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In December 2021, the U.
S.
Food and Drug Administration (FDA) approved a new combination therapy, Entadfi, a daily fixed-dose oral capsule consisting of finasteride [a 5α-reductase inhibitor] and tadala Non-[phosphodiesterase type 5 inhibitor] composition) for the initial treatment (up to 26 weeks) of patients with benign prostatic hyperplasia (BPH) with benign prostatic hyperplasia
.
A placebo-controlled prospective study showed good safety and efficacy of tadalafil (5 mg) + finasteride (5 mg) for 26 weeks
.
However, current US and European guidelines do not support this combination therapy due to relatively recent data on this therapy
.
However, guidelines have included tadalafil monotherapy, and the level of evidence is moderate
.
There are no detailed study data on disease progression over 1 year
.
Prescribing cascades should be avoided Prescribing cascades in the traditional sense are when an adverse drug reaction is misdiagnosed as a new medical condition and an avoidable drug is used that can further lead to additional adverse effects
.
Finasteride + tadalafil may be an avoidable prescription cascade
.
Finasteride + tadalafil is recommended for patients with erectile dysfunction who respond to 5α-reductase inhibitors
.
Tadalafil, in addition to improving the short-term efficacy of finasteride treatment, can also reduce erectile dysfunction, one of the common sexual side effects of finasteride use
.
In other words, finasteride combined with tadalafil treatment involves a cascade of prescriptions
.
How to Avoid Prescribing Cascades Consider that patients with lower urinary tract symptoms secondary to BPH-induced BPH have more options for medications and novel surgical approaches
.
Finasteride should be discontinued in men with baseline erectile dysfunction or in those who develop erectile dysfunction after finasteride use
.
Physicians should consider alternative treatment options for patients with BPH and erectile dysfunction
.
Possible alternatives for patients wishing to preserve sexual function include tadalafil monotherapy and novel minimally invasive surgery with the potential for better protection of sexual function
.
Erectile dysfunction may accompany or follow in patients with an enlarged prostate (due to BPH) after starting treatment with finasteride
.
Considering that finasteride + tadalafil is particularly attractive to these patients or to young, sexually active men with lower urinary tract symptoms
.
Careful consideration should be given when prescribing for this population
.
In the U.
S.
and other high-income countries, healthcare spending continues to grow, with medicines being one of the main expenditures, so there is a need to eliminate lower-value healthcare spending
.
Physician and patient should make shared decision-making about treatment choices.
Despite the above shortcomings, the management of BPH still mainly relies on the shared decision-making of physicians and patients, and treatment decisions should be tailored according to the patient's goals and preferences.
For patients with subsequent erectile dysfunction who refuse surgery, or who are considered unsuitable for surgery or who have failed alternative medical therapy, the combination therapy will improve safety and tolerability
.
Conclusion Based on a prospective randomized controlled study, the combination of finasteride and tadalafil capsules may be effective and safe for BPH-induced lower urinary tract symptoms caused by benign prostatic hypertrophy
.
Currently, a variety of alternative medical and surgical options are available for the initial and subsequent treatment of BPH-induced lower urinary tract symptoms
.
In the context of ever-increasing treatments, it is necessary to consider alternative monotherapy
.
Reference: David-Dan Nguyen, Quoc-Dien Trinh and N.
Bhojani, Combination of Tadalafil and Finasteride for the Treatment of Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia: Commercialization of the Prescribing Cascade, Eur Urol (2022), https:/ /doi.
org/10.
1016/j.
eururo.
2022.
01.
009
S.
Food and Drug Administration (FDA) approved a new combination therapy, Entadfi, a daily fixed-dose oral capsule consisting of finasteride [a 5α-reductase inhibitor] and tadala Non-[phosphodiesterase type 5 inhibitor] composition) for the initial treatment (up to 26 weeks) of patients with benign prostatic hyperplasia (BPH) with benign prostatic hyperplasia
.
A placebo-controlled prospective study showed good safety and efficacy of tadalafil (5 mg) + finasteride (5 mg) for 26 weeks
.
However, current US and European guidelines do not support this combination therapy due to relatively recent data on this therapy
.
However, guidelines have included tadalafil monotherapy, and the level of evidence is moderate
.
There are no detailed study data on disease progression over 1 year
.
Prescribing cascades should be avoided Prescribing cascades in the traditional sense are when an adverse drug reaction is misdiagnosed as a new medical condition and an avoidable drug is used that can further lead to additional adverse effects
.
Finasteride + tadalafil may be an avoidable prescription cascade
.
Finasteride + tadalafil is recommended for patients with erectile dysfunction who respond to 5α-reductase inhibitors
.
Tadalafil, in addition to improving the short-term efficacy of finasteride treatment, can also reduce erectile dysfunction, one of the common sexual side effects of finasteride use
.
In other words, finasteride combined with tadalafil treatment involves a cascade of prescriptions
.
How to Avoid Prescribing Cascades Consider that patients with lower urinary tract symptoms secondary to BPH-induced BPH have more options for medications and novel surgical approaches
.
Finasteride should be discontinued in men with baseline erectile dysfunction or in those who develop erectile dysfunction after finasteride use
.
Physicians should consider alternative treatment options for patients with BPH and erectile dysfunction
.
Possible alternatives for patients wishing to preserve sexual function include tadalafil monotherapy and novel minimally invasive surgery with the potential for better protection of sexual function
.
Erectile dysfunction may accompany or follow in patients with an enlarged prostate (due to BPH) after starting treatment with finasteride
.
Considering that finasteride + tadalafil is particularly attractive to these patients or to young, sexually active men with lower urinary tract symptoms
.
Careful consideration should be given when prescribing for this population
.
In the U.
S.
and other high-income countries, healthcare spending continues to grow, with medicines being one of the main expenditures, so there is a need to eliminate lower-value healthcare spending
.
Physician and patient should make shared decision-making about treatment choices.
Despite the above shortcomings, the management of BPH still mainly relies on the shared decision-making of physicians and patients, and treatment decisions should be tailored according to the patient's goals and preferences.
For patients with subsequent erectile dysfunction who refuse surgery, or who are considered unsuitable for surgery or who have failed alternative medical therapy, the combination therapy will improve safety and tolerability
.
Conclusion Based on a prospective randomized controlled study, the combination of finasteride and tadalafil capsules may be effective and safe for BPH-induced lower urinary tract symptoms caused by benign prostatic hypertrophy
.
Currently, a variety of alternative medical and surgical options are available for the initial and subsequent treatment of BPH-induced lower urinary tract symptoms
.
In the context of ever-increasing treatments, it is necessary to consider alternative monotherapy
.
Reference: David-Dan Nguyen, Quoc-Dien Trinh and N.
Bhojani, Combination of Tadalafil and Finasteride for the Treatment of Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia: Commercialization of the Prescribing Cascade, Eur Urol (2022), https:/ /doi.
org/10.
1016/j.
eururo.
2022.
01.
009
