Tamsulosin and finasteride are the two most common drugs licensed and used for the management of benign prostatic hyperplasia (BPH). BPH is a condition characterised by an enlarged prostate, which may produce common symptoms such as increased urgency to urinate, poor urinary flow (difficult to start urination), increased urination at night (polyuria) and incomplete bladder emptying with males going back to the toilet several times a day/night. Tamsulosin vs finasteride reviews the most common questions surrounding both drugs.
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Tamsulosin vs finasteride: legal classification
In the UK, both drugs are classified as prescription-only medication, which means a doctor or another qualified prescriber needs to issue a prescription (NHS or private prescription) for the supply to happen.
What tamsulosin or finasteride are used for?
Tamsulosin and finasteride are mainly used for the management of benign prostatic hyperplasia (BPH).
At a lower dose, finasteride (1mg) is also used for the treatment of alopecia in male adults (hair loss).
Tamsulosin and finasteride: what is the drug classification?
Tamsulosin and finasteride belong to different classes of drugs. Tamsulosin is classified as an alpha-blocker, whereas finasteride is a 5‑alpha reductase inhibitor. The main difference between both drugs comes from their mechanism of action.
Tamsulosin vs finasteride: mechanism of action
Tamsulosin mechanism of action
In simple terms, alpha-blockers, formally known as alpha 1-adrenergic blocking drugs relax the prostatic smooth muscle which accounts for the large density (amount) of BPH tissues (Lowe, 1999). Relaxation of smooth muscle improves urine flow and reduces lower urinary tract symptoms (Dunn et al., 2002). Tamsulosin starts to work fast and is effective in controlling of moderate to severe symptoms of lower urinary tract symptoms (LUTS) and related BPH (ibid).
Finasteride mechanism of action
5 alpha-reductase is a chemical (enzyme) which converts testosterone to dihydrotestosterone (DHT), both of which are a type of steroids. DHT plays important role in prostate gland development and growth. Finasteride stops (inhibits) 5 alpha-reductase and therefore reduces the conversion of testosterone to dihydrotestosterone (DHT). This process leads to a reduction in prostate size. It is estimated that the prostate gland shrinks by about 20% with a corresponding improvement in urinary flow. When the treatment with finasteride is ceased, the amount of DHT production increases with symptoms most likely coming back (Steiner, 1996).
The difference in mechanism of action affects how fast initial relief of symptoms is achieved. Read more in the later part of this post.
Tamsulosin vs finasteride: which drug is more popular?
Number of prescriptions issued in the last 12 months:
- Finasteride: 4,044,485
- Tamsulosin: 8,485,640
Period: Dec ’21—Nov ’22 (OpenPrescribing.net, 2023)
Tamsulosin is more commonly prescribed in the UK than finasteride. The significant difference in prescribing between tamsulosin and finasteride comes from the main recommendations in the management of lower urinary tract symptoms (LUTS) in men and related conditions, for example, benign prostatic hyperplasia (BPH). BPH is the main cause of LUTS in men.
All men with LUTS need to be assessed, including possible referral to a doctor who specialises in the management of LUTS. If ‘conservative’ measures are unsuccessful, drug treatment may be offered. Alpha-blockers (tamsulosin, alfuzosin, doxazosin, or terazosin) are offered as first-line treatment in males with severe lower urinary tract symptoms.
5‑alpha reductase inhibitors such as finasteride or dutasteride are offered to male patients whose prostate is estimated to be bigger than 30g (weight of the prostate) or a PSA level greater than 1.4 ng/ml.
What is PSA?
Prostate-specific antigen (PSA) is measured (a blood test) to determine prostate size. PSA is produced by the prostate but also by cancer cells in the prostate. Males with a ‘normal’ size prostate have a small amount of PSA in the blood. When the prostate gets bigger, for example with age, PSA levels increase.
Can you take tamsulosin and finasteride at the same time?
Tamsulosin and finasteride can be taken at the same time. A combination of an alpha blocker (tamsulosin) and a 5‑alpha reductase inhibitor (finasteride) is recommended for men with severe LUTS and an estimated prostate size bigger than 30g or PSA level greater than 1.4 ng/ml. For the explanation see the previous paragraph.
Tamsulosin vs finasteride: side effects
Both tamsulosin and finasteride are associated with the risk of side effects.
The most common side effects associated with finasteride are:
- impotence (unable to achieve erection)
- decreased libido and
- decreased volume of ejaculate
Most common side effects which may be experienced by taking tamsulosin:
- dizziness
- sexual dysfunction (ejaculation disorders, failure to ejaculate)
Do finasteride and tamsulosin interact with each other?
Both drugs have distinct mechanisms of action. There is no interaction between drugs and in some way both drugs complement each other. The treatment with tamsulosin and finasteride aims to decrease the symptoms of urinary tract obstruction and improve urine flow rate (Steiner, 1996). These effects are achieved with some success by both tamsulosin and finasteride.
Tamsulosin vs finasteride: Which drug is better?
Few studies compared the effectiveness of tamsulosin and finasteride.
