Alpha blockers in the treatment of prostate adenoma

Alpha-blockers: drugs for prostatitis and prostate adenoma

The use of selective alpha-blockers is one of the cornerstones in the treatment of Prostate adenoma, as well as acute and chronic prostatitis. These drugs have proven themselves in urology, thanks to which thousands of men around the world have a chance for a full recovery from the disease.

Classification of alpha-blockers

In the treatment of prostate diseases, the use of uroselective alpha-adrenergic blockers, which have a competitive effect on the tissues of the prostate gland, the bladder neck and the muscles of the urinary ducts, is considered relevant. However, there are other varieties of these drugs that are effective in alternative medical directions.

In general, alpha-blockers are synthetic substances, the principle of which is to block the transmission of nerve vasoconstrictor impulses from adrenomimetics and norepinephrine to post-asynaptic alpha-adrenergic receptors.

The standard classification divides the medicines under consideration into three groups:

• selective alpha1-blockers;
• selective alpha2-blockers;
• non-selective alpha1- and alpha2-blockers.

It is important to add that alpha1-blockers can be either short-acting or long-acting. The final choice remains with the attending physician, however, in most cases, the activity of the drug lasts a day, and involves taking the prescribed dose daily.

As for the most common subtypes of alpha1-blockers, the most commonly used in urology are alfuzosin, doxazosin, yohimbine, prazosin, silodosin, tamsulosin, terazosin and their derivatives.

Mechanism of drug action

The effect of alpha1-blockers on the body is the expansion of arterioles and small peripheral blood vessels, which improves blood flow, relieves swelling and spasms, and also produces a pronounced hypotonic effect on the patient. With prostatitis, the best drugs are alpha1-blockers, since they directly affect the organs and tissues of the genitourinary system, which is important both for prostate adenoma (in order to reduce the volume of the gland) and for the inflammatory process in the prostate.

It should be noted separately that the effect of this group of drugs on blood vessels will be useful for patients suffering from hypertension, while there is no response in the form of tachycardia or an increase in heart rate.

At the same time, adrenoblockers of this type do not reduce blood pressure in normotonic patients, and therefore do not require additional dosage adjustment during therapy. The pharmacokinetics of the described drugs, on average, is similar: rapid absorption by the body of up to 90% of the drug taken, active metabolism in the liver, half-life of about 4-6 hours and excretion of metabolites from the body partly by the kidneys, partly through the intestines.

List of popular alpha blockers

Alpha-blockers used in the treatment of diseases of the male genitourinary system include drugs of a selective type that affect the prostate and surrounding tissues and pelvic organs. The final choice in favor of one or another remedy depends on the patient's individual response to therapy, taking into account side effects and contraindications, as well as the cost of the drugs in question.

Alfuzosin

In addition, it reduces increased pressure in the urethra, eliminates urinary tract obstruction and relieves symptoms of dysuria.

The list of drugs on alfuzosin includes:

• Alfuzosin;
• Alfuprost;
• Dalfaz;
• Dalphaz Retard;
• Dalfaz SR;
• Alfuzosin hydrochloride

Doxazosin

Doxazosin powder dissolves in dimethyl sulfoxide, and is produced mainly in tablets. It has an antihypertensive effect, lowers peripheral vascular resistance, reduces afterload on the heart and inhibits the production of collagen fibers in the walls of blood vessels. It begins to act one to two hours after administration, and the course of therapy successfully helps, on average, 70% of men with prostatitis.

The following trade names for doxazosin may be noted:

• Kardura;
• Doxazosin;
• Artesine;
• Kamiren;
• Urocard;
• Tonocardin;
• Artezin Retard;
• Doxazosin Belupo.

The description of terazosin-based drugs begins with the fact that this alpha1-blocker is able not only to dilate blood vessels, but also stimulates the renin-angiotensin-aldosterone complex, which has an additional relaxing effect on smooth muscles.

Another positive quality of terazosin is the stabilization of blood lipid levels - both their total number and their relationship to other components.The best terazosin preparations treat both prostate adenoma and prostatitis, as well as chronic arterial hypertension:

• Setegis;
• Cornam;
• Terazosin;
• Terazosin-Teva;
• Terazosin hydrochloride dihydrate;
• Haytrin.

