What would be the best recommendation for a male with symptomatic benign prostatic hyperplasia (BPH) who cannot tolerate alpha blockers due to severe hypotension? — MARIA-LUCIA DEAUSEN, MSN, DNP, CRNP, Gaithersburg, Md.

If a male with symptomatic BPH is unable to tolerate alpha blockers due to severe hypotension, there are other agents that have been approved for the management of BPH, including dutasteride, finasteride, and tadalafil. Dutasteride and finasteride are in the pharmacologic category of a 5 alpha-reductase inhibitor, which inhibits the conversion of testosterone to dihydrotestosterone and decreases serum dihydrotestosterone levels.

Tadalafil is a phosphodiesterase (PDE) type 5 inhibitor. Although its mechanism of action is not well known, tadalafil’s effects are thought to be due to PDE-5-mediated reduction in smooth muscle and endothelial cell proliferation, reduced nerve activity, and increased smooth muscle relaxation, to name a few. — Abimbola Farinde, PhD, PharmD, is a professor at Columbia Southern University in Orange Beach, Ala. (199-2)

Continue Reading

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.