On 1 August 2011 dutasteride-with-tamsulosin fixed-dose combination (Duodart; 0.5 mg dutasteride/0.4 mg tamsulosin hydrochloride) was listed on the Pharmaceutical Benefits Scheme for men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH).1
The streamlined authority listing requires treatment to be initiated by a urologist but can be continued by a general practitioner or nurse practitioner.
The Pharmaceutical Benefits Advisory Committee recommended subsidy of the dutasteride with tamsulosin combination product on a cost-minimisation basis — that is, similar efficacy and cost — compared with a combination of dutasteride and prazosin.1 Tamsulosin is as effective as prazosin — the only PBS-listed alpha blocker — but may be better tolerated.2,3
Dutasteride co-administered with tamsulosin improves urinary flow, and reduces the incidence of acute urinary retention and prostate surgery compared with dutasteride monotherapy or tamsulosin monotherapy at 4 years.4,5
Guidelines recommend combination therapy with a 5-alpha-reductase inhibitor (dutasteride or finasteride) and an alpha blocker (tamsulosin, alfuzosin, prazosin or terazosin) for men with moderate or severe urinary symptoms, a prostate volume > 30 mL and PSA > 1.4 ng/mL, who are considered at increased risk of disease progression.6,7,8
The recent NPS RADAR review of dutasteride (Avodart) has been updated to include information on the fixed dose combination of dutasteride with tamsulosin.
