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Enlarged Prostate (BPH) Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 12, 2020.

Introduction

Benign prostatic hyperplasia (BPH) is a male condition in which the prostate gland grows larger than normal, but it is not cancerous. The prostate gland is a small gland that is part of the male reproductive tract found below the bladder and in front of the rectum. This gland produces a fluid that mixes with sperm to make semen.

Drug classes used for treatment of BPH:

Alcohol has a mild effect to increase vasodilation and lead to low blood pressure, fainting or other effects. When combined with medications that can also lead to low pressure or vasodilation, these side effects can be magnified.

Alpha blockers

When combined with alcohol, alpha blockers like tamsulosin (Flomax) and silodosin (Rapaflo) may increase the risk of low blood pressure and possible fainting upon standing (orthostatic hypotension). Headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate may occur. These effects may be most common at the beginning of treatment, when a dose is increased, or when treatment is restarted after an interruption.

Some patients may experience warmth, redness flushing or a tingly feeling after using alcohol with an alpha blocker. Patients of Asian descent may be especially prone to this interaction due to an aldehyde dehydrogenase deficiency. If they experience this interaction they should be advised to limit or avoid alcohol. Aldehyde dehydrogenase is a primary enzyme involved in breaking down alcohol (metabolism) in the body.

PDE5 inhibitors

Tadalafil (Cialis), a 5-alpha-reductase inhibitor (PDE5 inhibitor) used for erectile dysfunction, is also approved for treatment of BPH. Tadalafil can have an additive effect in lowering blood pressure when combined with alcohol. You may also experience symptoms such as dizziness, lightheadedness, fainting, flushing, headache, and heart palpitations with this drug. These effects may be more prominent at the beginning of therapy. You should avoid or limit use of alcohol with tadalafil treatment.

When tadalafil is used for BPH treatment, alpha 1-blockers should not be used at the same time and are not recommended by the manufacturer. As noted in labeling, patients on alpha-blocker therapy for BPH should discontinue their alpha-blocker at least one day prior to starting tadalafil for once daily use for the treatment of BPH. However, discuss this interaction with your doctor before stopping your alpha blocker.

5-alpha-reductase inhibitors

The 5-alpha-reductase inhibitors such as finasteride (Proscar) and dutasteride (Avodart) prevent the conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is involved in the development of benign prostatic hyperplasia (BPH). In product labeling, these drugs are not noted to interact with alcohol.

Jalyn, a combination alpha blocker (tamsulosin) and 5-alpha-reductase inhibitor (dutasteride) is also available for BPH treatment and may have similar interactions to either agent alone. Low blood pressure and feeling dizzy or faint may occur when you stand up from sitting or lying down (orthostatic hypotension).

Common Benign Prostatic Hyperplasia (BPH) Medications

*Note: This is not a complete drug list; always check with your pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the other medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products. 

Types of Drug Interactions With Alcohol

Sources

  1. Tadalafil (Cialis). Product Information. Eli Lilly. Accessed January 12, 2020 at pi.lilly.com/us/cialis-pi.pdf
  2. Kawano Y, Abe H, Kojima S, et al. Interaction of alcohol and an a1-blocker on ambulatory blood pressure in patients with essential hypertension. Am J Hypertens  2000;13: 307-12.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.