<p><strong>In patients with LUTS/BPH, with or without ED, clinicians may offer the combination of daily 5 mg tadalafil with uroselective ABs. (<em>Conditional Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>There was a high degree of heterogeneity with results among the different trials looking at AB therapy with 5 mg tadalafil. One systematic review evaluated tadalafil combined with any AB versus an AB alone. This demonstrated a small improvement in IPSS; however, clinical significance was borderline (MD: 2 points).<sup>141</sup> In addition, sexual function outcomes were not reported. Two additional RCTs looked at tadalafil with silodosin or tamsulosin; one demonstrated a small statistically significant improvement in IPSS that was not clinically significant,<sup>192</sup> while the other found no significant difference in symptoms.<sup>192, 193</sup> Overall, these 12 trials show small improvement in symptom scores with combination therapy, but the benefits are small when looking at individual trials (see <strong>Appendix I)</strong>. Combination therapy is generally considered safe but there is a risk for potentiated hypotension and requires monitoring.</p>
<p><em>PDE-5Is + ABs Versus PDE-5Is</em></p>
<p>Five RCTs compared a PDE-5I combined with an AB to a PDE-5I alone, including combinations of tadalafil, vardenafil, or sildenafil with silodosin, tamsulosin, or doxazosin.<sup>192-196</sup> These studies showed a small improvement in LUTS associated with combination therapy, as well as better quality of life and erectile function. Most studies reported no differences in adverse events.</p>