臨床症例報告ジャーナル

Deprescribing Dual Therapy in Benign Prostatic Hyperplasia: A Patient Case

Abstract

Chandni Bardolia, Veronique Michaud, Jacques Turgeon and Nishita S. Amin

Background: Benign prostatic hyperplasia is a common condition affecting men worldwide that often requires the use of multiple medications. Older men may already be on several other medications for a variety of chronic conditions leading to a high prevalence of polypharmacy. Deprescribing is one approach to reduce polypharmacy, particularly if a medication is found to be high risk or no longer of benefit. Case report: A 68 year-old male, with a past medical history of benign prostatic hyperplasia, acid reflux, hyperlipidemia, major depressive disorder, blindness, low body-mass index, and frailty was prescribed several medications including tamsulosin and finasteride. The clinical pharmacist noted that the patient had been prescribed this dual therapy for benign prostatic hyperplasia since 2015. Amongst other recommendations, the clinical pharmacist suggested deprescribing the alpha-blocker due to several factors including duration of use; potential risk of adverse events secondary to multi-drug interactions; and presence of polypharmacy. Once the recommendation was implemented, the patient reported no instances of increased lower urinary tract symptoms and was well maintained on monotherapy. Conclusion: In patients with polypharmacy, the reduction of one medication may provide significant benefits. In the case of benign prostatic hyperplasia, patients who received six to twelve months of dual therapy may be able to control this condition with a 5-alpha-reductase inhibitor monotherapy. This class of medications has reportedly slowed clinical disease progression, reduced the risk of acute urinary retention and the need for invasive therapy, and improved voiding and storage symptoms. Healthcare providers should continue the practice of assessing medication regimens for appropriateness of therapy and deprescribing inappropriate therapy.