Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
7.4.1 Drugs for urinary retention
Related guidance: NICE Clinical Guideline CG97 (2010): Lower urinary tract symptoms
-updated June 2015
NICE Pathway-Lower urinary tract symptoms in men
Management of Lower Urinary Tract Symptoms (LUTS) associated with Benign Prostatic Hyperplasia (BPH) involves:
• Alpha-blockers – as below, cross refer to CV section for recommendations on use of alpha-blockers in hypertension
• 5-alpha reductase inhibitors (finasteride and dutasteride)– cross refer to section 6.4.2. for details
Evidence from the MTOPS study which combined Finasteride with Doxazosin showed that dual-therapy provides additional symptomatic benefit for patients and delays the progression of BPH, compared to monotherapy. Patient management of LUTS associated with BPH is available here from the British Association of Urological Surgeons.
Alpha-blockers
First-line:
Doxazosin instant release
4mg tablets: £0.81 (28)





Doxazosin prolonged release should NOT be initiated. Please prescribe instant release.
Second line:Tamsulosin MR capsules
400mcg m/r capsules: £3.93 (30
Tamsulosin MR tablets (Flomaxtra XL®) are not included in the formulary due to cost
Tabphyn brand no longer available
Do not offer phosphodiesterase‑5‑inhibitors (sildenafil, vardenafil, tadalafil, avenafil, solely for the purpose of treating lower urinary tract symptoms in men, except as part of a randomised controlled trial.