Doxazosin in the Older Male: Efficacy in Treating Benign Prostatic Hyperplasia

Abstract

It is important to establish the efficacy of medical treatments for benign prostatic hyperplasia (BPH) in older patients. Several studies in the USA and in Europe have demonstrated that doxazosin produces a dose-dependent, statistically significant improvement in both the obstructive and irritative symptoms of BPH, and a significant increase in urinary flow in both younger and older men. A recent analysis of data from the USA studies demonstrated that changes in the total symptom severity score and in the bothersomeness score were similarly improved in younger (<65 years) and older patients (≥65 years). Doxazosin is also a first-line antihypertensive agent that has a favorable effect on many of the other risk factors for cardiovascular disease. The antihypertensive effect of doxazosin does not vary with age, thus offering benefit to older men with concomitant hypertension and BPH. Significantly, blood pressure is reduced to clinically relevant levels only if patients are hypertensive - no clinically significant effects on blood pressure are seen in either younger or older normotensive patients. The bioavailability and elimination half-life of doxazosin are also not influenced by age. The kinetics of doxazosin (peak plasma levels in 2-3 h ; t 1/2 = 22 h) translate into a dynamic effect that produces a rapid onset of effect and is sustained throughout the day. In summary, doxazosin produces a balanced effect in older men, improving the symptoms and uroflow in BPH, with the added benefit of a positive effect on several important risk factors for coronary heart disease