Tadalafil vs tamsulosin for BPH

I raised the possibility of this switch with my urologist when I saw him a month ago. To relieve the side effects of tamsulosin - light headedness, and retro ejac. But to my disappointment he dismissed it out of hand, he said "tadalafil is not indicated for your situation" and he changed the subject. I was quite looking forward to the good side effect of tadalafil, erection-wise that is

Interesting—AUA guidelines call for that as an alternative and the literature shows comparable effectiveness. Long term retro or anejaculation may lead to further problems for some. I guess I would push back on the quality of life issue. It probably costs more than tamsulosin and that may be why. You could also ask for a 90 trial period of tadalafil.

@scien123
I started tamulosin (flomax) with finasteride for BPH enlarged prostate in dec-25. Tamulosin relaxes muscle pretty quickly to improve urine flow while finasteride starts to shrink prostate over long term. After 2 weeks I noticed retrograde ejaculation (semen discharges into bladder) because tamulosin as an alpha-1 blocker relaxes the smooth muscle of prostate and bladder neck into urethra. Otherwise semen goes through the penis and out the urethra. That's why some people call it dry orgasm. However, Tamulosin can also relax blood vessels throughout the body, which can make some dizzy.

I did my research and found that after initially using tamulosin to relax the muscle/bladder neck to facilitate urination more quickly, it is better for most to switch to cialis (tadalafil) to "cure" the retrograde ejaculation side effect caused by tamulosin because as a PDE5 inhibitor it also relaxes smooth muscle and bladder neck without paralyzing the bladder neck ability to close during ejaculation -- thus pushing semen through the urethra more normally. Also, cialis is approved for ED, which many men with enlarged prostate need help with, so it solves 2 issues at same time. You wouldn't take all 3 because tamulosin and tadalafil are redundant for relaxing the muscle andvyou would still ha v e retrogradeejaculation.

So now I take cialis (tadalafil) paired with finasteride. I called my insurance to find out which was on formulary at what cost. They are all the same for me, essentially $10 copay. Tadalafil is also easy to get online from places like hims.

@deanhobart yeah I don't believe that is correct. Tamsulosin and Taladafil are often prescribed together. They work very differently, but both have similar effects on bph. I took both for many years before they eventually did not provide enough relief and I opted for aquablation (which was a God-send). I took the tamsulosin at bed time so i didn't experience any daytime dizziness or light headed-ness plus it really help me get to sleep quickly. Then I took the taladafil in the morning. I didn't need the tamsulosin post aquablation, but continued to take the 5mg daily taladafil.

@vtredwolf
It’s weird but I did not write that message. Somehow it was edited by someone and completely different than what I write.

@vtredwolf
Tamulosin and taladafil are NOT "often prescribed together". They can be but only by doctors up to date. And when they are, they typically are prescribed to be taken at different times of the day due to blood pressure concerns.

The FDA actually discouraged use together becauseof the BP concerns. It was not until 2012 when a European study showed that they were safe if taken together. And in the US, it wasn't until 2014 that the American Urologist Association officially approved it together. Prior to that there were actually warning labels NOT to combine them.

Finasteride was first approved to help BPH conditions in 1992.

Tamulosin was first approved to help BPH conditions in 1997, but it wasn't specifically approved to work with finasteride until the MTOPS Study in 2003 found that the combination was superior to either by themselves. Then in 2010, the FDA approved a "combo" product and so using them together before 2010 was off label, which many docs refuse to do.

Taladafil was not approved for BPH conditions until 2011, and then the Casabe Study in 2014 found that finasteride and taladafil together was superior when tamulosin caused side effects, and then the combo of taladafil and finasteride was approved in 2021 (when the combo drug Entadfi was approved).

It is important to know the history because many primary care docs make the prescription for BPH and there is a greater chance they aren't as up to date as a urologist. Also, if tamsulosin causes retrograde ejaculation, which is what is being discussed here, taking tadalafil doesn't help with that. That is why one would stop tamsulosin and start taladafil. Because retrograde ejaculation doesn't happen in everyone, a large number of men will probably start with tamsulosin and then need to tell their doc to switch.

For men with strong urination urges, tamsulosin works faster than taladafil (48 to 72 hrs) whereas tadalafil takes about 1 to 2 weeks. But tamsulosin can cause retrograde ejaculation. Taladafil takes longer to take effect but also helps with ED, which tamsulosin doesn't. A 2012 study found that in cases where tamsulosin or tadalafil were taken alone, there was no difference in flow rates or urges after 12 weeks.

Insurance in US tends to favor tamsulosin because it is less expensive and has been a generic longer.