Finasteride vs. Tamsulosin: How Do They Compare for Benign Prostatic Hyperplasia?
Key takeaways:
Finasteride (Proscar) and tamsulosin (Flomax) are two medications FDA approved for treating benign prostatic hyperplasia (BPH). Both medications help with urinary symptoms of BPH, such as a weak urine stream.
Finasteride works by reducing the size of the prostate, which relieves pressure on the urethra (the tube that empties the bladder). Tamsulosin works by relaxing muscles in the prostate and bladder, improving urine flow.
Both medications are relatively inexpensive and have generic versions to help you save money on your prescription. A month’s supply of finasteride may cost less than $6 with a GoodRx coupon. Similarly, a month of tamsulosin may cost as little as $7 with GoodRx.
Table of contents
Benign prostatic hyperplasia (BPH) is a common condition in men over age 50. It affects up to 60% of men by age 60, and, after age 80, it can affect up to 80% of men. BPH is caused by an enlarged prostate, which causes urinary symptoms. These symptoms may include using the restroom frequently, a weak urine stream, and incomplete emptying of the bladder.
Fortunately, there are treatments that can help with BPH. Finasteride (Proscar) and tamsulosin (Flomax) are two medications commonly prescribed to treat BPH. Both are relatively inexpensive and may cost you less than $10 a month with a GoodRx coupon.
In this article, we’ll review what you need to know about finasteride and tamsulosin, including how they work, potential side effects, and how you can save on your prescription.
What is finasteride?
Finasteride is a type of medication called a 5-alpha reductase inhibitor. There are two different brand names for finasteride. The first is Proscar, which is used to treat BPH. The second is Propecia, which is commonly used to treat hair loss in men.
Both Proscar and Propecia have the same active ingredient: finasteride. The difference between the products is the dose. Proscar is available in a 5 mg tablet. Propecia is available in a 1 mg tablet.
What conditions is finasteride approved to treat?
The 5 mg dose of finasteride (generic Proscar) is FDA approved to treat BPH in order to:
Relieve symptoms
Lower the chance of needing prostate surgery
Lower the chance of worsening BPH symptoms when combined with doxazosin (Cardura)
The 1 mg dose of finasteride (generic Propecia) is FDA approved to treat hair loss in men (androgenetic alopecia).
In this article when we talk about finasteride, we’re referring to the dose approved to treat BPH.
How does finasteride work for BPH?
Finasteride works for BPH by preventing the body from changing testosterone into dihydrotestosterone (DHT). Both testosterone and DHT are male sex hormones. DHT has stronger effects than testosterone and can enlarge the prostate in middle-aged and older men.
By lowering the amount of DHT in the body, finasteride can cause the prostate to become smaller over time. A smaller prostate can help relieve BPH symptoms.
What is tamsulosin?
Tamsulosin is an alpha blocker. This class of medications also includes prazosin (Minipress), alfuzosin (Uroxatral), and silodosin (Rapaflo). But not all alpha blockers are used to treat BPH. Tamsulosin comes as a 0.4 mg capsule.
What conditions is tamsulosin approved to treat?
Tamsulosin is FDA approved to treat BPH symptoms.
While some alpha blockers are approved to treat high blood pressure, tamsulosin isn’t approved to treat this condition.
How does tamsulosin work for BPH?
Tamsulosin works by relaxing certain muscles in the prostate and bladder. Relaxing these muscles causes a wider opening in the urethra (the tube that empties the bladder). This lets urine pass through more easily. These actions can help relieve urinary symptoms of BPH.
How are finasteride and tamsulosin dosed and given?
The typical finasteride dose and tamsulosin dose are similar: 1 pill by mouth once daily. However, a healthcare provider can raise tamsulosin dosages to 2 capsules once a day if needed. Finasteride can be taken with or without food. Tamsulosin should be taken after a meal.
How effective are finasteride and tamsulosin for treating BPH?
Tamsulosin and other alpha blockers are considered first-choice treatments for BPH. People who took tamsulosin or other alpha blockers in research studies had improved symptoms.
Finasteride and other 5-alpha reductase inhibitors are also effective treatment options for BPH. Finasteride improved urinary symptoms for men in research studies. But the improvement was not as much as with alpha blockers.
Medications like finasteride are recommended in men who have urinary symptoms and a significantly enlarged prostate. If the prostate gets too big, surgery may be needed to correct this. Finasteride can shrink the prostate and help prevent or delay needing surgery. Tamsulosin, on the other hand, doesn’t help reduce the size of the prostate.
What are the known side effects of finasteride and tamsulosin?
Overall, the common side effects of finasteride and tamsulosin are mild. Most people taking these medications don’t experience serious problems with them.
