Drug combinations for lower urinary tract symptoms

This study looked at the effectiveness of different combinations of drugs to treat male and female lower urinary tract symptoms (LUTS). It concluded that combination drug therapy is a good option for patients who do not benefit from taking only one drug. 

Lower urinary tract symptoms (LUTS) are symptoms which result in decreased urinary function. This can include feelings of urgent urination, not emptying your bladder completely when urinating, urine dribble, straining to urinate, a weak or interrupted stream of urine and prolonged urination, among many others. Both men and women can be affected by LUTS. LUTS are often caused by a blockage of the bladder or urethra (the tube carrying urine out of the body). LUTS can be caused by conditions such as benign prostatic hyperplasia (in men) and overactive bladder.

There are many drugs available to treat LUTS. However, these drugs are not effective for every patient. These patients will often try taking two drugs in combination to ease LUTS. There are many different combinations of drugs which can be taken for LUTS. Some of these combinations are more effective than others. 

Alpha blockers, anticholinergics and anti-muscarinics are types of drug which relax muscles in the bladder. An example of an alpha blocker is tamsulosin (Flomax). Imidafenacin (Staybla) and tolterodine (Detrol) are anticholinergics. An example of an anti-muscarinic is solifenacin (Vesicare), trospium (Sanctura) and fesoterodine (Toviaz). 5 alpha reductase inhibitors (5-ARI) are a type of drug which tries to stop prostate growth. An example of 5-ARI is dutasteride (Avodart) and finasteride (Proscar). Mirabegron (Myrbetriq) is another drug which relaxes bladder muscles and is a type of drug called a beta 3 agonist. Phosphodiesterase-5 inhibitors (PDE5-I) relax muscles of the lower urinary tract. An example of PDE5-I is tadalafil (Cialis) and vardenafil (Levitra). 

58 studies were identified from a study database. These studies looked at taking a combination of LUTS drugs to try and ease symptoms and improve quality of life. 

The best identified drugs for men were:

Tamsulosin and dutasteride improved prostate symptoms, urinary function and the amount of urinations per night. However, this combination therapy had more side effects. Solifenacin and mirabegron, when taken after dutasteride, improved quality of life, number of urinations per day and the number of urgent urination episodes. Though constipation, dry mouth and retaining urine were reported side effects. Solifenacin and trospium improved urinary symptoms, incontinence episodes and night time urinations. Fesoterodine and tamsulosin improved prostate symptoms, number of urinations and quality of life. Imidafenacin and tamsulosin improved the number of day and night-time urinations, the number of urgent urinations, incontinence episodes and quality of life. Tamsulosin and mirabegron improved urinary symptoms and quality of life. An alpha blocker and desmopressin improved urinary symptoms and the number of urinationsper night. But this can lower the amount of salt in the blood. Tadalafil and vardenafil improved prostate symptoms, erectile function and the flow of urine. Tadalafil and finasteride improved prostate symptoms and erectile function but did not have a significant effect on urinary symptoms. Palmetto and tamsulosin did not have any significant results. 

In women:

Solifenacin and mirabegron improved the number of urinations per day and night, urinary urgency, quality of life, patient self esteem, number of incontinence episodes and OAB symptoms. Solifenacin and trospium decreased the number of urination and the number of urgent urinations. Pregabalin and tolterodine increase the amount of urine removed from the body but result in dry mouth and dizziness. Tamsulosin and tolterodine improved urine storage symptoms. Hormone treatments did not achieve any significant results in the treatment of LUTS in women. 

This study concluded that two drugs given together is effective for LUTS. This works best when single drug therapy no longer works for a patient. 

The authors note that the studies they looked at included a small number of patients. This may have affected their results. 

If you are interested in learning more about combination drug therapy for LUTS, talk to your doctor.