The patient has since discontinued therapy and complains of worsening BPH/LUTS (AUA-SI score, 9) and ED. What is the new treatment plan for this patient?
Decrease tamsulosin dose to minimize sexual AEs
Consider combination therapy with tadalafil
Consider monotherapy with tadalafil
Encourage the patient to take saw palmetto, per AUA guidelines
Although tamsulosin AEs are dose dependent, the patient does not want to use this therapy again. Tadalafil is contraindicated with α-blocker therapy in patients with BPH, but PDE5 inhibitor monotherapy may resolve the patient's mild ED and the couple's concerns about his diminished libido and ejaculatory dysfunction from the α-blocker.
When tadalafil is prescribed for ED in a patient already taking an α-blocker, the patient should be stable on the α-blocker therapy prior to starting the tadalafil and tadalafil should be initiated at the lowest recommended dose. However, tadalafil is not recommended for use in combination with α-blockers for the treatment of BPH.
Switch from combination therapy to daily tadalafil to improve concomitant BPH/LUTS and ED symptoms.
The patient returns for follow-up 3 months later. He reports that the couple's "sex life is back to normal," and he is grateful "[he] won't have to hold client meetings in the restroom, which is what it was coming to!" The patient's AUA-SI score is back to 6.