Nonbacterial Prostatitis Medication
- Author: Sunil K Ahuja, MD; Chief Editor: Edward David Kim, MD, FACS more...
Medical therapy is important in the treatment of nonbacterial prostatitis to decrease the severity of symptoms and to allow patients to return to normal function. Because nonbacterial prostatitis may originate from infection with a fastidious organism, an empiric trial of antibiotic therapy may provide relief.
These are often used on a trial basis despite a negative culture result to check for symptom improvement and to rule out infection with a fastidious organism.
Trimethoprim blocks dihydrofolate reductase and sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid (PABA). These are 2 sequential steps in bacterial biosynthesis of nucleic acids and proteins. This agent is available in single- and double-strength form. In adults, it is most commonly taken in pill form, although a liquid suspension is available.
A derivative of pyridine carboxylic acid with a broad-spectrum bactericidal effect, levofloxacin penetrates the prostate well and is effective against Neisseria gonorrhoeae and Chlamydia trachomatis.
Ciprofloxacin is a fluoroquinolone with activity against pseudomonads, streptococci, methicillin-resistant Staphylococcus aureus (MRSA), S epidermidis, and most gram-negative organisms, but no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth. It diffuses into prostatic fluid and is indicated for chronic prostatitis.
Alpha-Adrenergic Blocking Agents
Selective alpha-1 receptor blockers relax smooth muscle in the prostate and bladder neck. They have been found to improve symptoms of prostatic obstruction. They are the first choice in therapy for benign prostatic hyperplasia and can be very effective in patients with prostatitis symptoms by improving urine flow and decreasing irritative symptoms.
Doxazosin inhibits postsynaptic alpha-adrenergic receptors, resulting in vasodilation of veins and arterioles and decrease in total peripheral resistance and blood pressure.
This agent has antihypertensive effects and is recommended to be given at bedtime to prevent patient injury if a syncopal episode occurs. If added to the regimen of antihypertensive medicines a patient is already taking, monitor patient's blood pressure while in titration phase. This agent is usually started as a titration up to the effective dose. It is available in a starter pack containing 1-, 2-, 4-, and 8-mg tablets. The usual effective dose is 4 or 8 mg.
Terazosin decreases arterial tone by allowing peripheral postsynaptic blockade. It has minimal alpha-2 effect. As it is an antihypertensive agent, dosing at bedtime is recommended to prevent patient injury if a syncopal episode occurs. If given to a patient already on antihypertensive agents, monitor blood pressure routinely while in titration phase.
Terazosin is usually titrated up to the effective dose. It is available as a starter pack that has doses of 1, 2, 5, and 10 mg.
This agent is sold in capsule form and cannot be broken in half easily; therefore, each specific dose must be prescribed.
Tamsulosin is an antagonist of the alpha-1a receptor found in smooth muscle of prostate and bladder neck. It is effective for relieving symptoms of prostatic enlargement. Because it is more selective than other alpha-blockers (ie, terazosin and doxazosin), it has minimal, if any, effect on blood pressure and does not require dose titration.
Silodosin is a selective antagonist of postsynaptic alpha-1-adrenoceptors. It helps relax the smooth muscle in the bladder neck and prostate, causing urine flow and benign prostatic hyperplasia symptoms to improve.
5-Alpha Reductase Inhibitors
These agents inhibit the conversion of testosterone to dihydrotestosterone (DHT).
Finasteride inhibits the steroid 5-alpha-reductase, which converts testosterone into 5-alpha-DHT, causing serum DHT levels to decrease.
Dutasteride is a selective inhibitor of the type 1 and type 2 isoforms of 5-alpha-reductase, which converts testosterone into 5-alpha-DHT, causing serum DHT levels to decrease.
Nonsteroidal Anti-Inflammatory Agents
These agents inhibit the action of cyclooxygenase, which results in decrease of prostaglandin synthesis.
Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. It also has anti-inflammatory and antipyretic properties. Ibuprofen is available in 200-, 400-, 600-, and 800-mg doses.
These agents are indicated for symptomatic relief of pain, burning, urgency, and frequency associated with prostatitis.
Diazepam depresses all levels of the CNS (eg, limbic, reticular formation), possibly by increasing activity of gamma-aminobutyric acid (GABA). It is available as 2-, 5-, and 10-mg doses.
Interstitial Cystitis Agents
For symptomatic relief of pain, burning, urgency, and frequency associated with prostatitis.
A heparinlike derivative of macromolecular carbohydrate that resembles glycosaminoglycans, this agent has anticoagulant and fibrinolytic properties. Its mechanism of action is unknown but it may act to prevent irritative or noxious stimuli in the bladder by inhibiting mucosal cell wall permeability.
This agent is converted to dimethyl sulfone and dimethyl sulfide in vivo. It is used intravesically to treat symptoms of interstitial cystitis. When administered intravesically, patients often report a garliclike taste.
These agents reduce uric acid levels. They have no analgesic or anti-inflammatory activity.
Allopurinol inhibits xanthine oxidase, the enzyme that synthesizes uric acid from hypoxanthine. It reduces synthesis of uric acid without disrupting biosynthesis of vital purines.
Pollen (male flower microspore) enables plant reproduction. Produced in anthers of the flower. May have effects on inflammatory response.
Cernitin pollen extract (Cernilton, Cervital, PollenAid)
This product may have anti-inflammatory activity.
These agents are helpful in relieving discomfort associated with tonically contracted muscles.
Methocarbamol reduces nerve impulse transmission from spinal cord to skeletal muscle
Cyclobenzaprine is a skeletal muscle relaxant that acts centrally and reduces motor activity of tonic somatic origins, influencing both alpha and gamma motor neurons. It is structurally related to tricyclic antidepressants and thus carries some similar liabilities.
These agents are used for treatment of overactive bladder to prevent associated symptoms of urinary frequency, urgency, and incontinence.
A competitive muscarinic receptor antagonist for overactive bladder, tolterodine differs from other anticholinergic types in that it has selectivity for urinary bladder over salivary glands. It exhibits high specificity for muscarinic receptors and has minimal activity or affinity for other neurotransmitter receptors and other potential targets, such as calcium channels.
Anticonvulsants used as neuropathic analgesics may be helpful, because myofascial pain may at its core be a spinal-mediated disorder affected by neuropathic dysfunction. Gabapentin has been shown to be effective in treating myofascial and neuropathic pain.
Gabapentin is a membrane stabilizer. It is a structural analogue of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), but, paradoxically, it is thought not to exert an effect on GABA receptors. Gabapentin appears to exert action via the alpha(2)delta1 and alpha(2)delta2 auxiliary subunits of voltage-gaited calcium channels. It is used to manage pain and provide sedation in neuropathic pain.
Titration to effect occurs over several days (300 mg on day 1, 300 mg twice on day 2, and 300 mg 3 times on day 3).
Tricyclic antidepressants are commonly used for chronic pain. They help to treat insomnia and reduce painful dysesthesia. These agents treat nociceptive and neuropathic pain syndromes.
Amitriptyline inhibits the reuptake of serotonin and/or norepinephrine at the presynaptic neuronal membrane, which increases their concentration in the central nervous system (CNS). Amitriptyline may increase or prolong neuronal activity, since the reuptake of these biogenic amines is important physiologically in terminating transmitting activity.
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