvements in urinary flow and symptoms. Each treatment was well tolerated.Does tamsulosin make you pee more at night? ›
Tamsulosin reduces nighttime urine production in benign prostatic hyperplasia patients with nocturnal polyuria: a prospective open-label long-term study using frequency-volume chart. Neurourol Urodyn.
Does tamsulosin affect the kidneys? ›
Your kidneys and liver clear tamsulosin from your body after you take a dose. If you have severe kidney or liver problems, your body might not be able to properly clear the drug. This can cause levels of it to build up, increasing your risk for side effects.Can an enlarged prostate go back to normal? ›
Can an Enlarged Prostate Be Cured? For most patients, BPH (enlarged prostate) is curable. Some people see a significant reduction in symptoms with medication alone. If medicine does not work, or your prostate is too large, surgery will often remove enough of the prostate to provide you with relief.What is the fastest way to shrink an enlarged prostate? ›
5-alpha reductase inhibitors.
These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective.
Your first dose of tamsulosin may make you feel dizzy or faint, so it is important that you take it just before you go to bed. If you feel dizzy or weary, or if you start sweating, remain lying down until these symptoms have completely gone. Take one tablet/capsule every day.Why is tamsulosin taken 30 minutes after a meal? ›
Take tamsulosin (Flomax) 30 minutes after the same meal every day. This will help your body absorb the medication. Don't crush, chew, or open tamsulosin (Flomax) capsules.Can I take saw palmetto instead of tamsulosin? ›
EVIDENCE-BASED ANSWER. Saw palmetto (Serenoa repens) extracts are no different than placebo or tamsulosin in lowering subjective patient symptom scores but slightly better than placebo in decreasing nocturia (SOR: A, meta-analysis of randomized controlled trials [RCTs]).Why is Flomax taken at night? ›
Dosage for Flomax
Take the first dose at bedtime to minimize the chances of getting dizzy or fainting.
Tamsulosin may cause a sudden drop in your blood pressure, which could lead to dizziness or fainting. This risk is higher when you first start taking this drug, after your doctor increases your dose, or if you restart treatment after you stop taking it.What is the new treatment for enlarged prostate? ›
The UroLift System is a straightforward procedure that utilizes tiny implants to lift and hold the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue.Can tamsulosin affect bowel movements? ›
The reported frequency of diarrhea with tamsulosin is 0.1–1%3 is lower compared with prazosin (<4%),4 terazosin (4%)5 and doxazosin (1–3%). Clinicians favor tamsulosin in the treatment of benign prostatic hyperplasia due to its uroselective action as well as the reduced cardiovascular and gastrointestinal side effects.
Is tamsulosin linked to dementia? ›
Recent findings: Duan et al. have recently shown that men taking tamsulosin have a higher risk of developing dementia when compared to men taking other α-adrenergic antagonists or no α-adrenergic antagonists at all (HR 1.17; 95% CI 1.14-1.21).What are the long term side effects of tamsulosin? ›
Tamsulosin side effects long term
The researchers found that some of the most common adverse effects included infection, accidental injury, runny nose, pain, and sore throat; other reported side effects included abnormal ejaculation, syncope, and orthostatic hypotension (Narayan, 2005).
Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue. 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate. A combination of the two, which, when used long-term, may help your symptoms more than either medicine alone.