General Notes
- Refer to NICE CG97, Lower Urinary Tract Symptoms.
- Uncomplicated lower urinary symptoms in males should initially be managed with conservative measures, specifically providing information and reassurance, and advice on lifestyle interventions (such as changes to fluid intake). To be effective, conservative care needs to be tailored, see CKS.
Alpha blockers
Prescribing Notes
- Refer to NICE CG97, Lower Urinary Tract Symptoms.
- Uncomplicated lower urinary symptoms in males should initially be managed with conservative measures, specifically providing information and reassurance, and advice on lifestyle interventions (such as changes to fluid intake). To be effective, conservative care needs to be tailored, see CG97.
Cautions
- Alpha–blockers reduce blood pressure and first doses may cause drowsiness and dizziness. Patients receiving antihypertensives may need lower doses and supervision.
- Patients already prescribed doxazosin for hypertension should not be prescribed another alpha blocker such as tamsulosin.
- Alpha-blockers should be avoided in patients with a history of postural hypotension and micturition syncope.
- Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome).
5-alphareductase inhibitors
Prescribing Notes
- Refer to NICE CG97, Lower Urinary Tract Symptoms.
- Uncomplicated lower urinary symptoms in males should initially be managed with conservative measures, specifically providing information and reassurance, and advice on lifestyle interventions (such as changes to fluid intake). To be effective, conservative care needs to be tailored, see CG97.
- 5-alpha reductase inhibitors can be considered for men with lower urinary symptoms who have prostates estimated to be larger than 30 g or a PSA level greater than 1.4ng/ml and who are considered high risk of progression, e.g. older men. Response to treatment should be reviewed after 3-6 months.
Caution
- A patient alert card is being introduced for men taking finasteride to help raise awareness of the risk of psychiatric side effects and sexual dysfunction, including the potential for sexual dysfunction to persist after treatment has stopped. Healthcare professionals are reminded to monitor patients for both psychiatric and sexual side effects. See MHRA.