bph and treatment
TRANSCRIPT
Benign Prostatic Hyperplasia (BPH)
LUTS/Retention
BACK
Watchful waiting
Medical management
Surgical approachesMinimal invasive TURPInvasive “open” procedures
Treatment options
“watchful waiting”
For mild symptoms. follow up 1 to 2 times yearly
Offer suggestions that help reduce symptoms
Avoid caffeine and alcohol Alteration of timing,volume of fluid intake
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Medical Managment2 major types:
Option 1: α 1 adrenergic blockers –“Relax” the smooth muscle of prostate and provide a larger urethral opening
Option 2: 5-α reductase inhibitors
“Shrink” the prostate glandOption
Growing Market Option
Combination of α 1 adrenergic blockers and 5-α reductase inhibitors– “Relax” and “Shrink” the prostate gland
Option 1 : Alpha (α) Blockers(relaxants)
• Prazosin, Terazosin, Tamsulosin• Relax the smooth muscle of the prostate, • Early- acting
Classifation of -Blockers• Nonselective– Phenoxybenzamine
• Short-acting selective a1-blocker– Prazosin, Alfuzosin
• Long-acting selective a1-blockers– Terazosin– Doxazosin
• Long-acting selective a1A-subtype– Tamsulosin– Alfuzosin-SR
Option 2: 5-α Reductase Inhibitors(shrinkers)(5ARI)
• Finasteride• Slow-acting• Taken orally as once daily for at least 6 months
Option 3: Combination – Separate or 2-in-1 Tablet
•“FinMax” (Finarid + Pimax)
•Duodart (Dutasteride + Tamsulosin)
•Tamplus (Finasteride + Tamsulosin)
“Combination therapy gives better outcome.”- Medical treatment of prostate symptoms study
Surgical Management:
“Gold Standard” of care for BPH
Uses an electrical “knife” to surgically cut and remove excess prostate tissue
Effective in relieving symptoms and restoring urine flow
TURP (transurethral resection of the prostate)
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Finasteride(FINARID)
5mg
FINASTERIDE
• is an antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT).
• It is used as a treatment in benign prostatic hyperplasia (BPH) in low doses, and prostate cancer in higher doses.
Benign Prostatic Hyperplasia (BPH)
Testosterone Dihydrotestosterone5-Alpha reductase Enzyme
Synthetic 4-azasteroid compound
Specific inhibitor of 5-alpha reductase
FINARID (Finasteride)
Mechanism of Action (“SHRINKS” the PROSTATE)
Testosterone Dihydrotestosterone
Synthetic 4-azasteroid compound
Specific inhibitor of 5-alpha reductase
FINARID (Finasteride)
Dosage and Administration
• Orally 5mg daily with or without food• Evaluate effect after 6-12 months• No dosage adjustment required in renal impairment
or otherwise• Not indicated in women and children• Box of 30’s = Box of 2 blister packs of 15 tabs per
blister pack
Attention Statement of Finarid
DETAILING FLAP (inner)
DETAILING FLAP
COMPETITORS
BRAND NAME GENERIC PACKING PRICE PER BOX PRICE PER TAB COMPANY1 AVODART Dutasteride 500mcg box of 30's 1,346.40Php 44.88Php GSK
2 PRONAX Finasteride 5mg box of 70'sIntas (Singapore Genebio)
3 PROSCAR Finasteride 5mg box of 30's 2,202.10Php 73.40Php MSD
4 PROSTAB Finasteride 5mg box of 30'sUnicure (Singapore Genebio)
5 PROSTANUS Finasteride 5mg box of 10's Sandoz6 PROSTERIDE Finasteride 5mg box of 30's Yoo Young
PIMAX (TAMSULOSIN 400 MCG)Tamsulosin
Clinical dataLegal status Prescription Only
Routes oral
Pharmacokinetic data
Bioavailability 100% (oral)Metabolism hepatic
Half-life 9–13 hoursExcretion 76% renal
Peak Plasma Concentration 6 hours (modified release)
How Tamsulosin Works• Smooth muscle tone is mediated by the sympathetic nervous stimulation
of α1 adrenoreceptors, which are abundant in the prostate, prostatic capsule, prostatic urethra, and bladder neck.