Below are some of the common side effects of both medications, along with the percentage of people who experienced them in clinical trials. It’s important to note that these aren’t all the possible side effects. Speak to your healthcare provider if you notice any unusual or bothersome side effects after starting either medication.
| Side effect | Finasteride (Proscar) | Tamsulosin (Flomax) |
|---|---|---|
| Headache | 2% | 19% |
| Dizziness | 7% | 15% |
| Drop in blood pressure after changing positions (orthostatic hypotension) | 9% | 16% |
| Lower sex drive | 10% | 1% |
| Erectile dysfunction | 19% | Not listed |
| Abnormal ejaculation | 7% | 8% |
| Weakness | 5% | 8% |
| Runny nose | 1% | 13% |
The main difference between common side effects of finasteride and tamsulosin are dizziness, blood pressure changes, and sexual side effects. Finasteride seems to cause more sexual side effects. And tamsulosin may cause more dizziness and blood pressure effects.
What are the serious side effects of finasteride and tamsulosin?
Serious finasteride side effects include:
Change in levels of prostate specific antigen (PSA), which is used to diagnose prostate cancer
Higher chance of developing high-grade prostate cancer
Problems with development of genitals if an unborn male baby is exposed to the medication during a pregnancy
There’s also a chance of having post-finasteride syndrome from taking finasteride. This condition causes sexual, physical, and mental health side effects that continue even after stopping the medication. But experts still aren’t fully sure whether the finasteride truly causes this group of long-lasting symptoms.
Serious tamsulosin side effects include:
Fainting from a drop in blood pressure when changing positions
Priapism, a long-lasting erection that won’t go away on its own
Intraoperative floppy iris syndrome (IFIS), which can cause a higher chance of complications during cataract and glaucoma surgery
What interactions do finasteride and tamsulosin have?
Finasteride isn’t known to have any interactions. So, it’s usually not a problem with other medications you might be taking.
Tamsulosin is known to have significant interactions with the following medications:
Medications that interfere with how tamsulosin is broken down, like ketoconazole and paroxetine (Paxil)
PDE5 inhibitor medications, like sildenafil (Viagra) or tadalafil (Cialis)
Warfarin (Coumadin, Jantoven)
These aren’t the only possible interactions with tamsulosin. Be sure to share an updated medication list with your pharmacist and healthcare provider. They can double-check for interactions.
How can I save on finasteride and tamsulosin?
Both finasteride and tamsulosin are available as generic medications and fairly inexpensive. But with a GoodRx coupon, you may save close to 90% on the cost of these medications in certain locations.
For a 30-day supply of finasteride 5 mg tablets, you may pay less than $6 at some pharmacies with a free GoodRx coupon. This is compared to the average retail price of about $47.
A GoodRx coupon can get you a 30-day supply of tamsulosin 0.4 mg capsules for less than $7 at certain pharmacies. The typical retail cost for this medication is around $63.
Can you take finasteride and tamsulosin together for BPH
Yes. Finasteride and tamsulosin can be taken together for BPH.
Experts recommend combining these medications when a person is at risk of needing prostate surgery. The combination of finasteride and tamsulosin can help prevent or delay needing surgery.
How do healthcare providers decide which medication to prescribe?
Your healthcare provider will choose which medication to prescribe based on your symptoms and prostate size. Tamsulosin is a first-choice treatment for symptoms of BPH. But finasteride can help with a significantly enlarged prostate.
Finasteride may also be preferred if you have a severe or life-threatening sulfa allergy. While rare, tamsulosin can cause allergic reactions for people with sulfa allergies.
The bottom line
Finasteride and tamsulosin are both safe and effective once-daily options for treating BPH. Tamsulosin seems to do a better job of helping with symptoms. However, finasteride may be preferred if your prostate is significantly enlarged.
Finasteride and tamsulosin have different risks of side effects. Finasteride is linked to sexual side effects, like erectile dysfunction. Tamsulosin is more likely to cause low blood pressure or dizziness. If you have bothersome BPH symptoms, talk with your healthcare provider. They can help determine if one of these treatments is right for you.
Why trust our experts?
References
Ho, C.H., et al. (2021). Androgenetic alopecia. StatPearls.
Kinter, K.J., et al. (2022). Biochemistry, dihydrotestosterone. StatPearls.
Lerner, L.B., et al. (2021). Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline part I, initial work-up and medical management. The Journal of Urology.
MedlinePlus. (2018). Tamsulosin.
National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Prostate enlargement (benign prostatic hyperplasia).
Proficient Rx LP. (2022). Finasteride [package insert].
Remedyrepack Inc. (2022). Finasteride [package insert].
Remedyrepack Inc. (2022). Tamsulosin [package insert].
Zaman, F., et al. (2012). The floppy iris syndrome – what urologists and ophthalmologists need to know. Current Urology.
Zito, P. M., et al. (2022). Finasteride. StatPearls.
