Efficacy of alfuzosin and sildenafil combination in male patients with lower urinary tract symptoms

Öztürk, Metin İshak; Kalkan, Senad; Koca, Orhan; Güneş, Mustafa; Akyüz, Mehmet; Karaman, Muhammet İhsan

doi:10.1111/j.1439-0272.2011.01268.x

Cited by 20 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No large double‐blind placebo‐controlled study has evaluated the combination of a PDE5 inhibitor and α‐blocker for the improvement in LUTS suggestive of BPH, but several small studies with few patients [40], unblinded designs [41], and short treatment periods [42] have suggested that some patients may experience some additive effect, clinical results consistent with our findings. However, other small studies could not identify any additive effect [43] or the data could not be interpreted [44]. On the other hand, considering both LUTS and sexual dysfunctions, a panel of experts recently suggested that combination therapy with PDE5 inhibitors and α 1 ‐adrenergic blockers would be superior to PDE5 inhibition alone [45].…”

Section: Discussionmentioning

confidence: 99%

Tadalafil Enhances the Inhibitory Effects of Tamsulosin on Neurogenic Contractions of Human Prostate and Bladder Neck

Angulo¹,

Cuevas²,

Fernández³

et al. 2012

The Journal of Sexual Medicine

View full text Add to dashboard Cite

Introduction Lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTSs) may be associated with erectile dysfunction (ED). Phosphodiesterase type 5 (PDE5) inhibitors used for treating ED have shown clinical benefit in patients with LUTS but their actions in human LUT tissues are not well defined. Aim To determine the effects of the long-acting PDE5 inhibitor, tadalafil, on smooth muscle tone in human prostate and bladder neck as well as to evaluate the influence of tadalafil on the efficacy of the α-adrenergic receptor antagonist, tamsulosin, in inhibiting contractile responses in these tissues. Methods Strips of human peripheral prostate (HPP), human internal prostate (HIP), and human bladder neck (HBN) were obtained from organ donors and patients with BPH. The strips were then disposed in organ baths to evaluate nitric oxide/cyclic guanosine monophosphate (cGMP)-mediated relaxation and cGMP kinetics in HPP and HIP, and electrical field stimulation (EFS)-induced neurogenic contractions in HPP and HBN. Main Outcome Measures Tadalafil-induced effects on sodium nitroprusside (SNP)-induced relaxation and cGMP accumulation in HPP and HIP and influence of tadalafil and tamsulosin on EFS-induced contractions of HPP and HBN. Results SNP-induced relaxation of HPP and HIP was significantly potentiated by tadalafil (30–60 nM). SNP-induced cGMP accumulation in HPP and HIP was enhanced by tadalafil (30–60 nM), but significant difference was only obtained in HPP. EFS-induced contractions sensitive to tetrodotoxin in HPP were significantly inhibited by tadalafil (30 nM) but not by tamsulosin (0.01–100 nM) or vehicle. Further inhibition of neurogenic responses in HPP was achieved by combining tadalafil and tamsulosin treatments. Tamsulosin, but not tadalafil, significantly reduced EFS-induced contractions in HBN, but the coadministration of both therapies resulted in additional inhibition of contractions. Conclusions While tadalafil enhances cGMP accumulation and potentiates prostate relaxation, tadalafil combined with tamsulosin results in enhanced inhibition of neurogenic contractions of HPP and HBN.

show abstract

Section: Discussionmentioning

confidence: 99%

Tadalafil Enhances the Inhibitory Effects of Tamsulosin on Neurogenic Contractions of Human Prostate and Bladder Neck

Angulo¹,

Cuevas²,

Fernández³

et al. 2012

The Journal of Sexual Medicine

View full text Add to dashboard Cite

show abstract

“…Four trials ( n = 281) compared sildenafil combined with an AB versus AB monotherapy [47–49,51]. Two 3-mo trials evaluated sildenafil combined with alfuzosin 10 mg versus alfuzosin monotherapy; one used daily sildenafil 25 mg [48] and the other used sildenafil 50 mg (dosing frequency not reported) [51].…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Two 3-mo trials evaluated sildenafil combined with alfuzosin 10 mg versus alfuzosin monotherapy; one used daily sildenafil 25 mg [48] and the other used sildenafil 50 mg (dosing frequency not reported) [51]. One 4-mo trial evaluated sildenafil 50 mg combined with doxazosin 2 mg versus doxazosin alone, but dosing frequency was not reported [47].…”

