What are the recommended first-line pharmacological treatments for men with moderate to severe lower urinary tract symptoms due to BPH?

The recommended first-line pharmacological treatments for men with moderate to severe LUTS caused by benign prostatic hyperplasia are alpha-blockers, such as alfuzosin, doxazosin, tamsulosin, or terazosin. These are advised because of their rapid onset of action, good efficacy, and low rate of adverse events ¹.

Review of men on alpha-blockers should occur at 4 to 6 weeks and then every 6 to 12 months, with re-assessment of symptoms and adverse effects ¹.

If residual storage symptoms persist after alpha-blocker treatment, consider adding an antimuscarinic drug, such as oxybutynin, tolterodine, or darifenacin, or alternatively mirabegron if antimuscarinics are contraindicated or not tolerated ¹.