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Evidence Summary

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In older people, dutasteride, fesoterodine, and finasteride are recommended for long-term treatment of lower urinary tract symptoms

Oelke M, Becher K, Castro-Diaz D, et al. Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014). Age Ageing. 2015;44:745-55.

Review question

In older people, which drugs are recommended for long-term treatment of lower urinary tract symptoms?

Background

Lower urinary tract symptoms involve the bladder and/or urethra. Symptoms may include the urge to urinate, frequent urination, burning sensation when urinating, cloudy or coloured urine, and pelvic or rectal pain.

Lower urinary tract symptoms can be treated with many drugs.

How the review was done

The researchers did a systematic review based on studies available up to March 2014.

They found 25 studies, including 18 randomized controlled trials. People in the studies were at least 65 years of age and had lower urinary tract symptoms.

Experts independently reviewed these studies and classified each of 14 drugs for use in older people as: Indispensable, Beneficial, Caution, or Avoid.

What the researchers found

Indispensable

No drugs were classified as indispensable (having clear-cut benefits).

Beneficial

Dutasteride, fesoterodine, and finasteride were classified as beneficial (having proven or obvious efficacy).

Caution

Darifenacin, mirabegron, oxybutynin (low dose/extended release), solifenacin, tadalafil, tamsulosin, tolterodine, and trospium were classified as needing caution (having questionable efficacy/safety profiles).

Avoid

Alfuzosin, doxazosin, and oxybutynin (standard dose/immediate release) were classified as to be avoided.

Conclusion

In older people, dutasteride, fesoterodine, and finasteride are recommended for long-term treatment of lower urinary tract symptoms.

Classification of drugs for lower urinary tract symptoms in people 65 years of age or older*

Classification

Drug name

Number of studies (number of people)

Approximate rate of side effects

Indispensable

No drugs identified

Beneficial

Dutasteride

3 (4430)

12%

 

Fesoterodine

6 (2511)

60%

 

Finasteride

2 (3283)

12%

Caution

Darifenacin

2 (421)

58%

 

Mirabegron

1 (1183)

56%

 

Oxybutynin (low dose/extended release)

1 (111)

65%

 

Solifenacin

2 (1159)

36%

 

Tadalafil

2 (558)

26%

 

Tamsulosin

2 (1121)

37%

 

Tolterodine

3 (643)

48%

 

Trospium

1 (178)

47%

Avoid

Alfuzosin

1 (2121)

6%

 

Doxazosin

1 (341)

42%

 

Oxybutynin (standard dose/immediate release)

2 (60)

73%

*Only drugs for which evidence of efficacy exists.




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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