Benign Prostatic Hyperplasia (BPH)

LUTS/Retentio
n

BACK

Treatment options
Watchful waiting

Medical management

Surgical approaches

Minimal invasive
TURP
Invasive open procedures

watchful

waiting

For mild symptoms. follow up 1 to 2

times yearly

Offer suggestions that help

reduce symptoms
n

Avoid caffeine and alcohol

Alteration of timing,volume of fluid

intake

Medical Managment
2 major types:
Option 1:

1 adrenergic blockers

Relax the smooth muscle of prostate and

provide a larger urethral opening

Option 2:

5- reductase inhibitors

Shrink the prostate glandOption

Growing Market Option

Combination of 1 adrenergic
blockers and 5- reductase
inhibitors
Relax and Shrink the prostate
gland

Option 1 : Alpha ()
Blockers(relaxants)
Prazosin, Terazosin, Tamsulosin
Relax the smooth muscle of the
prostate,
Early- acting

Classifation of -Blockers
Nonselective
Phenoxybenzamine

Short-acting selective 1-blocker

Prazosin, Alfuzosin

Long-acting selective 1-blockers

Terazosin
Doxazosin

Long-acting selective 1A-subtype

Tamsulosin
Alfuzosin-SR

Option 2:

5- Reductase
Inhibitors(shrinkers)(5ARI)

Finasteride
Slow-acting
Taken orally as once daily for at least 6
months

Option 3:

Combination Separate or 2-in-1

Tablet

FinMax (Finarid + Pimax)

Duodart (Dutasteride + Tamsulosin)
Tamplus (Finasteride + Tamsulosin)

Combination therapy gives better outcome.

- Medical treatment of prostate symptoms study

Surgical
Management:

TURP (transurethral resection of

the prostate)

Gold Standard of care for BPH

Uses an electrical knife to surgically cut and remove excess

prostate tissue

Effective in relieving symptoms and restoring urine flow

Finasteride
(FINARID)
5mg

FINASTERIDE
is an antiandrogen which acts by
inhibiting type II 5-alpha reductase, the
enzyme that converts testosterone to
dihydrotestosterone (DHT).
It is used as a treatment in
benign prostatic hyperplasia (BPH) in
low doses, and prostate cancer in
higher doses.

Benign Prostatic Hyperplasia

(BPH)
Testosterone

Dihydrotestoste
rone
5-Alpha reductase
Enzyme

Synthetic 4-azasteroid compound

Specific inhibitor of 5-alpha reductase

FINARID (Finasteride)
Mechanism of Action (SHRINKS
the PROSTATE)
Testosterone

Dihydrotestoste
rone

Synthetic 4-azasteroid compound

Specific inhibitor of 5-alpha reductase

FINARID (Finasteride)
Dosage and Administration
Orally 5mg daily with or without food
Evaluate effect after 6-12 months
No dosage adjustment required in renal
impairment or otherwise
Not indicated in women and children
Box of 30s = Box of 2 blister packs of 15
tabs per blister pack

Attention Statement of
Finarid

DETAILING FLAP (inner)

DETAILING FLAP

COMPETITORS

PIMAX (TAMSULOSIN 400

MCG)
Tamsulosin
Clinical data
Legal status
Prescription Only
Routes
oral
Pharmacokinetic data
Bioavailability
Metabolism
Half-life
Excretion
Peak Plasma Concentration

100% (oral)
hepatic
913 hours
76% renal
6 hours (modified release)

How Tamsulosin Works

Smooth muscle tone is mediated by the sympathetic

nervous stimulation of 1 adrenoreceptors, which are
abundant in the prostate, prostatic capsule, prostatic
urethra, and bladder neck.

Blocking these adrenoceptors can cause smooth muscles in

the bladder neck and prostate to relax, resulting in an
improvement in urine flow rate and reduction in symptoms
in BPH.

Tamsulosin is a selective 1 receptor antagonist

(blocking agent) that has preferential selectivity for the 1A
receptor in the prostate versus the 1B receptor in the
blood vessels.

Mechanism of Action
TAMSULOSIN
RELAXES
the PROSTATE
by blocking 1A receptors in the
prostate.

Peripheral zone
Transition zone
Urethra

INDICATION
Tamsulosin is primarily used for
benign prostatic hyperplasia,
But is sometimes used for the
passage of kidney stones by the
same mechanism of smooth muscle
relaxation via alpha antagonism.
(off-label indication)

Attention Statement of
Pimax

Pimax Detailing Flap (inner)

Pimax Detailing Flap (outer)

Efficacy of Tamsulosin
Tamsulosin has been reported to
significantly improve BPH symptom
scores and quality-of-life measures
after 1 week
and peak urinary flow within 4 to 8 hours of
administration.

DOSAGE and ADMINISTRATION

Orally 200mcg or 400mcg or 1 tablet
to be taken 30 minutes after the
same meal each day
Or as prescribed by the physician

Drug Combinations for the

Treatment of Benign Prostatic
Hyperplasia (BPH)
Alpha-Blocker and 5reductase Inhibitors
Sound drug combinations:
1. Alpha-blocker, PIMAX, for rapid symptom
improvement and
2. 5-reductase inhibitor, FINARID, for long-term
shrinkage of the prostate.
The efficiency of the combination was demonstrated in
randomized trials.
In the further course of the treatment, the alphablocker could often be discontinued after 35 months

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