This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .
Interaction between the phosphodiesterase 5 inhibitor, tadalafil and 2 alpha-blockers, doxazosin and tamsulosin in healthy normotensive men.
PURPOSE Tadalafil , a phosphodiesterase type 5 inhibitor , is effective therapy for erectile dysfunction ( ED ) . Men with ED have a high incidence of comorbid conditions including cardiovascular disease , diabetes mellitus and benign prostatic hyperplasia . Although phosphodiesterase type 5 inhibitors are safe when administered with most medications , sildenafil given with doxazosin and vardenafil given with terazosin evoke orthostatic hypotension in some patients . We examined the hemodynamic interactions of tadalafil with the alpha-blockers doxazosin and tamsulosin . MATERIAL S AND METHODS In separate double-blind , placebo controlled , r and omized crossover studies ( 18 patients in each study ) we evaluated the hemodynamic effects of doxazosin 8 mg with tadalafil 20 mg , and tamsulosin 0.4 mg with tadalafil 10 and 20 mg .  Blood pressure ( BP ) and heart rate were recorded before dosing and for 24 hours after dosing . RESULTS Tadalafil 20 mg augmented the hypotensive effect of doxazosin by producing a mean maximal decrease in st and ing systolic BP ( SBP ) that was significantly greater than placebo ( a mean difference of 9.8 mm Hg ) . Analysis of BP outliers showed that the number of subjects with a st and ing SBP of less than 85 mm Hg was greater after doxazosin plus tadalafil ( 28 % ) versus doxazosin plus placebo ( 6 % ) . In subjects on tamsulosin , tadalafil 10 and 20 mg produced mean maximal decreases in st and ing SBP that were similar to placebo ( mean difference of 1.7 and 2.3 mm Hg , respectively ) . No subject taking tamsulosin had a decrease in st and ing SBP less than 85 mm Hg . CONCLUSIONS Tadalafil augmented the hypotensive effects of doxazosin but had little hemodynamic interaction with tamsulosin . In patients taking tadalafil for ED , tamsulosin 0.4 mg may be given for the treatment of benign prostatic hyperplasia
This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .