Patient guide
BPH tablets: tamsulosin, finasteride and dutasteride, how long to take them, side effects and when they stop working
How do enlarged prostate tablets work, how long do you take them, what are the side effects and what if they are not enough? What a 3,047-man trial and sexual side effect studies show, and the options when tablets fall short.
BPH tablets at a glance
- They do workCut the risk of worsening by a third to two thirds
- Often long-termMany men take them for years
- Sexual side effectsEjaculation changes in some men on tablets
- Not enough?There are options that do not mean cutting
How do enlarged prostate tablets work?
There are two main kinds. Alpha-blockers, such as tamsulosin, relax the muscle around the urine pipe and prostate, so the urine flows more easily. They work fairly quickly. 5-alpha-reductase inhibitors, such as finasteride and dutasteride, lower the hormone that makes the prostate grow, so the gland gradually shrinks. They take months. Some men take both.
Do they work, and for how long should I take them?
They work, and they also slow the condition down. In a trial of 3,047 men followed for 4.5 years, the risk of the condition getting worse was lower by 39% with doxazosin (an alpha-blocker), by 34% with finasteride, and by 66% when the two were taken together, compared with a dummy tablet. Finasteride and the combination also lowered the risk of sudden urine retention and of needing a procedure [1].
In practice, many men take tablets for years. Your doctor decides how long, so do not stop or change them on your own.
What are the side effects?
Many men feel fine on tablets, but side effects are real, and it is better to know in advance. A review found that ejaculation problems affect about 4 to 30 in 100 men on alpha-blockers and about 4 to 18 in 100 men on 5-alpha-reductase inhibitors [2]. A separate analysis of trials found that 5-alpha-reductase inhibitors carried about 1.9 times the risk of sexual side effects compared with a dummy tablet [3]. Dizziness on standing is also common with alpha-blockers. Tell your doctor if side effects bother you. There is often something that can be changed.
What if tablets are not working?
If your symptoms are still bothersome, the side effects are a problem, or you do not want to be on tablets for life, you have options. The usual operations remove prostate tissue through the urine pipe. Prostate artery embolization (PAE) is a different option that works without cutting, by reducing the prostate's blood supply, usually under local anaesthesia and as a day-case. PAE suits some men and not others, which is why a consultation with scans comes first.
Check how bad your symptoms really are
Our free prostate symptom score takes about two minutes. If you are on tablets and your score is still moderate or severe, it can be a sign that it is time to talk about the next step. You can share the result with our team.
Frequently asked questions
- How long should I take tamsulosin or finasteride?
- Many men take them for years. Your doctor decides how long. In a 4.5-year trial of 3,047 men, tablets lowered the risk of the condition getting worse [1]. Do not stop on your own.
- What are the side effects of finasteride and tamsulosin?
- Ejaculation problems affect about 4 to 30 in 100 men on alpha-blockers such as tamsulosin, and about 4 to 18 in 100 on finasteride-type tablets [2]. Trials show finasteride-type tablets carry about 1.9 times the risk of sexual side effects [3].
- Do BPH tablets stop working?
- They slow the condition down, but they do not stop it in every man. If symptoms are still bothersome on tablets, ask about the next step.
- Can I avoid taking tablets for life?
- Some men can. Procedures that treat the prostate, including prostate artery embolization (PAE), are options if tablets are not enough or you would rather not take them for life.
- Where can I discuss this in Hyderabad?
- Dr. Nagateja Bonala sees men whose symptoms continue on tablets at Clinic Seven and explains every option. Bring your medicines list, ultrasound and PSA.
Check your prostate symptom score
References
- McConnell JD, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003. Read the source
- Couteau N, et al. Ejaculations and Benign Prostatic Hyperplasia: An Impossible Compromise? A Comprehensive Review. J Clin Med. 2021;10(24). Read the source
- Zhang JJ, et al. Sexual, physical, and overall adverse effects in patients treated with 5α-reductase inhibitors: a systematic review and meta-analysis. Asian J Androl. 2022. Read the source
Want to discuss your options?
Speak with the Clinic Seven team.