Section: Evidence Synthesismentioning

confidence: 99%

See 1 more Smart Citation

Comparative Effectiveness of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis

et al. 2017

View full text Add to dashboard Cite

Context Alpha-blockers (ABs) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). Recently, newer drugs have shown promise for this indication. Objective To assess the comparative effectiveness and adverse effects (AEs) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta-analysis. Evidence acquisition Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and Ovid Embase bibliographic databases (through June 2016) were hand searches for references of relevant studies. Eligible studies included randomized controlled trials published in English of newer ABs, antimuscarinics, a beta-3 adrenoceptor agonist, phosphodiesterase type-5 inhibitors, or combination therapy with one of these medications as an active comparator. Observational studies of the same agents with a duration ≥1 yr that reported AEs were also included. Evidence synthesis We synthesized evidence from 43 randomized controlled trials as well as five observational studies. Based on improvement of mean International Prostate Symptom Score and quality of life scores, the effectiveness of the newer ABs was not different from the older ABs (moderate strength of evidence [SOE]), but had more AEs (low SOE). Antimuscarinics/AB combination therapy had similar outcomes as AB monotherapy (all moderate SOE), but often had more AEs. Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone. Evidence was insufficient for the beta-3 adrenoceptor agonist. For all newer agents, the evidence was generally insufficient to assess long-term efficacy, prevention of symptom progression, or AEs. Conclusions None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment. Given the lack of superior outcomes, the studies’ short time-horizon, and less assurance of their safety, their current value in treating LUTS attributable to BPH appears low. Patient summary In this paper, we reviewed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate. We found none of the new drugs to be better but there was more concern about side effects.

show abstract

“…In the review by Trost et al [67], a pooled summary of all randomized, placebo-controlled trials evaluating 5-ARIs revealed slightly increased rates over placebo Placebo effects in studies are shown in parenthesis. Data from Gur et al [66] we found 16 RCTs on tadalafil [184,185,187,188,[192][193][194][195][198][199][200][201][202][203][204][205], 3 RCTs on sildenafil [183,191,196], 2 RCTs on vardenafil [186,197] and 2 RCTs on UK-369,003 [189,190]. The PDE5 inhibitors are used alone or in combination mostly with α-blocker alfuzosin or tamsulosin.…”

Section: Silodosinmentioning

confidence: 99%

Sexual Dysfunction Related to Drugs: a Critical Review. Part V: α-Blocker and 5-ARI Drugs

et al. 2015

View full text Add to dashboard Cite

Sexual dysfunction is a potential side effect of BPH (benign prostatic hyperplasia) and LUTS (lower urinary tract symptoms) drugs: this article is a critical review of the current literature. Many studies have been published on this topic. Methodological flaws limit the conclusions of these studies, mainly because of the lack of diagnostic criteria for ejaculatory and sexual desire dysfunction. Few of these studies are RCTs. The ?-blocker (also called ?1-adrenergic antagonist, alpha-adrenoceptor antagonist, alpha-blocker or AB) and 5-ARI (also called 5?-reductase inhibitor or testosterone-5-alpha reductase inhibitor) drugs can in particular cause erectile dysfunction, ejaculatory disorders and reduction of sexual desire. The sexual side effect profile of these drugs is different. Among the ?-blockers, silodosin appears have the highest incidence of ejaculatory disorders. Persistent sexual side effects after discontinuation of finasteride has recently been reported, however further studies are needed to clarify the true incidence and the significance of this finding. It is desirable that future studies include validated tools to assess and diagnose sexual dysfunction induced by these medications, especially for ejaculation and sexual desire disorders. Only a small amount of research has intentionally set out to investigate sexual dysfunction caused by ?-blocker and 5-ARI drugs: studies to specifically assess sexual dysfunction induced by these drugs are needed. Further studies are also needed to assess in the long term the role of combined therapy of phosphodiesterase type 5 inhibitors and ?-blockers or 5-ARIs in treating LUTS/BPH. Methods: This study was conducted in 2014 using the paper and electronic resources of the library of the ?Azienda Provinciale per i Servizi Sanitari (APSS)? in Trento, Italy (http://atoz.ebsco.com/Titles/2793). The library has access to a wide range of databases including DYNAMED, MEDLINE Full Text, CINAHL Plus Full Text, The Cochrane Library, Micromedex healthcare series, BMJ Clinical Evidence. The full list of available journals can be viewed at http://atoz.ebsco.com/Titles/2793, or at the APSS web site (http://www.apss.tn.it). In completing this review, a literature search was conducted using the key words ?benign prostatic hyperplasia drugs?, ?lower urinary tract symptoms drugs?, ??-blockers?, ?5-ARIs?, ?sexual dysfunction?, ?sexual side effects?, ?treatment-emergent sexual dysfunction?, ?phosphodiesterase type 5 (PDE5) inhibitors?. All resulting listed articles were reviewed. Studies published between 2002 and December 2014 were included in the review. We included all studies that explicitly reported data on sexual dysfunction during treatment with ?-blockers and 5-ARIs. We also reviewed studies that have evaluated the use of phosphodiesterase type 5 (PDE5) inhibitors in combination with these drugs. The purpose was to identify possible intervention strategies for sexual dysfunction related to these drugs.

show abstract

Efficacy of alfuzosin and sildenafil combination in male patients with lower urinary tract symptoms

Cited by 20 publications

References 22 publications

Tadalafil Enhances the Inhibitory Effects of Tamsulosin on Neurogenic Contractions of Human Prostate and Bladder Neck

Tadalafil Enhances the Inhibitory Effects of Tamsulosin on Neurogenic Contractions of Human Prostate and Bladder Neck

Comparative Effectiveness of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis

Sexual Dysfunction Related to Drugs: a Critical Review. Part V: α-Blocker and 5-ARI Drugs

Contact Info

Product

Resources

About