Comparison of 7 α1-adrenoceptor Antagonists in Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: A Short-term Crossover Study

A crossover study was conducted to identify the best alpha(1)-adrenoceptor (alpha(1)AR) antagonist for individual patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). One hundred thirteen patients (mean age 70.8 years) were enrolled. All patients met BPH clinical study guidelines. Seven agents were utilized: tamsulosin 0.2 mg, silodosin 8mg, urapidil 60 mg, naftopidil 50mg, prazosin 1 mg, terazosin 2 mg, and doxazosin 1 mg. Patients were initially prescribed tamsulosin or silodosin for a week and then urapidil for a week. Two weeks later, they were prescribed the better of the 2 agents for a week and a new agent for the next week. This cycle was repeated until all 7 agents were tested. Efficacy was evaluated with the International Prostate Symptom Score. The agent rankings were doxazosin (25 [22%]), silodosin (22 [19%]), urapidil (19 [17%]), naftopidil (17 [15%]), terazosin (12 [11%]), tamsulosin (11 [10%]), prazosin (7 [6%]). Only 12 patients (11%) changed agents after the crossover study was completed. The major reason was adverse events (83%). We found that each of the 7 alpha(1)AR antagonists has its own supporters. Further, the one-week crossover study was useful in identifying the best agent for the treatment of each individual with LUTS.