Alpha blockers: are all created equal?

Drug therapy with alpha blockers has become the standard treatment for patients with benign prostatic hyperplasia. Medical treatment is often preferred by patients as opposed to minimally invasive therapy or transurethral resection of the prostate. Alpha blockers reduce urethral pressure by blocking the motor sympathetic adrenergic nerve supply to the prostate. Several alpha blockers are available for treatment of benign prostatic hyperplasia, including alfuzosin, tamsulosin, terazosin, and doxazosin. Different meta-analyses have shown these agents to be comparable in terms of efficacy in improving symptom score and increasing urinary flow rates. The clinical uroselectivity of these agents differs, however, and translates into differences in side effects. Side effects that have been reported with some alpha blockers include dizziness, headache, postural hypotension, and retrograde ejaculation.