Uroxatral (Alfuzosin) vs Other BPH Medications: Full Comparison

Quick Takeaways

• Uroxatral (alfuzosin) is an alpha‑blocker that eases urine flow without affecting sexual function for most men.
• It works best for mild‑to‑moderate BPH, but may need combination therapy with a 5‑alpha‑reductase inhibitor for larger prostates.
• Common alternatives - tamsulosin, silodosin and doxazosin - share the same class but differ in dosing frequency and side‑effect profiles.
• Finasteride and dutasteride shrink the prostate over months but can cause sexual side effects and require regular PSA monitoring.
• Choosing the right drug depends on prostate size, symptom severity, cardiovascular health, and personal tolerance for side effects.

What Is Alfuzosin?

Alfuzosin is an oral alpha‑blocker approved for the treatment of benign prostatic hyperplasia (BPH). It relaxes the smooth muscle in the bladder neck and prostate, improving urine flow without significantly affecting blood pressure. The brand name Uroxatral is the most common formulation in Australia, taken once daily after a meal.

Understanding Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a non‑cancerous enlargement of the prostate gland that affects up to 50 % of men over 60. Enlarged tissue compresses the urethra, causing urinary frequency, urgency, weak stream, and nocturia. The condition is progressive, but symptom severity varies widely.

How Alpha‑Blockers Work

All alpha‑blockers, including alfuzosin, target the α1‑adrenergic receptors in prostatic smooth muscle. By inhibiting these receptors, they prevent muscle contraction and reduce outlet resistance. This class offers rapid symptom relief-often within days-making them first‑line for many patients.

Key Alternatives to Alfuzosin

Below are the most commonly prescribed alternatives, grouped by drug class.

• Tamsulosin another selective α1‑blocker that’s taken once daily, often at bedtime.
• Silodosin highly selective for the α1A subtype, reducing the risk of blood‑pressure drops.
• Doxazosin a non‑selective α1‑blocker that can be used for both BPH and hypertension.

In addition to alpha‑blockers, 5‑alpha‑reductase inhibitors (5‑ARIs) shrink the prostate over time:

• Finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT), reducing prostate volume.
• Dutasteride inhibits both type 1 and type 2 5‑alpha‑reductase enzymes, offering a stronger volume reduction.

Side‑Effect Landscape

Understanding side effects helps you match a drug to a patient’s lifestyle.

When to Choose Alfuzosin Over Others

Alfuzosin shines in several scenarios:

1. Patients need rapid relief (within days) but have a moderate prostate size (<30 mL).
2. Co‑existing cardiovascular disease limits the use of non‑selective blockers like doxazosin.
3. Concern about sexual side effects makes alfuzosin attractive, as it has the lowest reported rate of ejaculatory dysfunction among alpha‑blockers.
4. There’s a need for a once‑daily regimen that can be taken with food to improve adherence.

Combination Therapy: Alfuzosin + 5‑ARI

For men with larger prostates (>40 mL) or rapidly progressing symptoms, guidelines recommend adding a 5‑alpha‑reductase inhibitor to an alpha‑blocker. The combo reduces acute urinary retention risk by up to 30 % and can shrink the gland over 6-12 months.

Typical regimen: Alfuzosin 10 mg once daily plus Finasteride 5 mg daily. Monitor PSA every 6 months and reassess symptom scores (IPSS) after one year.

Cost & Accessibility in Australia (2025)

As of October 2025, the PBS lists both alfuzosin (Uroxatral) and tamsulosin at comparable subsidised prices, roughly AU$30 per month for a standard pack. Doxazosin, being older, is often cheaper but may require a private script if not covered for hypertension. 5‑ARIs sit slightly higher, especially dutasteride, which is not fully PBS‑listed for BPH alone.

Practical Decision Checklist

• Prostate size < 30 mL? → Start with an alpha‑blocker (alfuzosin, tamsulosin, silodosin).
• Prostate size ≥ 30 mL AND IPSS > 19? → Consider adding a 5‑ARI.
• History of orthostatic hypotension? → Prefer alfuzosin or silodosin over doxazosin.
• Concern about ejaculation? → Choose alfuzosin; avoid tamsulosin and silodosin.
• Need for blood‑pressure control? → Doxazosin can kill two birds with one stone.

Frequently Asked Questions

Bottom Line

If you need quick symptom relief, a moderate‑sized prostate, and want to keep sexual function intact, Uroxatral (alfuzosin) is often the best single‑agent choice. For larger glands or when long‑term shrinkage is desired, add a 5‑ARI or switch to a different alpha‑blocker based on cardiovascular profile. Always discuss personal health history with a urologist to fine‑tune the regimen.