Medicines are the first treatment for most men bothered by enlarged prostate symptoms. Several groups work in different ways, each with possible side effects. This page explains the main groups according to European and NICE guidelines and does not replace your doctor’s prescription.
| Group | Examples | How it works | Time to effect | Main side effects |
|---|---|---|---|---|
| Alpha-blockers | Tamsulosin, silodosin, alfuzosin, doxazosin, terazosin | Relax the prostate and bladder neck muscle | Days to weeks | Dizziness on standing, headache, less semen at ejaculation |
| 5-alpha reductase inhibitors | Finasteride, dutasteride | Shrink a large prostate | Several months | Lower desire or erections, less semen, rarely breast enlargement |
| PDE5 inhibitors | Daily tadalafil | Relaxes smooth muscle in the bladder and prostate | Weeks | Headache, indigestion; not with nitrates |
| Overactive bladder medicines | Antimuscarinics, mirabegron | Calm the bladder | Weeks | Dry mouth and constipation with antimuscarinics; residual urine is monitored |
| Desmopressin | Night-time dose | Reduces night-time urine production | Days | Low sodium; needs blood tests, especially in older men |
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed:
How does the doctor choose?
- Moderate to severe symptoms: an alpha-blocker is usually the first step.
- A large prostate (above about 40 ml) or a PSA raised by it: a 5-alpha reductase inhibitor is added or used; combination therapy lowers the long-term risk of retention and surgery.
- Erectile dysfunction with urinary symptoms: daily tadalafil may suit.
- Mainly storage symptoms: an overactive bladder medicine may be added after checking the bladder empties well.
- Night-time urination from producing too much urine at night: fluids and medicines are reviewed, and desmopressin may be used with care.
Tips during treatment
- Tell your doctor about all your medicines, especially blood pressure medicines and nitrates.
- Tell your eye surgeon about alpha-blockers before cataract surgery.
- Mention finasteride or dutasteride when PSA is tested.
- Do not stop your medicine on your own or buy products of unknown origin.
- See your doctor if symptoms do not improve or you cannot pass urine.
Herbal products have weak evidence. Read prostate herbal supplements: what is proven. If medicines are not enough, read prostate surgery types.
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Frequently asked questions
What is the best medicine for an enlarged prostate?
There is no single best medicine for everyone. The doctor chooses based on prostate size, the type of symptoms, other illnesses and medicines, and whether you want to preserve ejaculation.
How long do prostate medicines take to work?
Alpha-blockers work within days to weeks; finasteride and dutasteride take several months for their full effect.
Will I need prostate medicine for life?
Usually the medicine continues while it helps, because symptoms can return after stopping. The doctor reviews the need at follow-up.
Does finasteride affect the PSA test?
Yes. Finasteride and dutasteride lower PSA by about half after several months, so tell your doctor you take them when PSA is interpreted.
Does tamsulosin cause dizziness?
It can cause dizziness on standing, especially in the first days. Take it at the time your doctor advises and stand up slowly. Tell your eye surgeon about it before cataract surgery.
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Book a consultation
Prof. Al-Samarrai and Dr. Amer Mousa assess enlarged prostate symptoms and review your medicines at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
This information is for health education and does not replace a medical examination. See our medical content policy.