Is Tamsulosin the Same as Finasteride?
Dr. Gerardo Sison
One of the most common conditions affecting aging men is benign prostatic hyperplasia (BPH), commonly referred to as enlarged prostate. Benign prostatic hyperplasia can develop as a result of changing hormone levels in the body and health conditions such as diabetes and heart disease. Symptoms of BPH can get worse with age as hormone levels continue to change. Finasteride and tamsulosin are two popular FDA-approved treatment options for urinary BPH symptoms, but due to similarities between the two medications, they are commonly confused. If you’re wondering “is tamsulosin the same as finasteride?”, we will explain the similarities and differences between the two drugs.
Tamsulosin is not the same thing as finasteride. Tamsulosin is the generic version of a brand-name drug called Flomax and is usually taken once per day. It is often used along with dutasteride to treat BPH. Finasteride is a generic prescription drug that is sold under the brand name Proscar for the treatment of BPH. Finasteride is also available as a different brand name calledPropecia for the treatment of male pattern baldness. Finasteride is taken at a dose of 1 mg or 5 mg per day depending on which condition is being treated by the drug.
One similarity between finasteride and tamsulosin is that both drugs are used to treat urinary symptoms caused by benign prostatic hyperplasia, also known as enlarged prostate, in adult men. Finasteride is also FDA-approved to treat male pattern hair loss. Tamsulosin is sometimes used off-label to help people pass kidney stones. Finasteride is sometimes used off-label to treat excessive hair growth in women (hirsutism).
Benign prostatic hyperplasia
One of the most common medical conditions affecting adult men is benign prostatic hyperplasia. As men age, changing hormone levels in their bodies can cause the prostate to become enlarged due to increased levels of a hormone called DHT. The condition can range in severity from mild to severe and symptoms can vary among different individuals. Some men with mild prostate enlargement may experience urinary symptoms, while others with significant enlargement may experience few or no symptoms. Urethral symptoms of benign prostatic hyperplasia include:
- Inability to empty the bladder completely
- Nighttime urination (nocturia)
- Frequent need to urinate
- Urinary flow that stops and starts
- Difficulty starting to urinate
- Urgent need to urinate
- Weak urine stream
- Dribbling following urination
Male pattern baldness
An estimated 50 million men in the United States are genetically predisposed to a condition called male pattern baldness. This type of hair loss is caused by rising levels of a hormone called DHT in the body, which shrinks the size of the hair follicles. As the hair follicles shrink, existing hair falls out and new hair is unable to grow in. Male pattern baldness causes a distinctive pattern of hair loss that is characterized by a receding hairline and thinning hair that occurs primarily on the crown of the head.
When concentrated urine sits in the bladder for too long, the minerals found in the urine can crystallize, forming urinary stones. Urinary stones are common in men who suffer from benign prostatic hyperplasia or nerve damage in the area of the bladder because they often cannot empty their bladders completely. Other medical conditions that can contribute to the development of urinary stones include bladder inflammation, use of catheters, or the development of kidney stones that travel into the bladder. Urinary stones are most likely to affect men over the age of 50. Urinary stones are commonly associated with symptoms like lower abdominal pain, difficulty urinating, pain during urination, cloudy or abnormally dark-colored urine, blood in the urine, and frequent urination. Tamsulosin may be used off-label to improve lower urinary tract symptoms of advanced prostate cancer, although it can alter the results of the prostate specific antigen test (PSA) for the detection of prostate cancer.
Tamsulosin and finasteride are both used for the treatment of urinary symptoms associated with benign prostatic hyperplasia in men; however, the drugs have different treatment mechanisms, belong to different drug classes, and work differently.
