Combination Medical Therapy for Male Lower Urinary Tract Symptoms

There are clearly defined mechanisms of action for alpha adrenergic receptor blockers (AARB), 5 alpha reductase inhibitors (5ARI), antimuscarinics, and, to a lesser degree, phosphodiesterase type 5 inhibitors (PDE5i) in the management of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). Taking advantage of the different mechanisms of action and combining drugs from different classes to take advantage of an additive or synergistic effect is natural and has been explored in a large number of clinical trials. The combination of AARB+5ARI, AARB+antimuscarinics, and AARB+PDE5i has been studied in uncontrolled and controlled clinical trials. In properly chosen patients, the various combinations have been found to be effective in symptom relief and often superior to monotherapy. Adverse events associated with these combination therapies have been generally tolerable, self-limited, and reversible.