Editing Benign prostatic hyperplasia (section)

==== Alpha-blockers ====
[[Alpha-1 blocker|Selective α<sub>1</sub>-blockers]] are the most common choice for initial therapy.<ref name="Roehrborn2007">{{cite journal | vauthors = Roehrborn CG, Nuckolls JG, Wei JT, Steers W | title = The benign prostatic hyperplasia registry and patient survey: study design, methods, and patient baseline characteristics | journal = BJU International | volume = 100 | issue = 4 | pages = 813–819 | date = October 2007 | pmid = 17822462 | doi = 10.1111/j.1464-410X.2007.07061.x | hdl-access = free | s2cid = 21001077 | collaboration = BPH Registry and Patient Survey Steering Committee | hdl = 2027.42/73286 }}</ref><ref name="Black2006">{{cite journal | vauthors = Black L, Naslund MJ, Gilbert TD, Davis EA, Ollendorf DA | title = An examination of treatment patterns and costs of care among patients with benign prostatic hyperplasia | journal = The American Journal of Managed Care | volume = 12 | issue = 4 Suppl | pages = S99–S110 | date = March 2006 | pmid = 16551208 | url = http://www.ajmc.com/pubMed.php?pii=3096 }}</ref><ref name="Hutchison2007">{{cite journal | vauthors = Hutchison A, Farmer R, Verhamme K, Berges R, Navarrete RV | title = The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries | journal = European Urology | volume = 51 | issue = 1 | pages = 207–15; discussion 215–6 | date = January 2007 | pmid = 16846678 | doi = 10.1016/j.eururo.2006.06.012 }}</ref> They include [[alfuzosin]],<ref name="MacDonald2005">{{cite journal | vauthors = MacDonald R, Wilt TJ | title = Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects | journal = Urology | volume = 66 | issue = 4 | pages = 780–788 | date = October 2005 | pmid = 16230138 | doi = 10.1016/j.urology.2005.05.001 }}</ref><ref name="Roehrborn2001">{{cite journal | vauthors = Roehrborn CG | title = Efficacy and safety of once-daily alfuzosin in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a randomized, placebo-controlled trial | journal = Urology | volume = 58 | issue = 6 | pages = 953–959 | date = December 2001 | pmid = 11744466 | doi = 10.1016/S0090-4295(01)01448-0 }}</ref> [[doxazosin]],<ref name="MacDonald2004">{{cite journal | vauthors = MacDonald R, Wilt TJ, Howe RW | title = Doxazosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects | journal = BJU International | volume = 94 | issue = 9 | pages = 1263–1270 | date = December 2004 | pmid = 15610102 | doi = 10.1111/j.1464-410X.2004.05154.x | s2cid = 6640867 | doi-access = free }}</ref> [[silodosin]], [[tamsulosin]], [[terazosin]], and [[naftopidil]].<ref name="Hwang_2018" /> They have a small to moderate benefit at improving symptoms.<ref name="Wilt_2003" /><ref name="Hwang_2018" /><ref name="Djavan1999">{{cite journal | vauthors = Djavan B, Marberger M | title = A meta-analysis on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction | journal = European Urology | volume = 36 | issue = 1 | pages = 1–13 | year = 1999 | pmid = 10364649 | doi = 10.1159/000019919 | s2cid = 73366414 }}</ref> Selective alpha-1 blockers are similar in effectiveness but have slightly different side effect profiles.<ref name="Wilt_2003">{{cite journal | vauthors = Wilt TJ, Mac Donald R, Rutks I | title = Tamsulosin for benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002081 | date = 2003 | pmid = 12535426 | doi = 10.1002/14651858.CD002081 | veditors = Wilt T }}</ref><ref name="Hwang_2018" /><ref name="Djavan1999" /> Alpha blockers relax smooth muscle in the prostate and the bladder neck, thus decreasing the blockage of urine flow. Common side effects of alpha-blockers include [[orthostatic hypotension]] (a head rush or dizzy spell when standing up or stretching), [[ejaculation]] changes, [[erectile dysfunction]],<ref>{{cite journal | vauthors = Santillo VM, Lowe FC | title = Treatment of benign prostatic hyperplasia in patients with cardiovascular disease | journal = Drugs & Aging | volume = 23 | issue = 10 | pages = 795–805 | year = 2006 | pmid = 17067183 | doi = 10.2165/00002512-200623100-00003 | s2cid = 24428368 }}</ref> headaches, nasal congestion, and weakness. For men with [[Lower urinary tract symptoms|LUTS]] due to an enlarged prostate, the effects of naftopidil, tamsulosin, and silodosin on urinary symptoms and quality of life may be similar.<ref name="Hwang_2018" /> Naftopidil and tamsulosin may have similar levels of unwanted sexual side effects but fewer unwanted side effects than silodosin.<ref name="Hwang_2018" />

Tamsulosin and silodosin are selective α1 receptor blockers that preferentially bind to the α1A receptor in the prostate instead of the α1B receptor in the blood vessels. Less-selective α1 receptor blockers such as terazosin and doxazosin may lower blood pressure. The older, less selective α1-adrenergic blocker prazosin is not a first-line choice for either [[hypertension|high blood pressure]] or prostatic hyperplasia; it is a choice for patients who present with both problems at the same time. The older, broadly non-selective alpha-blocker medications such as [[phenoxybenzamine]] are not recommended for control of BPH.<ref name="pmid12853821">{{cite journal | title = AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations | journal = The Journal of Urology | volume = 170 | issue = 2 Pt 1 | pages = 530–547 | date = August 2003 | pmid = 12853821 | doi = 10.1097/01.ju.0000078083.38675.79 | author1 = AUA Practice Guidelines Committee }}</ref> Non-selective alpha-blockers such as terazosin and doxazosin may also require slow dose adjustments as they can lower blood pressure and cause [[syncope (medicine)|syncope]] (fainting) if the response to the medication is too strong.