Prazosin is an antihypertensive drug that does not increase heart rate during the course of treatment, but at the same time normalizes lipid levels, dilates capacitive and resistive vessels, and selectively blocks postsynaptic alpha1-adrenergic receptors.

It should be noted that the drug is often used in the treatment of not only urological diseases, but also heart failure, but it also has a drawback - a sharp drop in blood pressure at the first dose of the drug. To date, the following prazosin generics can be distinguished:

Tamsulosin

In the treatment of BPH and prostatitis, tamsulosin preparations are among the most common, as they are a compromise between cost and effectiveness. By reducing the tone of the smooth muscles of the prostate, urethra and bladder neck, this medication ensures the normalization of urine outflow while eliminating obstruction or inflamed irritation of the epithelium.

On average, the maximum therapeutic effect of tamsulosin occurs by the end of the second week of treatment, and the following brands are the most popular representatives of this drug:

Contraindications and side effects

In general, contraindications and side effects of drugs from the group of alpha1-blockers can be considered similar. Among the restrictions on the use of drugs of this type are hypersensitivity, pregnancy and breastfeeding, age under 18 years, severe renal and hepatic insufficiency, and arterial hypotension.

In addition, Prazosin should not be given to patients with heart failure, and Alfuzosin should not be given concomitantly with other drugs of this type (including 5-alpha reductase inhibitors).

With regard to negative side effects, the most common patients experience:

• dizziness;
• headaches;
• drowsiness;
• tachycardia;
• orthostatic hypotension;
• nausea.

In addition, Tamsulosin suppresses libido and leads to retrograde ejaculation, like Terazosin, which additionally causes swelling, cough, rhinitis and bronchitis.

In turn, Prazosin can provoke diarrhea, frequent urination and swelling of the legs in a patient, and Doxazosin, with long-term therapy, can cause circulatory disorders of the brain and blurred vision. Without exception, all alpha1-blockers are capable of causing allergic reactions in a certain number of patients, expressed by skin itching, rashes and redness.

Alpha blockers - drugs for prostatitis and prostate adenoma

Combination therapy for diseases of the prostate gland is aimed at achieving several goals: eliminating symptoms, combating spasms and inflammation, restoring the normal functioning of the main functions of the internal organ.

Alpha blockers in the treatment of prostate adenoma and prostatitis contribute to the normalization of urination, the elimination of pain and a decrease in the volume of gland tissues. There are contraindications and side effects of taking drugs in this group. The treatment regimen, dosage and duration of therapy will be prescribed by the doctor after a complete examination of the patient.

What alpha blockers are used for

Medicated treatments are mostly conservative. The therapy is aimed at overcoming the negative manifestations: pain, dysuric disorders and erectile dysfunction caused by prostatitis and prostate adenoma (BPH). You can eliminate the symptoms with the help of drugs containing alpha-blockers. Indications for use:

With the help of adrenoblockers, conservative treatment is performed that does not replace the main therapy: taking antibiotics, NSAIDs. The choice of drug depends entirely on the patient's condition and the type of developing disease.

Adrenergic blockers are not prescribed if there is an infection in the urinary tract. The term of application is limited. If the dosage and duration of therapy are exceeded, retrograde ejaculation develops. With non-infectious prostatitis and benign hyperplasia, a positive effect and symptom reduction can be achieved.

It is impossible to completely cure adenoma and inflammation of the prostate. But the use of alpha blockers slows down the development of pathological changes and enhances the effectiveness of other drugs prescribed in the complex.

The following drugs of the group are most often used:

• Tamusolosin is an a1-adrenergic blocker that has a calming effect on the smooth muscles of the neck and walls of the bladder and relieves irritation. Slightly affects the level of blood pressure.The preferred use is benign prostatic hyperplasia.
• Terazosin is a symptomatic drug that blocks the action of adrenoreceptors. Under the influence of active components, arterial vessels expand, cholesterol content in the blood decreases, urination normalizes. The drug is contraindicated in hypotension.
• Doxazosin - belongs to the group of drugs of the second generation, characterized by a long-term effect, as well as the absence of a negative effect on blood pressure. The drug is recommended for prostatitis and adenoma. With prolonged use, it does not contribute to the development of hypotension.
• Alfuzosin is a selective adrenoblocker, the action of which is aimed at eliminating dysuric disorders. It is not prescribed for serious violations of the kidneys, as well as in combination with other drugs of the group. It affects blood pressure, therefore it is not recommended for men diagnosed with coronary heart disease and over 70 years old.
• Prazosin - is mainly used in the complex therapy of inflammation of the prostate. With prolonged use, addiction to the active components of the drug occurs, which requires an increase in dosage. Eliminate stagnation.

