Daily CIALIS for benign prostatic hyperplasia

As a clinical pharmacist, you will hear about using daily Cialis (tadalafil) for benign prostatic hyperplasia (BPH), not just erectile dysfunction. It's just been approved for this use. Cialis and other phosphodiesterase-5 inhibitors seem to enhance smooth muscle relaxation in the prostate, bladder, and urethra. But don't expect a large improvement in BPH symptoms.

Tadalafil (Cialis) modestly improves urinary frequency, urgency, and straining, but not urine flow rate. And you have to treat 6 men for 12 weeks for one to benefit. Continue to recommend alpha-blockers (tamsulosin, etc) first for BPH, they're likely to be more effective and they cost less. 

Suggest considering daily Cialis for men with both erectile dysfunction and milder BPH symptoms. Or suggest adding daily Cialis if a man with both erectile dysfunction and BPH isn't getting adequate relief from an alpha-blocker. The combo might work better than either drug alone for BPH. When Cialis is added to an alpha-blocker, recommend starting with just 2.5 mg/day to reduce hypotension, and titrate to 5 mg/day.

References

• Uckert S, Oelke M. Phosphodiesterase (PDE) inhibitors in the treatment of lower urinary tract dysfunction. Br J Clin Pharmacol. 2011 Aug;72(2):197-204. Available at: https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2010.03828.x

  Martínez-Salamanca JI, Carballido J, Eardley I, Giuliano F, Gratzke C, Rosen R, Salonia A, Stief C. Phosphodiesterase type 5 inhibitors in the management of non-neurogenic male lower urinary tract symptoms: critical analysis of current evidence. Eur Urol. 2011 Sep;60(3):527-35. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0302283811006026?via%3Dihub

  McVary KT, Monnig W, Camps JL Jr, Young JM, Tseng LJ, van den Ende G. Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol. 2007 Mar;177(3):1071-7. Available at: https://www.auajournals.org/doi/10.1016/j.juro.2006.10.055

  Andersson KE, de Groat WC, McVary KT, Lue TF, Maggi M, Roehrborn CG, Wyndaele JJ, Melby T, Viktrup L. Tadalafil for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: pathophysiology and mechanism(s) of action. Neurourol Urodyn. 2011 Mar;30(3):292-301. Available at: https://onlinelibrary.wiley.com/doi/10.1002/nau.20999