Dutasteride

Brand name Proscar

Subtype inhibition of Type II the 5a-reductase enzyme Percentage of 70-70

inhibition of serum dihydrotestosterone level

Percentage of 49

patients with reduction in serum dihyrotestosterone Time to peak onset of 6 months reduction in serum dihydrotestosterone level

Avodart Types I and II

90-95

Greater than 85

1 month

Percentage of Inhibition of intra prostatic d f hy d rotestostero ne I J N":'■

□ally dosage (nig) Recommended dose reduction in patients with renal dysfunction Recommended dose reduction in patients with hepatic dysfunction

Greater than 95

6.2 hours 5

None needed

Manufacturer provides no specific recommendation. Finasteride should be used cautiously as it undergoes extensive hepatic metabolism

None needed

Manufacturer providés no specific recommendation. Dutosfende should be used cautiously as i t undergoes extensive hepatic metabolism

From liefs. 41,44.

To streamline and reduce the cost of treatment regimens, it has been suggested that the a-adrenergic antagonist may be discontinued after the first 6 to 12 months of combination therapy. However, long-term treatment is required to determine if such a regimen is as effective as continuous combination therapy.48,49

Another enhancement to BPH symptom management is the addition of an anticholinergic agent to an a-adrenergic antagonist. The rationale for the anticholinergic agent is that irritative symptoms (e.g., urinary urgency and frequency) are thought to be due to hyper-reactive bladder detrusor muscle contraction, which can be ameliorated by blockade of acetylcholine receptors.49,50 Also, a1D-adrenergic receptors in the detrusor muscle, which cause muscle contraction when stimulated, can be blocked by a-adrenergic antagonists. As a result, use of an a-adrenergic antagonist may also decrease involuntary bladder muscle contraction and increase the bladder's compliance. Thus, the combination may have an additive pharmacologic effect on relieving irritative voiding symptoms. 1,52 A recent study documenting the addition of tol-terodine to tamsulosin showed significant irritative symptom improvement, more than what was observed with tamsulosin alone. No cases of urinary retention were reported.51

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