Home' Australian Pharmacist : Australian Pharmacist Sept 2013 Contents Australian Pharmacist September 2013 I © Pharmaceutical Society of Australia Ltd.
by a urologist. Sexual adverse effects with
the combination therapy are relatively
common, occurring in up to 10% of men.
The AMH Aged Care Companion suggests
that the combination may be considered
as an alternative to surgery if the prostate
size exceeds 30–40 cm3 and rapid relief
of symptoms is required; some evidence
suggests that the alpha-blocker can
be stopped after 6–12 months with no
deterioration in symptoms.11
Dutasteride may cause birth defects and
men taking dutasteride should avoid
donating blood, until six months after
stopping the drug, to avoid transmission
to pregnant women.17 Dutasteride has
an elimination half-life of about five
weeks and is detectable in serum for up
to 4–6 months after stopping treatment.1
Also, using a condom is recommended if
the patient’s sexual partner is pregnant or
likely to become pregnant, as dutasteride is
excreted in semen.17
Surgery may be necessary for up
to 30% patients with moderate to
severe LUTS if other treatment options
(medication, lifestyle adjustment, and fluid
management) are not sufficiently effective
or if there are complications (e.g. urinary
retention). Various surgical methods are
available, of which transurethral resection of
the prostate (TURP) is the most common.1,11
Saw palmetto extract (Serenoa repens)
had often been used in the past for
BPH. However, a number of trials and
meta-analyses have now consistently
demonstrated that it is no more effective
than placebo in improving the symptoms or
objective measures of BPH.21–24 Interestingly,
there is some evidence that non-steroidal
anti-inflammatory drugs (NSAIDs) improve
urinary symptoms and flow measures in
men with BPH, although their long-term
effectiveness, safety and ability to prevent
BPH complications are not known.25
1. Roehrborn CG. Male lower urinary tract symptoms (LUTS)
and benign prostatic hyperplasia (BPH). Med Clin North Am
2. Sarma AV, Wei JT. Clinical practice. Benign prostatic
hyperplasia and lower urinary tract symptoms. N Engl J Med
3. Marberger M. Medical management of lower urinary tract
symptoms in men with benign prostatic enlargement.
Advances in therapy 2013;30(4):309–19.
4. Latz I, Weber M, Korda R, Smith D, Clements M, Patel M, et al.
Lower urinary tract symptoms in relation to region of birth
in 95,393 men living in Australia: the 45 and Up Study. World
journal of urology 2013;31(3):673–82.
5. Holden CA, McLachlan RI, Pitts M, Cumming R, Wittert G, Agius
PA, et al. Men in Australia Telephone Survey (MATeS): a national
survey of the reproductive health and concerns of middle-
aged and older Australian men. Lancet 2005;366(9481):218–24.
6. Naslund MJ, Gilsenan AW, Midkiff KD, Bown A, Wolford ET,
Wang J. Prevalence of lower urinary tract symptoms and
prostate enlargement in the primary care setting. Int J Clin
7. Miner M. Managing the multiple symptoms of benign prostatic
hyperplasia. J Fam Pract 2012;61(6 Suppl):S5–10.
8. Paolone DR. Benign prostatic hyperplasia. Clin Geriatr Med
9. Lepor H, Kazzazi A, Djavan B. alpha-Blockers for benign
prostatic hyperplasia: the new era. Curr Opin Urol
10. Keating GM. Dutasteride/tamsulosin: in benign prostatic
hyperplasia. Drugs Aging 2012;29(5):405–19.
11. Benign prostatic hyperplasia. Australian Medicines Handbook,
Aged Care Companion Online: Australian Medicines
12. Djavan B, Eckersberger E, Finkelstein J, et al. Benign prostatic
hyperplasia: current clinical practice. Prim Care 2010;37(3):583–
13. Parsons JK. Lifestyle factors, benign prostatic hyperplasia, and
lower urinary tract symptoms. Curr Opin Urol 2011;21(1):1–4.
14. Sea J, Poon KS, McVary KT. Review of exercise and the risk of
benign prostatic hyperplasia. Phys Sportsmed 2009;37(4):75–
15. Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign
prostatic hyperplasia: clinical connections, emerging
etiological paradigms and future directions. J Urol 2013;189(1
16. Vande Griend JP, Linnebur SA. Inhaled anticholinergic agents
and acute urinary retention in men with lower urinary tract
symptoms or benign prostatic hyperplasia. Ann Pharmacother
17. NPS MedicineWise. Dutasteride (Avodart) and dutasteride
with tamsulosin (Duodart) for lower urinary tract symptoms
due to benign prostatic hyperplasia. NPS RADAR, Aug 2011.
18. Roehrborn CG, Siami P, Barkin J, et al. The effects of dutasteride,
tamsulosin and combination therapy on lower urinary tract
symptoms in men with benign prostatic hyperplasia and
prostatic enlargement: 2-year results from the CombAT study. J
19. Roehrborn CG, Siami P, Barkin J, et al. The effects of
combination therapy with dutasteride and tamsulosin on
clinical outcomes in men with symptomatic benign prostatic
hyperplasia: 4-year results from the CombAT study. Eur Urol
20. Barkin J. Benign prostatic hyperplasia and lower urinary
tract symptoms: evidence and approaches for best case
management. Can J Urol 2011;18 Suppl:14–9 .
21. Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of
saw palmetto extract on lower urinary tract symptoms: a
randomized trial. JAMA 2011;306(12):1344–51.
22. Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign
prostatic hyperplasia. N Engl J Med 2006;354(6):557–66 .
23. MacDonald R, Tacklind JW, Rutks I, Wilt TJ. Serenoa
repens monotherapy for benign prostatic hyperplasia
(BPH): an updated Cochrane systematic review. BJU Int
24. Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ. Serenoa
repens for benign prostatic hyperplasia. Cochrane Database
Syst Rev 2012;12:CD001423.
25. Kahokehr A, Vather R, Nixon A, Hill AG. Non-steroidal
anti-inflammatory drugs for lower urinary tract symptoms
in benign prostatic hyperplasia: systematic review and
meta-analysis of randomized controlled trials. BJU Int
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