臨床泌尿器科75巻7号

2021年06月発行

特集 前立腺肥大症（BPH）薬物治療のニューノーマル―“とりあえず”ではなくベストな処方を目指して

〈併用療法〉

α₁遮断薬＋PDE5阻害薬

著者： 千葉博基¹ 橘田岳也¹ 篠原信雄¹

所属機関： ¹北海道大学大学院医学研究院腎泌尿器外科学教室

ページ範囲：P.506 - P.509

文献概要

▶ポイント

・前立腺肥大症（BPH）に対するα₁遮断薬＋PDE5阻害薬併用療法は，単剤と比較して最大尿流率（Qmax），国際前立腺症状スコア（IPSS），国際勃起機能スコア（IIEF）の改善が見込める．また，蓄尿障害の改善が特徴的である．

・併用することによる重篤な有害事象は少なく，忍容性は高い．

参考文献

1） 日本泌尿器科学会 （編） : 男性下部尿路症状・前立腺肥大症診療ガイドライン. p109, リッチヒルメディカル, 東京, 2017

2） Furuta A, et al : Effects of Combined Treatment of Tadalafil and Tamsulosin on Bladder Dysfunction Via the Inhibition of Afferent Nerve Activities in a Rat Model of Bladder Outlet Obstruction. Int Urol Nephrol 50 : 839-844, 2018

3） Regades RP, et al : Effects of Chronic Administration of Tamsulosin and Tadalafil, Alone or in Combination, in Rats with Bladder Outlet Obstruction Induced by Chronic Nitric Oxide Deficiency. Int Braz J Urol 40 : 546-552, 2014

4） Angulo J, et al : Tadalafil Enhances the Inhibitory Effects of Tamsulosin on Neurogenic Contractions of Human Prostate and Bladder Neck. J Sex Med 9 : 2293-2306, 2012

5） Gacci M, et al : A Systematic Review and Meta-Analysis on the Use of Phosphodiesterase 5 Inhibitors Alone or in Combination with Alpha-Blockers for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Eur Urol 61 : 994-1003, 2012

6） Kim SW, et al : Efficacy and Safety of a Fixed-Dose Combination Therapy of Tamsulosin and Tadalafil for Patients with Lower Urinary Tract Symptoms and Erectile Dysfunction : Results of a Randomized, Double-Blinded, Active-Controlled Trial. J Sex Med 14 : 1018-1027, 2017

7） Karami H, et al : Comparing Monotherapy with Tadalafil or Tamsulosin and Their Combination Therapy in Men with Benign Prostatic Hyperplasia : A Randomized Clinical Trial. Urol J 13 : 2920-2926, 2016

8） Negoro H, et al : Add-on Effects of Tadalafil in Tamsulosin-Treated Patients with Small Benign Prostatic Enlargement : A Randomized, Placebo-Controlled, Double-Blind, Crossover Study. Neurourol Urodyn 39 : 237-242, 2020

9） Takeda M, et al : Safety and Efficacy of the Combination of Once-Daily Tadalafil and Alpha-1 Blocker in Japanese Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia : A Randomized, Placebo-Controlled, Cross-Over Study. Int J Urol 24 : 539-547, 2017

10） Yoshida T, et al : Comparison of Silodosin Monotherapy vs Silodosin with Tadalafil Add-on Therapy in Patients with Benign Prostatic Hyperplasia. Urology 106 : 153-159, 2017

11） Regadas RP, et al : Urodynamic Effects of the Combination of Tamsulosin and Daily Tadalafil in Men with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia : A Randomized, Placebo-Controlled Clinical Trial. Int Urol Nephrol 45 : 39-43, 2013

12） Sebastianelli A, et al : Which Drug to Discontinue 3 Months After Combination Therapy of Tadalafil plus Tamsulosin for Men with Lower Urinary Tract Symptom and Erectile Dysfunction? Results of a Prospective Observational Trial. Eur Urol Focus 7 : 432-439, 2021

13） Ahn ST, et al : Treatment Persistence with a Fixed-Dose Combination of Tadalafil （5 mg） and Tamsulosin （0.4 mg）and Reasons for Early Discontinuation in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction. Investig Clin Urol 61 : 81-87, 2020