The method of treatment with alpha blockers is to relieve the symptoms of the disease and prepare the prerequisites for taking other medications. Medicines increase the effectiveness of other drugs: enhance the effect of anti-inflammatory drugs.

The mechanism of action of alpha blockers on the prostate

What alpha blockers are prescribed for prostatitis

Inflammation of the prostate gland differs from BPH in that an increase in the volume of the prostate is associated solely with swelling of the tissues. Constant irritation, the presence of congestion leads to an increase in the sensitivity of the prostate gland. With hypertonicity of the prostate, increased excitability, excessively "bright" orgasms, etc. may be felt.

As chronic prostatitis develops, symptoms appear similar to those present in adenoma. At this stage, urination disorders, a decrease in erectile dysfunction are characteristic. With prostatitis, alpha 1 blockers help, relaxing the walls of the prostate and bladder, soothing tissues.

The use of 5-alpha reductase inhibitors is limited due to low efficacy during inflammation. The urologist may decide to prescribe drugs if a malignant growth of the tumor is suspected. For prostatitis, alpha 1 adrenergic blockers are recommended. Medicines of this group relieve tissue irritation, which leads to the elimination of inflammatory processes.

Therapy of inflammation of the prostate with the help of adrenoblockers, in order to avoid complications, is carried out under the strict supervision of a physician. If during the initial intake (1-2 months) there is an increase in potency and normalization of erectile function, then with long-term use, the opposite effect is diagnosed.

Medicines of the alpha-blocker group for prostatitis, belonging to the group of inhibitors: Doxazosin, Terazosin. With low efficiency, increase the dosage.

Alpha blockers for the treatment of prostate adenoma

The relationship between the synthesis and metabolism of testosterone and hyperplasia remains a recognized fact in urology. Undergoing age-related metamorphoses, the prostate gland loses its original functionality. As a rule, habits in sexual life change. Some men, undergoing a midlife crisis, begin to engage in promiscuity, or vice versa, do not have regular sex.

The male sex hormone is produced in the same volume, but the prostate is not able to properly process the substance, which leads to increased synthesis of dihydrotestosterone. The latter causes an enlarged prostate gland.

The preferred drugs of the alpha blocker group for benign prostatic hyperplasia are reductase inhibitors. Moreover, it is better to choose drugs of the latest generation for therapy, as they, as a rule, are easily tolerated by the patient, regardless of age, and are also intended for long-term use.

Modern alpha blockers for the treatment of prostate adenoma work in two ways:

The expediency of use in BPH 2-3 stages of development. Alpha blockers for prostate adenoma are taken in a course of up to 12 months. During this time, the volume of the prostate is significantly reduced. The drugs are prescribed in the preoperative period to reduce the tissues to the required size in order to allow free surgical manipulations.

When choosing medicines, the urologist will give preference to those of them, whose action will be the most selective (selective) for the prostate. The choice of a drug is influenced by the presence of related diseases and pathologies, the relationship with the hormonal background.The action of drugs should have the desired effect with a minimal threat of complications.

Recommendations and review of alpha blockers for the treatment of BPH

Prostate adenoma is a complex and serious disease. Even after a transurethral resection, or other surgery, some men experience complications, such as urinary incontinence after removal of prostate adenoma or, conversely, acute urinary retention. When prescribing drug therapy, urologists, in combination with other drugs, prescribe medications from the group of alpha blockers. What is it and how they affect adenoma, we will analyze in this article.

How alpha blockers work

Unpleasant and dangerous symptoms associated with the process of urination (acute urinary retention, incontinence) occur in men after a tour of prostate adenoma. In the second case, such a symptom is a complication. Sometimes urination is characterized by a change in ischuria with incontinence. This is due to impaired functioning of the bladder and requires treatment.

With such symptoms and with prostate adenoma, doctors prescribe alpha blockers that relax the smooth muscles of the bladder and prostate. In this case, there is a decrease in the pressure of the urinary canal, it becomes possible to normalize the outflow of urine. As a result, the man ceases to suffer from acute urinary retention or incontinence. Also, the drugs of this group effectively show themselves in the treatment of chronic prostatitis, which is often found in patients with prostate adenoma.

