Tamsulosin alternatives: What can I take instead of tamsulosin?

Compare tamsulosin alternatives | Uroxatral | Rapaflo | Avodart | Proscar | Cialis | Natural alternatives | How to switch meds

Tamsulosin, also known by the brand- name Flomax, is a prescription medicine approved by the U.S. Food and Drug Administration (FDA) for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). Tamsulosin comes in a 0.4 mg capsule and should be taken once daily, approximately one-half hour following the same meal each day. The dose may be increased to 0.8 mg (two 0.4 mg capsules) once daily for those who fail to respond to the 0.4 mg dose after two to four weeks of dosing. Adverse effects common to tamsulosin include dizziness, fatigue, fainting, vertigo, headache, nasal congestion, erectile dysfunction, postural hypotension (low blood pressure when changing position), and retrograde ejaculation.

BPH, also known as an enlarged prostate gland, is a condition commonly found in men as they get older. The main symptom of the enlarged prostate gland is blockage of the bladder causing uncomfortable urinary symptoms, such as urine flow interruption, incontinence, or urinary tract infections. Tamsulosin is in a class of medicines known as alpha blockers. These medications relax muscles in the bladder and in the prostate gland making urination easier.

While tamsulosin is an effective treatment for many, it may not be the best option for all men who have BPH. For various reasons, such as cost, side effect profile, or hypersensitivity to the active or inactive ingredients, an alternative BPH treatment may be necessary.

What can I take in place of tamsulosin?

Different treatment options are available that can be used as alternatives to tamsulosin. There are other alpha blockers that are FDA approved to treat BPH: Cardura (doxazosin), Hytrin (terazosin), Uroxatral (alfuzosin), and Rapaflo (silodosin). There are two other drug classes FDA approved to treat BPH–5-alpha reductase inhibitors and phosphodiesterase inhibitors.

5-alpha reductase inhibitors work by shrinking the prostate gland by preventing hormonal changes that cause prostate growth. These medications include Proscar (finasteride) and Avodart (dutasteride) and are most effective in men with large prostate glands, unlike alpha blockers, which work best on smaller glands. 

Phosphodiesterase inhibitors, such as Cialis (tadalafil) and Viagra (sildenafil), were originally developed for treating erectile dysfunction (ED). Cialis was found also to be effective in treating the urinary symptoms of BPH by relaxing muscle cells in the bladder and prostate and has been FDA approved to treat urinary symptoms of BPH.

If a single medication alone is not effective, combination drug therapy may be tried. Your prescribing healthcare provider might recommend combining an alpha blocker with a 5-alpha reductase inhibitor to relieve BPH symptoms.

BPH can be a frustrating condition, but fortunately, there are many different medications other than tamsulosin that have proven effective in treating it. Your healthcare provider will prescribe the BPH medicine that is the best fit for your health, lifestyle, and medical history. The table below highlights the most common alternatives to tamsulosin.

Other alternatives to tamsulosin

Combination drug:

• Jalyn (dutasteride and tamsulosin)

There are alternatives to drug treatment for BPH, particularly if the prostate size causes more severe problems. These alternatives include the following minor surgical procedures typically performed by a urologist:

• Transurethral resection of the prostate (TURP)—surgery to remove parts of the prostate gland through the penis.
• Transurethral incision of the prostate (TUIP)—surgery using a laser beam or electric current to widen the urethra. 
• Transurethral microwave thermotherapy (TUMT)—a minimally invasive treatment which uses microwave energy to harden parts of the prostate tissue to reduce the size of the prostate gland. 
• Laser therapy— a high-energy laser destroys or removes overgrown prostate tissue. 
• Prostatic urethral lift (PUL)—small metallic implants are placed in the prostate tissue to reduce the obstruction of the urethra.

Top 5 tamsulosin alternatives

The following are some of the most common alternatives to tamsulosin.

1. Uroxatral (alfuzosin)

Uroxatral is a brand-name medication that is available as a generic drug called alfuzosin. Alfuzosin, like tamsulosin, is an alpha blocker and is approved for the treatment of signs and symptoms of BPH. Both are tablets, and both are dosed once a day. Because they are in the same drug class, they share many of the same common adverse effects, such as headache, dizziness, and nasal congestion. There is one side effect of tamsulosin that alfuzosin does not share, and that is symptoms of sexual dysfunction, which include reduced sex drive and abnormal ejaculation. For this reason, alfuzosin may be preferred for sexually active patients. 

