How effective are phosphodiesterase-5 (PDE5) inhibitors in the treatment of benign prostatic hyperplasia (BPH)?

Updated: Feb 19, 2021
  • Author: Levi A Deters, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Phosphodiesterase-5 (PDE5) inhibitors are known to mediate smooth muscle relaxation in the lower urinary tract. The long-acting PDE5 inhibitor tadalafil (Cialis) has been shown to be significantly better than placebo in improving the symptoms of BPH/LUTS. [30, 31]  Tadalafil is approved for treatment of the signs and symptoms of BPH, used alone or with finasteride (tadalafil 5 mg plus finasteride 5 mg orally, once daily for 26 weeks or less. Tadalifil is also approved for daily use in patients with both BPH and erectile dysfunction (ED).

In patients with BPH who also have ED, the alpha-1 blocker dose should be established first, before treating the ED. The medication used to treat ED should be titrated to the lowest effective dose. If sildenafil is used, doses of greater than 25 mg should not be taken within 4 hours of any alpha-blocker. [32, 33, 34]


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