I. Doxazosin Medication

Doxazosin is indicated for the treatment of both the urinary outflow obstruction and obstructive and irritative symptoms associated with BPH: obstructive symptoms (hesitation, intermittency, dribbling, weak urinary stream, incomplete emptying of the bladder) and irritative symptoms (nocturia, daytime frequency, urgency, burning).

Doxazosin works to relax the muscles around the neck of the bladder, allowing urine to flow out more freely. It may take up to two weeks for symptoms to improve.

Doxazosin may be used in all BPH patients whether hypertensive or normotensive. In patients with hypertension and BPH, both conditions were effectively treated with Doxazosin monotherapy. Doxazosin provides rapid improvement in symptoms and urinary flow rate in 66-71% of patients.

Doxazosin is used for the treatment of mild to moderate high blood pressure. Doxazosin may be used alone or in combination with other medications that treat high blood pressure. Doxazosin works to control blood pressure by relaxing blood vessels.

Benign Prostatic Hyperplasia (BPH): Information

Diagram 1:

The prostate is one of the main components of the male reproductive system and plays a vital role in the development of the male sex organs. In adult men, its main function is to add important fluids to the semen supplying nourishment to the sperm during ejaculation. This protects the semen against naturally occurring acids located within the vagina. In many men, the prostate begins to grow when they are in their 50s and usually continues to grow throughout the rest of their lives.

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a non-cancerous enlargement of the prostate, a small gland that encircles the urethra in males and produces a fluid that makes up part of semen. As the volume of the prostate increases, it can put pressure on the urethra, causing a slowdown in the urine stream, hesitancy in urinating, a frequent and urgent need to urinate, and sometimes dribbling of urine at the end of the flow. It can also cause urine retention, which can weaken the bladder muscle and increase the risk of developing a urinary tract infection (UTI) or kidney stones. In severe cases of BPH, urine may back up into and damage the kidneys. Rarely, BPH may prevent a patient from urinating at all, a situation that requires immediate medical attention.

BPH can also affect sexual functioning. It can lead to reduced sexual ability, painful orgasm, and impotence. The type and severity of symptoms experienced will vary from person to person and may vary over time. For many men, BPH never progresses beyond a minor to moderate annoyance; for others, it may represent a significant challenge to their quality of life. BPH becomes a very common condition in men as they age. According to the American Urology Association, about 50% of men will have some degree of BPH by the time they are 60 years old, and up to 90% will be affected by age 80. While BPH does not cause prostate cancer, both may be found together.

Diagram 2: Normal Prostate

Diagram 3: Enlarged Prostate

Causes of BPH

The cause of benign prostatic hyperplasia is unknown. It is possible that the condition is associated with hormonal changes that occur as men age. The testes produce the hormone testosterone, which is converted to dihydrotestosterone (DHT) and Estradiol (estrogen) in certain tissues. High levels of dihydrotestosterone, a testosterone derivative involved in prostate growth, may accumulate and cause hyperplasia. How and why levels of DHT increase remains a subject of research.

Signs and Symptoms of BPH
Common symptoms of benign prostatic hyperplasia include the following:

• Blood in the urine (i.e., hematuria), caused by straining to void
• Dribbling after voiding
• Feeling that the bladder has not emptied completely after urination
• Frequent urination, particularly at night (i.e., nocturia)
• Hesitant, interrupted, or weak urine stream caused by decreased force
• Leakage of urine (i.e., overflow incontinence)
• Pushing or straining to begin urination
• Recurrent, sudden, urgent need to urinate

In severe cases of BPH, another symptom, acute urinary retention (the inability to urinate), can result from holding urine for a long time, alcohol consumption, long period of inactivity, cold temperatures, allergy or cold medications containing decongestants or antihistamines, and some prescription drugs (e.g., ipratropium bromide, albuterol, epinephrine). Any of these factors can prevent the urinary sphincter from relaxing and allowing urine to flow out of the bladder. Acute urinary retention causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder and obtain relief.

Treatment of B PH

There are several treatment options for men with benign prostate hyperplasia, depending on the severity of symptoms. If symptoms do not threaten the man's health, he may choose not to be treated. If symptoms are severe enough to cause discomfort, interfere with daily activities, or threaten health, treatment is usually recommended.

• Watchful waiting
  Men with mild symptoms may choose to return for annual examinations. The physician will perform an examination that includes a DRE, PSA tests, and a urinary flow rate. The patient will be asked to describe symptoms in order to determine if the condition is worsening.
• Medication
  5-Alpha reductase inhibitors such as finasteride (Proscar) and dutasteride (Avodart) prevent the conversion of testosterone to the hormone dihydrotestosterone (DHT). In many cases, a treatment period of 6-month is necessary to see if the therapy is going to work. These drugs are taken orally, once a day.
• Alpha blockers relax smooth muscle tissue in the bladder neck and prostate, which increases urinary flow. They typically are taken orally, once or twice a day.

Commonly prescribed alpha blockers include the following:

• alfuzosin (UroXatral), extended-release tablet taken once daily
• Doxazosin (Doxazosin), tablet taken once daily
• prazosin (Minipress), capsule taken 2 or 3 times daily
• tamsulosin hydrochloride (Flomax), capsule taken once daily
• terazosin (Hytrin), capsule taken once daily

Patients taking an alpha blocker require follow-up during the first 3 or 4 weeks to evaluate the effect on symptoms and adjust the dosage, if necessary.

• Prostatic stents

Although a prostatic stent is not a medical treatment, neither does it fall under the classification of a surgical procedure. Prostatic stents are used most often for patients with significant medical problems that prohibit medication or surgery. It is a tiny, spring-like device inserted into the urethra. When expanded, it pushes back the surrounding tissue and widens the urethra. Prostatic stents have several advantages:

• They can be placed in less than 15 minutes under regional anesthesia.
• Bleeding during and after surgery is minimal.
• The patient can be discharged the same day or the next morning.

There are also several disadvantages:

• Prepositioning can be difficult.
• They may cause irritation and frequent urination.
• They may cause pain or incontinence.
• Removing them (necessary in one-third of cases) can be difficult.

Side effects of BPH Medications

• Side effects of BPH Medications like Proscar, Avodart and Cadura include reduced libido, impotence, breast tenderness and enlargement, and reduced sperm count. Long-term risks and benefits have not been studied.
• Women who may be pregnant must avoid handling dutasteride capsules and broken or crushed finasteride tablets because exposure to the drugs may cause serious side effects to the fetus. Intact tablets are coated to prevent absorption through the skin during normal handling. Patients should wait at least 6 months after dutasteride treatment to donate blood to prevent pregnant women from being exposed to the drug through blood transfusion.
• Side effects of Alpha blockers include headache, dizziness, low blood pressure, fatigue, weakness, and difficulty breathing. Long-term risks and benefits have not been studied.

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III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=698&rot=4

http://www.labtestsonline.org/understanding/conditions/bph.html

http://www.urologychannel.com/prostate/bph/index.shtml

http://www.avodart.com

http://www.urologychannel.com/prostate/bph/treatment_med.shtml

Pharmacy sites

http://www.roche.com/home/company/com_hist.htm

http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php

http://www.hsforum.com/stories/storyReader$1509

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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