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Drug Class and Treatment Mechanisms
Tamsulosin and finasteride belong to two different classes of prescription drugs. Tamsulosin is part of a class of drugs called alpha blockers. Alpha blockers are most well known for the treatment of high blood pressure, but they are also commonly used to treat prostate problems in men. Alpha blockers work by inhibiting the action of norepinephrine, a hormone which causes the walls of the smaller arteries and veins in the body to contract. When a patient takes alpha blockers, the action of norepinephrine is blocked, meaning that the blood vessels are able to remain relaxed and open, contributing to improved blood flow and lower blood pressure. The medication also helps to relax other muscles in the body, including the muscles of the urinary tract. When the muscles of the urinary tract are relaxed, men experience fewer urinary symptoms associated with benign prostatic hyperplasia. One important difference between tamsulosin and finasteride is that tamsulosin improves the symptoms associated with enlarged prostate but does not reduce the sizeside of the prostate itself, while finasteride actively shrinks the size of the prostate.
Finasteride belongs to a class of drugs called 5-alpha reductase inhibitors. The 5-alpha reductase enzyme is used by the body to convert free testosterone in the body into a substance called DHT. DHT levels rise naturally in many men as they age, contributing to benign prostatic hyperplasia and hair loss in men who are genetically predisposed to male pattern baldness. By blocking the action of 5-alpha reductase, the body creates less DHT and levels of the hormone in the body are reduced. As a result, the size of the prostate begins to decrease and urinary symptoms associated with benign prostatic hyperplasia improve.
Most patients tolerate the use of finasteride and tamsulosin well, and side effects of the drugs are relatively uncommon. However, like all medications, both drugs are associated with the risk of certain side effects. Finasteride is associated with more side effects than tamsulosin, and the side effects caused by the drug are generally less well tolerated. Notably, finasteride can cause more sexual side effects than tamsulosin, including erectile dysfunction or a reduction in libido (sex drive), particularly when treatment is first started. Regardless of which drug is used, patients are more likely to experience side effects when they first start treatment with a medication, but the side effects are likely to disappear or diminish as the patient’s body adjusts to the medication.
Tamsulosin is associated with fewer side effects and less severe side effects than similar medications. Nonetheless, some of the side effects associated with tamsulosin could be serious or potentially life-threatening. For the most part, tamsulosin is well tolerated, and most patients find that these adverse events diminish over time as their body adjusts to the medication. Common side effects associated with tamsulosin include:
- Sore throat
- Chest pain
- Runny nose
- Decreased semen
Life threatening side effects associated with tamsulosin are rare, but they have been known to occur. Patients should call 911 or seek medical attention immediately if they notice signs of any of the following side effects:
- Dizziness, lightheadedness, or fainting associated with orthostatic hypotension (low blood pressure) that occurs when you go from sitting to standing or lying down to sitting or standing.
- Priapism, or painful erection lasting four hours or longer that is not relieved by having sex.
- Serious skin reactions, including facial swelling, difficulty breathing, raised welts, fever, or Stevens-Johsnon syndrome.
- Intraoperative floppy iris syndrome, a complication of surgery that is performed for cataracts or glaucoma in patients who are being treated with tamsulosin.
- Allergic reaction, as evidenced by difficulty breathing, swelling of the face, throat, or tongue, rash, hives, or itching.
The use of finasteride for the treatment of benign prostatic hyperplasia is associated with more side effects than the use of the medication for the treatment of male pattern baldness because of the higher dose of the drug taken for the treatment of enlarged prostate. Mild side effects associated with finasteride include:
- Trouble getting or keeping an erection (erectile dysfunction)
- Decreased sex drive (sexual dysfunction)
- Skin rash
- Breast enlargement and tenderness to the touch
- Ejaculation disorder
- Reduced ejaculate
Most people who experience adverse effects while taking finasteride will experience minor baseline side effects. However, some side effects can be severe and even potentially life threatening. Patients experiencing any of the following side effects should contact a doctor right away and should contact 911 if their symptoms feel life threatening.
- Swelling of the lips, tongue, throat, or face
Tamsulosin and finasteride are two different medications that are both used for the treatment of urinary symptoms caused by benign prostatic hyperplasia in aging men. Both drugs offer effective long-term relief from urinary symptoms, but tamsulosin may provide better short-term relief of symptoms. Tamsulosin is associated with fewer and less severe side effects than finasteride, although both drugs are generally well tolerated. Talk to your urologist or healthcare professional to see if tamsulosin or finasteride is right for you. Tamsulosin and finasteride are sold by prescription only and can be purchased at your local pharmacy.