Tamdura for Enlarged Prostate: Tamsulosin, Dutasteride and Long-Term Use

Hello Mr. Karan,

Your question raises several separate issues: why tamsulosin did not reduce the size of your prostate, what Tamdura actually contains, what residual urine means, and whether treatment should be continued or restarted after three months.

The first point I want to clarify is that your previous experience with tamsulosin was not necessarily a treatment failure simply because your prostate did not become smaller.

Why Didn’t Tamsulosin Shrink Your Prostate?

Tamsulosin is an alpha-1 blocker. It works mainly by relaxing smooth muscle around the prostate and bladder outlet. This can make urination easier and may improve symptoms such as a weak stream, hesitancy and incomplete emptying.

However, tamsulosin does not materially reduce prostate size.

So if your urine flow improved while taking tamsulosin but an ultrasound showed that the prostate remained enlarged, that would not be unexpected.

You can read more about this distinction in my guide to BPH medications.

What Is Tamdura?

Tamdura is a combination medicine containing:

• tamsulosin 0.4 mg, an alpha blocker; and
• dutasteride 0.5 mg, a 5-alpha-reductase inhibitor.

These medicines have different purposes.

This explains why Tamdura may be prescribed when a doctor believes a man has both bothersome urinary symptoms and a sufficiently enlarged prostate to benefit from longer-term dutasteride treatment.

How Long Does Dutasteride Take to Work?

Dutasteride is very different from tamsulosin because its effect develops slowly.

Clinical guidance indicates that 5-alpha-reductase inhibitors such as dutasteride and finasteride generally require several months before their full clinical benefit becomes apparent.

Over longer-term treatment, these medicines can reduce prostate volume and lower the risk of acute urinary retention and the need for BPH surgery in appropriately selected men.

Can Tamdura Be Taken Long Term?

Yes, tamsulosin/dutasteride combination therapy can be used long term in appropriately selected men. However, it should not be continued automatically without periodic medical review.

Your doctor may consider:

• how bothersome your urinary symptoms are;
• your prostate size;
• your post-void residual urine volume;
• your urinary flow rate;
• PSA results when appropriate;
• blood pressure and dizziness;
• sexual side effects;
• kidney function when clinically relevant; and
• whether another bladder or urinary condition is contributing to your symptoms.

If you have not already had a structured assessment, my guide to prostate tests and BPH evaluation explains some of the tests doctors may use.

What Side Effects Should You Know About?

Tamsulosin

Tamsulosin can cause dizziness or a fall in blood pressure when standing, especially early in treatment. It may also cause ejaculatory changes in some men.

If you are planning cataract surgery, your ophthalmologist should know that you currently take or previously took tamsulosin because of its association with intraoperative floppy iris syndrome.

Dutasteride

Dutasteride may cause sexual side effects such as reduced libido, erectile dysfunction or changes in ejaculation in some men.

It also affects PSA interpretation. Dutasteride can lower PSA substantially after several months, so a doctor interpreting future PSA results needs to know that you are taking it.

What About the Residual Urine in Your Bladder?

You mentioned that some urine remains in the bladder after urination. This is called post-void residual urine (PVR).

A small amount of residual urine may not necessarily be dangerous, but larger or increasing amounts can suggest that the bladder is not emptying effectively.

Possible contributors include:

• bladder outlet obstruction from BPH;
• reduced bladder-muscle strength;
• neurological conditions;
• medication effects; and
• diabetes-related bladder dysfunction.

Because you have diabetes, this point is especially relevant. Long-standing diabetes can affect the nerves controlling the bladder in some patients and contribute to incomplete bladder emptying.

Therefore, residual urine should not automatically be assumed to come entirely from the prostate.

What Is Uroton or Urotone?

This part requires some caution because brand names vary between countries and manufacturers.

In India, a product called Urotone 25 mg has been marketed as bethanechol 25 mg. Bethanechol stimulates bladder contraction and may be used for certain forms of urinary retention related to poor bladder muscle activity.

However, bethanechol is generally not appropriate when urinary retention is caused by significant mechanical obstruction.

Should You Stop and Restart These Medicines Yourself?

I would not recommend doing that.

If symptoms return after stopping treatment, the important question is why they returned. Frequent urination may result from BPH, poorly controlled diabetes, urinary infection, bladder overactivity, excessive fluid intake, diuretic medicines or another urinary condition.

Restarting medication without reassessment could therefore treat the wrong problem or delay investigation of a new one.

Instead, agree with your doctor in advance on:

• how long you should take each medicine;
• when your next review should occur;
• what symptoms should trigger earlier assessment;
• whether residual urine should be rechecked;
• whether prostate volume or urinary flow should be reassessed; and
• how PSA should be monitored while taking dutasteride.

Diabetes and Frequent Urination

You also mentioned that frequent urination improved as your diabetes came under better control. That can happen because high blood glucose may increase urine production.

However, diabetes and BPH can exist at the same time. Good glucose control may reduce diabetes-related urinary frequency without eliminating urinary symptoms caused by the prostate or bladder.

This is one reason your doctor should evaluate the whole picture rather than judging treatment only by how often you urinate.

When Should You Seek Prompt Medical Care?