6 Medication Treatments for Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a medical condition where the prostate becomes enlarged. This can lead to blockages in the urethra as it carries urine from the bladder — interrupting normal urine flow. 

BPH is common in men as they age, so you’re not alone. If you have BPH, your healthcare provider may prescribe you medication to help lessen your symptoms. Several types of medications can treat BPH. Let’s take a closer look at common BPH medications and how they can help treat BPH symptoms. 

1. Alpha blockers

Alpha blockers are a group of BPH medications. They work by blocking alpha receptors (chemical binding sites) in the prostate and bladder. This relaxes prostate muscles and lessens pressure on the urethra. And that helps lessen urinary symptoms of BPH.

Some examples of alpha blockers include Flomax (tamsulosin) and Uroxatral (alfuzosin).

2. 5-alpha reductase inhibitors

5-alpha reductase inhibitors (5-ARIs) work by stopping testosterone from changing to dihydrotestosterone (DHT). Testosterone and DHT are male sex hormones, but DHT is more powerful than testosterone. Blocking this change may lead to a smaller prostate over time. 

These medications include Proscar (finasteride) and Avodart (dutasteride).

3. Anticholinergics

In BPH, the urethra can get pinched and cause urine to back up into the bladder. This can make it hard for the bladder muscle to work properly and cause sudden urges to use the restroom. Anticholinergic medications work by blocking receptors on the bladder muscle to help it relax.

Anticholinergics include Ditropan (oxybutynin) and Detrol (tolterodine).

4. Beta-3 agonists

Beta-3 agonist medications are another option if you can’t use an anticholinergic medication. Myrbetriq (mirabegron) is an example of this type of medication. Myrbetriq also works by attaching to receptors to help the bladder muscle relax.

5. Phosphodiesterase-5 inhibitors

The phosphodiesterase-5 (PDE5) inhibitor Cialis (tadalafil) is a possible treatment option for BPH. Scientists aren’t sure how Cialis relieves BPH symptoms, but it seems to lessen symptoms in men with erectile dysfunction (ED) as well.

6. Combination therapies

Sometimes these medications can be used in combination with one another to treat BPH symptoms. Alpha blockers are typically used first to treat BPH. But if symptoms persist, other medications are sometimes added.

Common combination therapies for BPH include:

• Alpha blockers and 5-alpha reductase inhibitors: This combination is for people with severe BPH symptoms and urinary retention (being unable to urinate).

• Alpha blockers and anticholinergics or beta-3 agonists: This treatment is for people with symptoms of an overactive bladder.

• 5-alpha reductase inhibitors and PDE-5 inhibitors: This combination is for people who also have ED. Entadfi is a combination pill that contains both medications.

What are common side effects of BPH medications?

Common side effects of BPH medications include:

• Dizziness

• Headaches

• Cold-like symptoms

Each medication may also have other side effects. For information about a specific medication’s side effects, talk with a pharmacist or your healthcare provider. 

Are there any serious risks or side effects?

Serious side effects are also possible with BPH medications. Get medical help as soon as you can if you experience any of the following side effects:

• Allergic reaction: Any medication can cause an allergic reaction. Symptoms may include breathing troubles, itching, and swelling. 

• Blood pressure changes: Alpha blockers can cause very low blood pressure. This may lead to fainting. Taking Cialis and an alpha blocker together can also cause low blood pressure. But Myrbetriq can raise your blood pressure.

• Brain-related effects: Anticholinergics may cause brain-related side effects, like confusion, hallucinations, and sleepiness. 

• Digestive system effects: Anticholinergics — like oxybutynin — might worsen medical conditions like gastroesophageal reflux disease (GERD).

• Hearing or vision changes: A possible side effect of Cialis is suddenly not hearing as well or completely losing your hearing. Vision loss in one or both eyes is also possible.

• Intraoperative floppy iris syndrome (IFIS): Alpha blockers — especially tamsulosin — raise the risk of IFIS during cataract surgery. The iris is the part of the eye that controls pupil size. In IFIS, the iris may billow (rise and roll like the ocean), slip out of place, and make the pupil smaller.

• Sexual concerns: Alpha blockers and 5-ARIs can cause sexual problems. These include ED, low sex drive, and orgasm difficulties. Priapism — an erection that lasts more than 4 hours — can happen with alpha blockers and Cialis. 