The effect becomes noticeable only after 2-3 weeks of using the drugs.

Adrenergic blockers side effects

• headaches;
• lowering blood pressure;
• dizziness;
• weakness;
• swelling of the nasopharynx;
• disruption of the esophagus.

Each individual drug has additional, inherent side effects.

Adrenergic blockers for prostate adenoma are auxiliary drugs of symptomatic action, but they do not treat prostate adenoma. Only a doctor should prescribe them, as they can cause the “first dose” syndrome, which can result in loss of consciousness. There were cases of calling an ambulance due to the illiterate use of adrenoblockers!

Indications for the use of alpha blockers

The preparations of this group are suitable for men with normal and moderately enlarged prostates. Symptoms should be moderate, but when home treatment does not bring the desired results, even a slight decrease in the enlarged prostate can be observed. If you take alpha-blockers together with 5-alpha reductase inhibitors, then the effect of relieving symptoms will be more pronounced.

Alpha-blockers are not recommended to be taken together with drugs that improve potency. In this case, there may be a reflux of sperm into the bladder, as well as an increased severity of side effects from alpha-blockers.

The drugs of this group are perfect for people with adenoma who are being treated for hypertension. In this case, the drug will act not only in relation to the muscles of the genitourinary system, but also lower the pressure. For some men, they do not lower blood pressure, so this recommendation is not suitable for all hypertensive patients.

Contraindications

The use of these drugs is contraindicated in patients with hypertension and patients prone to infections of the genitourinary system.

Best Alpha Blockers

It should be fair to say that drugs from the proposed list can be expensive, but you can always choose an alternative. To do this, it is enough to find out the active ingredient from the instructions and ask the pharmacist at the pharmacy to choose the best alternative for the drug for treatment. It is advisable to read the instructions, as excipients can significantly affect the effect of the drug.

The active substance of dalfaz is Alfuzosin. The drug acts on postsynaptic alpha-adrenergic receptors, selectively blocking them in the urogenital triangle. As a result, there is a decrease in pressure inside the urethra, muscle spasm of the urinary canal and prostate gland is relieved, and the quality of urine in adenoma improves. In 30% of patients with BPH (Benign prostatic hyperplasia - more details in the Wiki.), the speed of urine increases during urination, the volume of residual urine in the bladder decreases. Cases of acute urinary retention are reduced.

May cause a severe drop in blood pressure when blood pressure drugs do not help. You need to be careful and consider this risk!

The drug blocks alpha-adrenergic receptors located in the bladder neck, stroma and prostate capsule. It is especially active against subtype IA, which is what distinguishes it from many other drugs. Safe for long-term use over several years.

With caution, people with a weak psyche (may cause depression) and with bronchial asthma and urinary incontinence (reverse effect) should be taken with caution.

Before taking it, you need to make sure that there is no oncology in your case.

Omnic (Tamsulosin)

Effectively improves urine flow by relaxing the smooth muscles of the bladder and prostate gland, acting on alpha adrenergic receptors. It relieves irritation, which is different from other similar medicines. Relaxes the muscles of blood vessels. It has a high selectivity for the treatment of prostate adenoma.

The advantage of the drug is that it practically does not affect blood pressure, therefore it is indicated for hypotensive patients.

It is not recommended to combine the drug with other alpha blockers. In this case, the risk of a significant decrease in pressure increases. Can be used in conjunction with tranquilizers and antidepressants, as well as sedatives.

Use with caution in people with impaired kidney function.

This drug differs in that it blocks alpha-adrenergic receptors located in the body of the bladder for the treatment of prostate adenoma. As a result, obstruction and irritation in the bladder is reduced. Omsulosin acts on blood pressure. Some patients feel an improvement after the first dose of the drug, but usually the effect is achieved after 2 weeks.

Patients with chronic renal failure should be careful in using the drug. Driving vehicles can be problematic.

Conclusion

It is important to understand that self-medication is contraindicated, especially when it comes to serious medications such as alpha-blockers. The above information is for informational purposes only, the final decision should be made by the doctor.

Video: Professor Pushkar D.Yu. talks about the problems of alpha-blockers in prostate adenoma.