Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED

Abstract

Purpose of Review Aim of our systematic review is to evaluate and summarize the efficacy and safety of tadalafil alone or in combination with tamsulosin for the management of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Recent Findings Daily tadalafil, in particular 5 mg, according to retrieved studies, appears to be both safe and effective in treating LUTS/BPH and ED, compared with placebo or tamsulosin. The combination of daily tadalafil 5 mg and tamsulosin 0.4 mg allows a better improvement of LUTS compared with both the monotherapies, even if with an increased, but acceptable and tolerated, adverse events rate. After discontinuation of tamsulosin or tadalafil in patients previously treated with their combination, the improvement of LUTS retains significance compared with baseline. Summary Tadalafil 5 mg should be considered a primary treatment option for patients with LUTS/BPH and ED. Evidence highlight an excellent tolerability, safety, and effectiveness profile, both alone or in combination with tamsulosin 0.4 mg. A better efficacy on LUTS relief has been observed for combination therapy, preserving also sexual function. The further switch to monotherapy allows to preserve LUTS relief, but tadalafil only is able to retain ED improvement. Our results support the evidence for a more and more tailored and modular LUTS treatment.

Erectile Dysfunction in Diabetic Patients: From Etiology to Management

“…These include sildenafil, tadalafil, vardenafil, and avanafil, which differ for bioavailability, pharmacokinetics, affinity, and selectivity for PDE isoenzymes. Sildenafil is mostly used on demand, due to its short bioavailability, while tadalafil can be used daily and could be preferred in patients with contemporary benign prostatic hyperplasia [33]. It is noteworthy that PDE5 is involved in the intracellular signaling of insulin.…”

Efficacy and Safety of 12-week Monotherapy With Once Daily 5 mg Tadalafil for Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: Evidence-based Analysis

“…Although these drug treatments are effective, they can cause troublesome adverse reactions, such as hypotension, dizziness, and sexual dysfunction (7,8). Tadalafil, one of the phosphodiesterase type 5 inhibitors (PDE5Is) used to improve the symptoms of erectile dysfunction (ED), has been increasingly investigated and gained approval for the treatment of BPH in many countries since 2011 (9). This is mainly because PDE5Is are believed to likely act mainly by increasing the concentration of nitric oxide (NO), which improves the activity of intracellular cyclic guanosine monophosphate (cGMP) (10).…”

“…Although these drug treatments are effective, they can cause troublesome adverse reactions, such as hypotension, dizziness, and sexual dysfunction ( 7 , 8 ). Tadalafil, one of the phosphodiesterase type 5 inhibitors (PDE5Is) used to improve the symptoms of erectile dysfunction (ED), has been increasingly investigated and gained approval for the treatment of BPH in many countries since 2011 ( 9 ).…”

“…This system is collectively called the NO-cGMP signaling pathway, and its activation could lead to the relaxation of smooth muscle in the detrusor, bladder neck, and prostate ( 10 ). In addition, PDE5Is not only ameliorate intraprostatic inflammation-associated BPH but also improve tissue oxygenation and blood supply and thereby playing a vital part in alleviating LUTS ( 9 , 11 ).…”

Commentary: Lower Urinary Tract Symptoms and Sexual Dysfunction: A Systematic Review and Meta-Analysis

“…Furthermore, tadalafil 5 mg daily treatment as monotherapy or in combination with α-blockers have shown efficacy in treating both LUTS and ED. Sebastianelli et al indicated that tadalafil 5 mg should be considered a primary treatment option for patients with LUTS/BPH and ED with an excellent tolerability, safety, and effectiveness profile, both alone or in combination with tamsulosin 0.4 mg ( 5 ). Tadalafil is not just a treatment alternative to other established drugs for LUTS that have some sexual adverse events associated with their use, it is the only drug that can treat both ED and LUTS at the same time ( 6 ).…”