Drug Topics - November 10, 2008 - (Page 32)

Clinical BPH treatments will become more common as population ages Maude Campbell T he aging of the population means there are more men in their 50s and 60s experiencing benign prostatic hyperplasia (BPH) symptoms and seeking treatment. BPH affects approximately 37 million men over 50 and is the fourth most-commonly diagnosed disorder in this age group. The prostatic hyperplasticity that characterizes the disease is diagnosed in approximately half of men over 60 and in up to 90 percent of those reaching age 85. With more evolved BPH medications already available and several in the pipeline, what does a pharmacist need to know, and what are the answers to the most frequent questions BPH patients are likely to ask? Benign prostatic hyperplasia (BPH) Cost, side effects, and proper administration are the most frequently asked questions, according to Jack Rosenberg, PharmD, PhD, professor of pharmacy practice and pharmacol- Treatment guidelines: monotherapy ogy, Arnold and Marie Schwartz College of Pharmacy, Brook- According to the AUA treatment guidelines, treatment preflyn, N.Y., and a Drug Topics editorial advisory board member. erences can vary. BPH patients often opt for medical therapy “Patients are frequently concerned about sexual side ef- because it is less costly and involves less risk than minimally fects such as erectile dysfunction,” said Dr. Michael O’Leary, invasive procedures or surgery. Alpha-adrenergic receptor professor of surgery, Harvard Medical School, Boston. antagonists and 5 alpha-reductase inhibitors can be used as The urethral compression caused by BPH leads to lower monotherapy or in combination for BPH treatment. urinary tract symptoms (LUTS), which can be obstructive “The most frequently asked question is whether they need (causing hesitancy, weak urine stream, straining, prolonged to take these medications permanently,” said Dr. Edward M. voiding, intermittency, incomplete voiding, and incontinence) Messing, chair of the department of urology, University of or irritative (causing nocturia, frequency, urgency, urge in- Rochester Medical Center, Rochester, N.Y. “Assuming they continence). Studies have shown that there is are working, the answer for 5 alpha-reductase no well-deﬁned correlation between the extent inhibitors is that they will be taken permanentof prostate disease and the degree of symptoms, ly unless the side effects are very unpleasant, and that the incidence of serious BPH-related or if they stop working. But the alpha blockers POWER POINTS complications such as retention incontinence is may be able to be stopped after a while if the low in untreated patients. More men in their 50s and prostate gets small enough.” Therefore, current BPH treatment guide60s are experiencing BPH. lines from the American Urological Association Selective alpha-adrenergic (AUA) advocate a “watchful waiting” approach receptor antagonists BPH affects 37 million men over age 50. for men with symptoms that do not alter their The agents in this class approved to treat LUTS quality of life. For patients with moderate to related to BPH include alfuzosin, doxazosin, BPH is the fourth mostsevere BPH who are bothered by symptoms tamsulosin, terazosin, and the newly approved commonly diagnosed (AUA Symptom Score ≥ 8 on a scale of 0 to 35), disorder in this age group. silodosin, expected to be available in early 2009. treatment with medication, minimally invasive Alpha blockers inhibit the alpha1-adrenergicprocedures, or surgery can be considered. mediated contraction of prostatic smooth muscle, 32 DRUG TOPICS N OV. 10, 2008 W W W.D R U GTO P I C S .C O M ILLUSTRATION BY CHRISTY KRAMES http://WWW.DRUGTOPICS.COM

Table of Contents Feed for the Digital Edition of Drug Topics - November 10, 2008

Drug Topics - November 10, 2008 Contents Up Front Up Front in Depth Letters Rx Care Government Community Practice First Responders Clinical Practice Self-Care FDA Safety Page Weighing the Complications of Obesity New Products Viewpoint

Drug Topics - November 10, 2008

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