In one study a group of 403 patients participated in a 52-week trial (Rigatti et al., 2003). Patients were randomly given either tamsulosin or finasteride. The aim of this study was to compare the efficacy and tolerability of both drugs in patients with lower urinary tract symptoms (BPH).
This study concluded that tamsulosin improved the symptoms to a greater extent than finasteride. Tamsulosin also improved urinary symptoms more quickly than tamsulosin.
How long does it take for tamsulosin to work?
The secondary aim of the above study was to measure how quickly symptom control is achieved. For tamsulosin, about half of the total effect was achieved after one week of the treatment. Maximum improvement in symptom control for tamsulosin was achieved during week 18 of the study.
When compared to finasteride, tamsulosin worked faster in improving storage symptoms, which are considered as most troublesome for patients. After 26 weeks of treatment, both drugs produced the same relief of symptoms (ibid).
Cochrane Collaboration (a collaboration of scientists from around the world) looked at the effectiveness of finasteride in the treatment of BPH by looking at different studies (Tacklind et al., 2010). Although the comparison of finasteride with alpha-blockers was not the main aim of this study, some useful facts about finasteride treatment were highlighted in this review.
Finasteride was found to be effective in improving urinary symptoms when compared to a placebo (a dummy pill) and reduced the risk of BPH progression. Finasteride is less effective than some alpha-blockers (doxazosin and terazosin), but equally effective as tamsulosin.
Short-term use of finasteride does not improve symptoms of BPH, but it does in longer treatment. Alpha-blocker, doxazosin improves symptoms of BPH better than finasteride in short and long-term treatment. A combination of finasteride and doxazosin improves symptom control, both short and long-term with significantly better results than monotherapy with finasteride.
Man with larger prostate a combination therapy improved symptoms more significantly than a single treatment with finasteride. Combination therapy with two drugs (alpha-blocker and 5‑alpha reductase inhibitor) increases the risk of side effects including dizziness, asthenia (weakness), erectile and ejaculation disorders and postural hypotension (a drop of blood pressure when an individual stands up).
Conclusion
Finasteride and tamsulosin play important role in the management of BPH. The main pointS to take away are as follows:
- both finasteride and tamsulosin are effective in the management of BPH
- tamsulosin provides faster symptom relief than finasteride
- other alpha-blockers, particularly doxazosin and terazosin are more effective in symptom control than finasteride.
Tamsulosin vs finasteride: FAQ
Which is better finasteride or tamsulosin?
Finasteride and tamsulosin have a different mechanism of action. In the treatment of BPH both drugs complement each other. Both drugs effective in the management of BPH .Tamsulosin provides faster symptom relief than finasteride.
Does finasteride damage prostate?
Finasteride does not damage prostate. Finasteride stops conversion of testosterone to dihydrotestosterone (DHT). DHT plays a role in prostate growth. Since finasteride reduces DHT production, with time it leads to prostate shrinkage.
Does finasteride worsen erectile dysfunction?
Finasteride has impact on erectile dysfnction. Common side effect associated with finasteride use is impotence (ejaculation disorder).
What happens if you take Viagra with finasteride?
Patients who take finasteride can use Viagra, providing no other contraindications exist. Both drugs have different mechanism of action and do not interact with each other.
Does finasteride make you pee more?
Increased urination is not known side effect of finasteride. In contrast, with time finasteride should help to reduce symptoms of BPH including frequency of urination.
References
Dunn CJ, Matheson A, Faulds DM (2002). Tamsulosin: a review of its pharmacology and therapeutic efficacy in the management of lower urinary tract symptoms. Drugs Aging. 2002;19(2):135-61. doi: 10.2165/00002512-200219020-00004. PMID: 11950378. Available at: https://doi.org/10.2165/00002512-200219020-00004 Accessed on 28/01/2023
Lowe F (1999). Alpha-1-adrenoceptor blockade in the treatment of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 1999 May;2(3):110-119. doi: 10.1038/sj.pcan.4500302. PMID: 12496820. Available at: https://doi.org/10.1038/sj.pcan.4500302 Accessed on 28/01/2023
OpenPrescribing.net (2023), Bennett Institute for Applied Data Science, University of Oxford, 2023
Rigatti P, Brausi M, Scarpa RM, Porru D, Schumacher H, Rizzi CA; MICTUS Study Group (2003). A comparison of the efficacy and tolerability of tamsulosin and finasteride in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2003;6(4):315-23. doi: 10.1038/sj.pcan.4500680. PMID: 14663474. Available at: https://doi.org/10.1038/sj.pcan.4500680 Accessed on 28/01/2023
Steiner JF (1996). Clinical pharmacokinetics and pharmacodynamics of finasteride. Clin Pharmacokinet. 1996 Jan;30(1):16-27. doi: 10.2165/00003088-199630010-00002. PMID: 8846625. Available at: https://doi.org/10.2165/00003088-199630010-00002 Accessed on 28/01/2023
Tacklind J, Fink HA, MacDonald
R, Rutks I, Wilt TJ. Finasteride for benign prostatic hyperplasia. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD006015. DOI: 10.1002/14651858.CD006015.pub3. Available at: https://doi.org/10.1002/14651858.CD006015.pub3 Accessed 28/01/2023
