ArcaMax

DEAR DR. ROACH: I have benign prostatic hyperplasia (BPH). In one of your recent columns, you touched upon the long-term use of tamsolusin. I, too, tried tamsolusin, and after several months, I saw no significant improvement to my symptoms. My primary care physician switched me to finasteride, and after three months on this new medication, I still did not see an improvement in my symptoms.

I do not like to play doctor and self-medicate, but I read that some people have taken both medications together and have gotten improved symptoms. I tried this, and in one to two days, my symptoms improved dramatically. Are there any long-term effects from combining these two medications? -- R.W.B.

ANSWER: Tamsulosin (and similar drugs called alpha blockers) are pretty effective, usually on the first day that men try them for most men with symptomatic prostate enlargement. When they don't work well enough, many urologists (and I do as well) use finasteride or dutasteride (both are 5-alpha reductase inhibitors) in combination with tamsulosin.

Finasteride takes weeks to work and months to reach its full effectiveness, but they are commonly used together. It's a little odd that tamsulosin didn't work at all by itself but worked dramatically in combination with finasteride. (Maybe it was long enough that finasteride started to work?) Although you should certainly tell your doctor, you did what many experts do in combining them.

The major side effect of alpha blockers is lightheadedness, especially upon standing. Most men have no side effects with 5-alpha reductase inhibitors, but they can cause sexual side effects.

DEAR DR ROACH: I am an 81-year-old male who is 5 feet, 3 inches tall; I weigh 150 pounds. My blood pressure is consistently low, having bottomed out at 80/40 mm Hg one evening when I almost passed out. My heart rate is usually between 50-55 bpm.

My cardiologist prescribed 5 mg of midodrine three times per day, but the side effects of blurry vision, itching and anxiety were too great for me to take it. My cardiologist says that I am not a candidate for a pacemaker. I am consistently lightheaded and have occasional chest pains. Do you have any recommendations? -- M.N.

ANSWER: Most people know that when blood pressure is too high, it's important to go easy on salt. The inverse is also true; when blood pressure is too low, then more salt (and water) is generally helpful.

It is usually not as effective as midodrine, which works by constricting the blood vessels, but most people find that more salt and water are helpful, especially at relieving the symptoms of low blood pressure. These symptoms include feeling like you are going to pass out ("presyncope") and actually passing out ("syncope"). Another medicine, fludrocortisone, enhances the retention of fluid and water, and it might be of some benefit if your cardiologist agrees.

With a slow heart rate and low blood pressure, I'm not sure why your cardiologist doesn't want to consider a pacemaker, but they certainly know more about you than I do. Still, it's worth another visit to your cardiologist to discuss this.

I strongly recommend that you take special care when changing positions in bed. When getting out of bed, sit up for a minute and make sure that you are OK before standing up next to the bed. Then wait another minute or so to make sure that you are balanced before walking.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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