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BPH & Overactive Bladder

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sgthuan's version from 2017-06-27 17:34

BPH

genericBrandClassDrug pearls
terazosinHytrinnon-selective alpha-1 blockers - work immediately, do NOT shrink prostate & change PSA1mg qHS, MORE SE orthostasis/syncope especially first dose, dizziness, HA, *** intraoperative floppy iris
doxazosinCardura, Cardura XLnon-selective alpha-1 blockers - work immediately, do NOT shrink prostate & change PSAIR 1mg qHS, ** XL take with Breakfast, --> OROS formula, MORE SE orthostasis/syncope especially first dose, dizziness, HA, *** intraoperative floppy iris
tamsulosinFlomaxselective alpha-1 blockers - work immediately, do NOT shrink prostate & change PSA0.4mg 30 minutes after the same meal each day, MAX 0.8mg, LESS SE orthostasis/syncope, dizziness, HA, ** abnormal ejaculation
alfuzosinUroxatralselective alpha-1 blockers - work immediately, do NOT shrink prostate & change PSA10mg immediately after same meal each day, LESS SE orthostasis/syncope, dizziness, HA, *** risk of QT prolong
silodosinRapafloselective alpha-1 blockers - work immediately, do NOT shrink prostate & change PSA8mg qd with meal, CI - strong 3A4 inhibitor, child pugh C, severe renal impairment --> CrCl<30 do NOT use, LESS SE orthostasis/syncope, dizziness, HA, *** retrograde ejaculation --> reversible upon d/c
finasterideProscar, Propecia (hairloss)5-alpha reductase inhibitor - used ONLY for symptomatic BPH with enlarged prostate5mg qd, CI - pregnancy, children, SE impotence, decreased libido, ejaculation disturbances, breast enlargement & tenderness, ** it shrink the prostate and decrease PSA level
dutasterideAvodart5-alpha reductase inhibitor - used ONLY for symptomatic BPH with enlarged prostate0.5mg qd, CI - pregnancy, children, SE impotence, decreased libido, ejaculation disturbances, breast enlargement & tenderness, ** it shrink the prostate and decrease PSA level
dutasteride + tamsulosinJalyn5-alpha reductase inhibitor + alpha-1 blockertake 30 minutes after the same meal each day
tadalafilCialis, Adcirca (for pulmonary arterial HTN)PDE-5 inhibitor5mg qd, 2.5mg qd if CrCl < 30, CI - use with nitrate or ricoguat, SE - HA, flushing, nausea, dyspepsia, priapism, hearing loss, vision loss, impaired color discrimination, *** CAUTION use with alpha-1 blockers because of additive hypotension
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overactive bladder - behavioral therapy 1st line

genericBrandClassDrug pearls
oxybutyninDitropan XL, Oxytrol, Oxytrol for women (patch - OTC), Gelniqueanticholinergics5mg BID or 3.9mg patch qd, patch changes every 3-4 days for RX and q4days for OTC, CI - urinary rentention, gastric retention, uncontrolled narrow angel glaucoma, SE dizziness and drowsiness, dry mouth, constipation
tolterodineDetrol, Detrol LAanticholinergics1-2 BID, CI - urinary rentention, gastric retention, uncontrolled narrow angel glaucoma, SE dizziness and drowsiness, dry mouth, constipation
trospiumSancturaanticholinergics20mg BID --> *** take on EMPTY stomach, CI - urinary rentention, gastric retention, uncontrolled narrow angel glaucoma, SE dizziness and drowsiness, dry mouth, constipation, **** CrCL < 30 decreased dose
solifenacinVesicareanticholinergics5-10mg qd, CI - urinary rentention, gastric retention, uncontrolled narrow angel glaucoma, SE dizziness and drowsiness, dry mouth, constipation, **** CrCL < 30 decreased dose
darifenacinEnablexanticholinergics7.5-15mg qd, CI - urinary rentention, gastric retention, uncontrolled narrow angel glaucoma, SE dizziness and drowsiness, dry mouth, ** MOST constipation, **** CrCL < 30 decreased dose
fesoterodineToviazanticholinergics4-8mg qd, CI - urinary rentention, gastric retention, uncontrolled narrow angel glaucoma, SE dizziness and drowsiness, dry mouth, constipation, **** CrCL < 30 decreased dose
mirabegronMyrbetriqbeta-3 agonist - relax detrusor muscle, increase bladder capacity25-50mg qd, CrCl < 30 - 25mg qd, ** angioedema of lips, face, tongue, SE HTN, efficacy seen within 8 weeks
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