Treatment Issues

Discussing Treatment With Your Patients

Treatment for BPH should be based on the best available scientific evidence but also individualized to patients' circumstances and personal choices. The primary consideration when choosing therapy should be the patient’s perception of the severity of his BPH symptoms and the degree to which these symptoms affect his quality of life and activities of daily living. The degree to which BPH patients are bothered by lower urinary tract symptoms varies among individual patients with the same level of symptoms. Although patients with mild symptoms or mild to severe symptoms that are not bothersome might prefer watchful waiting, patients with bothersome moderate to severe symptoms may have a range of preferences for treatment. Patients should be informed about the risks and benefits of each treatment and about which treatments are appropriate given individual patient characteristics. See how you can help your patient make an informed decision.

Discussing Sexual Side Effects

All treatments for BPH (with the exception of watchful waiting) have some impact on sexual health. Sexual side effects should be discussed with the patient before initiating treatment, as this may impact patient preferences for treatment.

The selective alpha-adrenergic receptors cause retrograde ejaculation (orgasm with reduced or no semen) in 10% to 30% of patients. This effect is not harmful to the patient’s health, is reversible on discontinuation, and does not affect erection quality or ability to achieve orgasm.

The 5-ARIs cause a range of sexual side effects including decreased libido (4%-6%), erectile dysfunction (7%-8%), and ejaculatory dysfunction (1%-4%). These side effects are likely due to the reduced levels of dihydrotestosterone after 5-ARI therapy.20

Minimally invasive procedures induce retrograde ejaculation in the range of 20% to 70% while TURP and open surgery cause retrograde ejaculation in up to 90% of patients. The rate of erectile dysfunction after surgery varies widely from 4% to 50%. This wide variation is likely due to the difficulty of assessing patients’ perception of sexual activity before and after surgery.20

References
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  20. Ponholzer A, Madersbacher S. Lower urinary tract symptoms and erectile dysfunction; links for diagnosis, management and treatment. Int J Impot Res. 2007;19:544-550.
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RAPAFLO® is indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). RAPAFLO® is not indicated for the treatment of hypertension.

Important Safety Information

RAPAFLO® is contraindicated in patients with severe renal impairment (CCr <30 mL/min), severe hepatic impairment (Child-Pugh score ≥10), and with use of strong CYP3A4 inhibitors. Postural hypotension with or without symptoms (eg, dizziness) may develop when beginning treatment with RAPAFLO®. As with all alpha-blockers, there is a potential for syncope. Patients should be warned of the possible occurrences of such events and should avoid situations where injury could result. RAPAFLO® should be used with caution in patients with moderate renal impairment. Patients should be assessed to rule out the presence of prostate cancer prior to starting treatment with RAPAFLO®. Patients planning cataract surgery should inform their ophthalmologist that they are taking RAPAFLO®.

The most common side effects are retrograde ejaculation, dizziness, diarrhea, orthostatic hypotension, headache, nasopharyngitis, and nasal congestion.