2. Rapaflo (silodosin) 

Rapaflo is a brand-name medication that is available as a generic drug called silodosin. Silodosin is also an alpha blocker, i.e., in the same category as both tamsulosin and alfuzosin and is likewise approved for the treatment of signs and symptoms of BPH. It comes in a capsule and is dosed once a day. Common side effects are closely aligned with tamsulosin (headache, dizziness, nasal congestion, and abnormal ejaculations). A clinical study found that silodosin improved urinary symptoms and quality of life in patients with BPH who did not respond to tamsulosin.

3. Avodart (dutasteride)

Avodart is a brand-name medication that is available as a generic drug called dutasteride. Tamsolusin and dutasteride belong to different drug classes and have different mechanisms of action in treating BPH. Tamsulosin, as described earlier, is an alpha-blocker that relaxes muscles in the bladder and in the prostate gland making urination easier. Dutasteride is a 5-alpha reductase inhibitor and works by inhibiting the conversion of testosterone to 5α-dihydrotestosterone (DHT). DHT is the hormone primarily responsible for the enlargement of the prostate gland. By reducing the prostate size, dutasteride improves urinary flow, reduces the incidence of urinary retention, and lowers the need for prostate surgery.

Dutasteride is associated with a variety of side effects, including dizziness, drowsiness, lightheadedness, erectile dysfunction, loss of libido, ejaculation problems, and stuffy or runny nose.

4. Proscar (finasteride)

Proscar is a brand-name medication that is available as a generic drug called finasteride. Finasteride, like dutasteride, is a 5-alpha reductase inhibitor and also works for BPH by shrinking the enlarged prostate. In clinical trials, finasteride and dutasteride were found to be equally effective in the reduction of prostate size and improving BPH symptoms. Common side effects are also similar to dutasteride and include dizziness, drowsiness, lightheadedness, erectile dysfunction, loss of libido, ejaculation problems, and stuffy or runny nose.

5. Cialis (tadalafil)

Cialis is a brand-name medication that is available as a generic drug called tadalafil. Tadalafil belongs to a class of drugs different from either the alpha blockers or the 5-alpha reductase inhibitors. Tadalafil was originally developed to treat erectile dysfunction (ED) and is in a class of drugs known as phosphodiesterase (PDE) inhibitors. It works by slowing the production of phosphodiesterase-5, an enzyme that breaks down chemicals that increase blood flow to the penis. It was discovered that tadalafil also helps relax muscle cells around the bladder and prostate, which eases the symptoms of BPH. Common side effects include nausea, diarrhea, headache, indigestion, muscle pain, stuffy nose, and flushing of the face. Because tadalafil widens arteries to let more blood flow to the penis, it may cause blood pressure to drop to unsafe levels in men already taking drugs for high blood pressure.

In clinical trials, tamsulosin showed greater efficacy in treating BPH urinary symptoms than tadalafil, however, tadalafil may be a good option for men with both BPH and ED. 

Natural alternatives to tamsulosin

Diet and lifestyle changes may help lessen symptoms due to prostate enlargement. Avoiding liquids before bedtime and limiting caffeine and alcohol drinks may reduce the urge to urinate. Cutting out or reducing fats such as butter, cheese, and milk may help reduce BPH symptoms. 

Over-the-counter herbal therapies and supplements may be used by some men for symptoms of an enlarged prostate. Although they can’t replace the efficacy of prescription drugs for enlarged prostate, options like rye-grass, pygeum, saw palmetto, and beta-sitosterol remain popular due to their mild side effect profiles. They may ease the urinary symptoms caused by an enlarged prostate to some extent. Increased intake of vitamin D from diet and supplements has shown some effectiveness in decreasing prostate volume. 

How to switch to a tamsulosin alternative

When switching from tamsulosin to an alternative BPH therapy, there are typically no withdrawal symptoms, nor is a washout period necessary. Because there is not one treatment approach that works for everyone equally, discussing symptoms with a healthcare professional for their medical advice is the best way to determine the proper course of therapy for prostate problems.