• Blocking these adrenoceptors can cause smooth muscles in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and reduction in symptoms in BPH.
• Tamsulosin is a selective α1 receptor antagonist (blocking agent) that has preferential selectivity for the α1A receptor in the prostate versus the α1B
receptor in the blood vessels.
• Approximately 75% of the alpha1 receptors in the prostate are of the alpha1A subtype
Mechanism of Action
• TAMSULOSIN
“RELAXES”
the PROSTATE by blocking α1A receptors in the prostate.
Peripheral zone
Transition zone
Urethra
INDICATION
• Tamsulosin is primarily used for benign prostatic hyperplasia,
• But is sometimes used for the passage of kidney stones by the same mechanism of smooth muscle relaxation via alpha antagonism.(“off-label” indication)
Attention Statement of Pimax
Pimax Detailing Flap (inner)
Pimax Detailing Flap (outer)
Efficacy of Tamsulosin
• Tamsulosin has been reported to significantly improve BPH symptom scores and quality-of-life measures – after 1 week – and peak urinary flow within 4 to 8 hours of
administration.
DOSAGE and ADMINISTRATION
• Orally 200mcg or 400mcg or 1 tablet to be taken 30 minutes after the same meal each day
• Or as prescribed by the physician
Drug Combinations for the Treatment of Benign Prostatic Hyperplasia (BPH)
Alpha-Blocker and 5α-reductase InhibitorsSound drug combinations:
1. Alpha-blocker, PIMAX, for rapid symptom improvement and
2. 5α-reductase inhibitor, FINARID, for long-term shrinkage of the prostate.
The efficiency of the combination was demonstrated in randomized trials.
In the further course of the treatment, the alpha-blocker could often be discontinued after 3–5 months
COMPETITION
BRAND NAME GENERIC PACKING PRICE PER BOX PRICE PER TAB COMPANYDoxazosin Mesylate 4mg Tab box of 30's 2,079.00Php 69.30Php PFIZERDoxazosin Mesylate 8mg Tab box of 30's 2,504.69Php 83.49Php
3 CONMY Terazosin HCL 2mg box of 100's 4,450.00Php 44.50Php New Smart Formulae4 HARNAL D Tamsulosin HCL 200mcg box of 28's 2,155.28Php 76.97Php Astellas5 HARNAL OCAS Tamsulosin HCL 400mcg box of 30's 2,640.00Php 88.00Php Astellas
Terazosin HCL 1mg box of 100's 6,437.86Php 64.38Php AbbottTerazosin HCL 2mg box of 100's 8,785.57Php 87.86Php AbbottTerazosin HCL 5mg box of 48's 7,368.75Php 153.52Php Abbott
7 HYZIN Terazosin HCL 2mg box of 100's Hawon8 LOTENCIN Terazosin HCL 2mg box of 100's Genace Pharma9 PROFUZOSIN Alfuzosin HCL 10mg box of 30's Sandoz10 PROZELAX Tamsulosin HCL 200mcg box of 28's 1,434.19Php 51.22Php Biomedis11 SULOPROS Tamsulosin HCL 400mcg box of 14's and 28's12 TAMSOLIN Tamsulosin HCL 400mcg box of 10's Getz Pharma13 XATRAL OD Alfuzosin HCL 10mg box of 30's 2,379.43Php 79.31Php Sanofi-Aventis
1 ALFADIL XL
6 HYTRIN
DEALING WITH COMPETITION
• PRICE• AVAILABILITY• COVERAGE• RAPPORT/RELATIONSHIP• MONTHLY DRE ACTIVITIES• Other Productive Activities