The variety of urology drugs seems confusing for an average person. Although prescription drugs are the domain of healthcare professionals, patients have their rights to understand what they are prescribed and why.
The most common urology conditions are urinary tract infections (UTIs), urinary incontinence (both in men and women), prostatic hyperplasia, and erectile dysfunction. Prostate cancer does not belong to urology only, and it is treated with cancer drugs or other methods. Surgery is often a suggestion for prostate cancer. Along with the consideration of what to prefer, medication or surgery, you may also want to know how the price policies affect the doctors’ choice of prescription drugs.
Classes of Urology Drugs
There are two main types of drugs used in the treatment of Benign Prostatic Dysplasia (BPH), or, simply said, enlarged prostate:
- 5-alpha inhibitors
This class of drugs works to relax the smooth muscles of the bladder neck, prostate, and urethra, which helps a patient to urinate. Here you can find a summary on the drug of the class:
|Chemical (generic) name||Brand name||Price, $*|
* Based on goodrx.com. According to PharmacyChecker.com, the prices for the generic analogs outside of the USA can be 20-fold less, but it seems too good to be true.
The most prescribed drug of the class is Flomax (tamsulosin), with annual spending in 2017 under the Medicare Part D more than $100 million, according to urologytimes.com.
Attention: Alpha-blockers decrease blood pressure and, for a long time, were the first-line drugs for the treatment of high blood pressure. Therefore, cannot be used in people with hypotension. Also, do not take them simultaneously with other drugs that low blood pressure.
Side effects: Hypotension, dizziness, tachycardia, stuffy nose, and retrograde ejaculation.
The risk of cardiovascular complications is considered low.
In case of chronic urinary retention and renal failure, treatment with alpha-blockers is not indicated. For this condition, surgery is the preferable treatment.
|A few words about pricing before we continue to the next section.
As Doctor Robert A. Dowling noticed in his article, health providers that work on a “buy and bill” basis — which corresponds to the Medicare Part B — often are interested to prescribe more expensive drugs as, in this case, they have more profit. Further, we will show how it works on the example of Myrbetriq®.
This class of urology medicines represses the production of dihydrotestosterone (DHT), a derivative of the male hormone testosterone. Currently, there are only two FDA-approved options:
- Dutasteride (Avodart)
- Finasteride (Propecia, Proscar)
In 2017, finasteride was among the six drugs “prescribed to more than 1 million unique beneficiaries”, according to Dr. Dowling. At the same time, 5-alpha inhibitors have side effects that make them unpopular among male patients.
Side effects: decreased libido, erectile dysfunction (low), and gynecomastia (breast growth).
|Did you know that finasteride for prostate treatment has the same active ingredient as a popular drug for hair growth Propecia?|
A combination of tamsulosin and dutasteride was approved by the FDA for BPH, combining, thus, an alpha-blocker and 5-alpha inhibitor in one compound formula. It is marketed under the brand name Jalyn.
Can be ED drugs Administered as Alternative Treatment for BPH?
There is certain evidence that PDE5 inhibitors routinely used in the treatment of erectile dysfunction can improve symptoms of BPH. They have never been approved for this condition, and, obviously, are not the number one choice, but your doctor might recommend some ED medications for off-label treatment of prostate enlargement. The most common or widely prescribed drugs of the type according to My Canadian Pharmacy customer review are:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Udenafil (Zydena)
Side effects: Adverse reactions of different PDE5 inhibitors may differ as well. The most common include sudden drop in blood pressure, syncope, headaches, vision blur, abnormal (bluish) vision, flushing, pianism, and some other.
Attention: Do not take PDE5 inhibitors with medicines called nitrates and other drugs that lower blood pressure.
|Tip: If your doctor will recommend a PDE5 inhibitor for BPH, the probability that you will get coverage is low as it is not approved for enlarged prostate. In this case, you have to pay out of pocket. Check whether your plan can cover it as ED medication.|
Medications for Bladder Control
Both men and women can suffer from Over Active Bladder (OAB), or urinary incontinence. Men often can experience symptoms of OAB after the surgical treatment of BHP. For women, there are many different causes of urinary incontinence, including hormonal misbalance.
Anticholinergic Medications to Regulate Your Bladder
Anticholinergic drugs help to relax the bladder wall muscles so that it can hold more urine and does not manifest urges to frequent urination.
The class of the drugs includes:
|Chemical (generic) name||Brand name||Price, $/ 1 pill*|
* Based on goodrx.com.
** Not available
Side effects: Constipation, dry mouth, dry eye, tachycardia, dizziness, headaches, dry skin.
Beta-3 adrenergic drugs for OAB
Currently, the only drug of this class is mirabegron (Myrbetriq). Similar to the medications from the previous category, mirabegron relaxes bladder muscle but through affecting different receptors.
|This drug is very well marketed. A sharp spike in spending on Myrbetriq was in 2017 — quite an impressive 52%. At the same time, this drug was one of the medications studied by independent resource ProPublica.org. According to the resource, “In 2016, doctors who received payments related to Myrbetriq, which treats overactive bladder, wrote 64% more prescriptions for the drug than those who did not”.|
Side effects: nausea, constipation, upset stomach, headaches, and dizziness.
Drugs to Treat Urinary Tract Infections
For UTIs, antibiotics are mostly used. Choosing a proper antibiotic for your treatment, your doctor considers many individual factors, so we just mention 4 most popular antibiotics in urology which are cheaper to find as generics:
|Chemical (generic) name||Brand name||Price, $/ 1 pill*|
The side effects of antibiotics can vary significantly. Your health provider can pick the best option for you.
Urology Cancer Medications
In terms of costs, cancer drugs lead the list of the drugs prescribed in urology. In 2017, spending on each of two oral drugs for hormonal therapy of cancer exceeded $800 million:
- Abiraterone (ZYTIGA) — $878 million
- Enzalutamide (XTANDI) — $855 million
Among the other anti-cancer hormonal drugs used in urology, we can name Flutamide, Bicalutamide, Buserelin, Goserelin, Histrelin, Leuprorelin, Triptorelin, Degarelix, Abarelix, and Apalutamide.
Except for cancer, urology conditions are not life-threatening and well curable. Even prostate cancer has an incredibly high survival rate: for local cancer that has not spread to other areas 5-year survival rate is 100%. With so many up-to-date medication options, the need for surgery for BPH, and even cancer is gradually decreasing.