• Urinary retention: Myrbetriq and anticholinergics — like oxybutynin — may make it harder to urinate.

How effective are BPH medications?

The International Prostate Symptom Score (IPSS) is a questionnaire that can help rank how well BPH medications work to lessen your symptoms. Depending on your symptoms, the total score may range from 0 to 35. Here are the scores based on how severe your BPH symptoms are:

• Mild: 0 to 7

• Moderate: 8 to 19

• Severe: 20 to 35

A medication is considered effective at relieving BPH symptoms if it can lessen your IPSS score by more than three points. Studies show that all of the BPH medications mentioned above can lower IPSS scores by more than three points.

If your current BPH medication isn’t helping control your symptoms, talk with your healthcare provider. They can help you find a treatment option that works better for you.

Are there any home remedies for BPH?

In addition to medications, some providers might recommend lifestyle changes to help BPH symptoms. Helpful lifestyle changes may include:

• Not smoking

• Limiting alcohol use

• Doing regular physical activity

• Trying Kegel exercises

There aren’t any clear dietary changes that can help the symptoms of BPH. But fluid intake was shown to increase the urge to urinate and the number of times you urinate. So limiting fluids after a certain time of day (depending on when you go to bed) may lessen how often you wake up in the night to use the bathroom.   

Some people are also interested in natural supplements. In general, natural supplements have much less supporting evidence than prescription medications. But experts have studied a few supplements to see if they might help with BPH symptoms:

• Pygeum africanum: This extract is from the African plum tree. Small studies suggest that it might be a short-term treatment option for BPH.

• Saw palmetto: This may help treat symptoms of BPH. There’s mixed evidence, but results from a large study suggest that saw palmetto is not an effective treatment for BPH.

• Urtica dioica (stinging nettle): This is a type of flowering plant. It might help relieve BPH symptoms.

Before taking any natural supplements, talk with your healthcare provider or pharmacist. They can check if they have any potential conflicts with your other medical conditions or medications.  

Other treatments for BPH

People who don’t get relief from medications may be candidates for surgical treatment of BPH. There are minimally invasive and more invasive options. The right treatment for you will depend on the size of your prostate and your overall health

Minimally invasive surgical treatments for BPH

These minimally invasive treatments can usually happen in an outpatient setting. They can relieve the most common BPH symptoms, and recovery is usually quick. These procedures include:

• Prostatic urethral lift: Tiny, permanent implants are placed with a needle to lift the prostate and pull it away from the urethra.

• Water vapor thermal therapy: Water vapor destroys prostate tissue so that the urethra is no longer compressed.

• Temporary implanted prostatic devices: Temporary implants reshape the urethra. They’re removed after about a week.

• Prostate artery embolization: This blocks blood flow to the prostate, causing the prostate tissue to die and shrink.

• Catheterization: A temporary tube is placed in the bladder to let urine flow. Catheters can be used at the time of urination (intermittent) or they can be left in longer (in-dwelling).

More invasive surgical procedures for BPH

These treatments are recommended if your prostate is blocked, bleeds a lot, or if you have recurrent infections. Recovery time is longer, and you may need to spend a few days in the hospital. Some of the more invasive treatments for BPH include:

• Prostatectomy: A surgeon removes the prostate to let the urethra open. This is for people with the most severe blockages.

• Transurethral resection of the prostate (TURP): This uses a laser or electric current to remove sections of the prostate. 

• Photoselective vaporization of the prostate (PVP): A laser vaporizes the prostate tissue. It can be used safely in most people except those with the largest prostates.

• Enucleation of the prostate: A variety of laser types are used to cut and remove parts of the prostate. There are no incisions and very little bleeding.

• Transurethral incision of the prostate (TUIP): This widens the urethra by making small incisions in the prostate. This is for people with urethral blockage but a small prostate.

• Transurethral water-jet ablation: A high pressure water jet removes extra prostate tissue. 

You and your healthcare provider will talk about which procedure is best for you. You may still need to take medications after a surgical treatment. And sometimes symptoms persist after a surgical treatment. Talk with your surgeon about the possible complications and the rate of success so you can make an informed decision.

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Written by:

Ross Phan, PharmD, BCACP, BCGP, BCPS

Ross Phan is a board-certified clinical pharmacist. She has roughly two decades of healthcare experience — with most of her experience being pharmacy related.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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