Compare Uroxatral (Alfuzosin) with Alternatives for BPH

If you're taking Uroxatral (alfuzosin) for an enlarged prostate, you might be wondering if there are better or cheaper options. You're not alone. Many men on this medication ask the same thing: Is there something else that works just as well - or better - without the side effects or cost? The answer isn't simple, but it’s practical. There are several alternatives, each with different pros, cons, and real-world results. This guide breaks down exactly how Uroxatral stacks up against the most common options - no fluff, no marketing speak, just what matters to you.

What Uroxatral (Alfuzosin) Actually Does

Uroxatral is a brand name for alfuzosin, an alpha-1 blocker. It works by relaxing the muscles in your prostate and bladder neck. That makes it easier to urinate, reduces urgency, and cuts down on nighttime bathroom trips. It’s not a cure for an enlarged prostate (BPH), but it helps manage symptoms. Most men notice improvement within a week or two.

Alfuzosin is designed to be taken once daily, right after the same meal each day. This matters. Taking it on an empty stomach can cause your blood pressure to drop too low - a real risk. The extended-release form (Uroxatral) is meant to release the drug slowly, reducing side effects like dizziness compared to older versions.

Common side effects include dizziness, headache, fatigue, and nasal congestion. About 1 in 10 men stop taking it because of these. Less common but serious: fainting or low blood pressure, especially if you’re also on blood pressure meds or nitrates.

Alternative 1: Tamsulosin (Flomax)

Tamsulosin is the most widely prescribed alpha blocker for BPH in the UK and US. It’s sold as Flomax, and also as generics. Unlike alfuzosin, tamsulosin is more selective for prostate muscles, which means less impact on blood pressure. That’s why many doctors start with it.

Studies show tamsulosin improves urinary flow about as well as alfuzosin. In a 2023 meta-analysis of over 2,000 men, both drugs reduced symptom scores by 40-50% after 12 weeks. But tamsulosin had fewer reports of dizziness when taken correctly - usually 30 minutes after dinner.

Here’s the catch: tamsulosin can cause retrograde ejaculation - semen goes into the bladder instead of out during orgasm. It’s harmless but can be unsettling. About 30% of men on tamsulosin experience this. Alfuzosin causes it less often - around 10-15%. If you’re sexually active and care about ejaculation, this matters.

Alternative 2: Silodosin (Rapaflo)

Silodosin is the most prostate-specific alpha blocker available. It’s stronger in the prostate, so it often works faster and better for men with severe symptoms. In clinical trials, silodosin improved peak urine flow more than alfuzosin or tamsulosin.

But it comes with trade-offs. The most common side effect? Retrograde ejaculation - up to 70% of men. That’s why it’s not usually a first choice unless symptoms are really bad. It’s also more expensive than generics. If you’ve tried other alpha blockers and still struggle to empty your bladder, silodosin might be worth discussing.

Alternative 3: Doxazosin and Terazosin (Older Alpha Blockers)

These are the original alpha blockers. They work, but they’re outdated. Both cause more dizziness, fainting, and low blood pressure than alfuzosin or tamsulosin because they affect blood vessels throughout the body.

Doctors still prescribe them because they’re cheap - doxazosin generics cost under £5 for a month’s supply in the UK. But the side effects are a real problem. One study found 1 in 4 men on doxazosin had to stop because of dizziness or fainting. If you’re older, on blood pressure meds, or have a history of falls, avoid these unless there’s no other option.

Alternative 4: Combination Therapy - Alfuzosin + Finasteride

If your prostate is truly enlarged (over 30-40ml), you might benefit from combining an alpha blocker with a 5-alpha reductase inhibitor like finasteride (Proscar) or dutasteride (Avodart).

Finasteride shrinks the prostate over 6-12 months. It doesn’t help with immediate urination - that’s where alfuzosin comes in. Together, they reduce the risk of acute urinary retention by 50% and lower the chance of needing surgery later. This combo is especially useful for men over 55 with large prostates and high PSA levels.

Downsides? Finasteride can lower libido or cause erectile dysfunction in about 5-10% of men. It takes months to work. But if you’re looking for long-term protection, this is the strongest option available.

Alternative 5: Natural Options - Saw Palmetto, Beta-Sitosterol

Many men turn to supplements like saw palmetto or beta-sitosterol. Saw palmetto has been studied for decades. The latest Cochrane review (2024) found it has no meaningful benefit over placebo for urinary symptoms. Beta-sitosterol shows a bit more promise - some trials report modest improvement in flow rate and reduced nighttime urination.

But here’s the truth: supplements aren’t regulated like drugs. One bottle of saw palmetto might have 320mg of active ingredient; another might have 50mg. There’s no guarantee of quality or effect. They’re safe, but don’t expect them to replace medication. They’re best used as a supplement - not a substitute - if you’re already on something like alfuzosin and want to add a mild boost.

Alternative 6: Minimally Invasive Procedures - UroLift, Rezum

If pills aren’t working or side effects are too much, procedures like UroLift and Rezum are now mainstream options. These aren’t surgery - no cutting, no catheters, no hospital stay.

UroLift uses tiny implants to hold the prostate open. It preserves sexual function - no retrograde ejaculation, no erectile issues. Recovery is quick: most men go back to normal in a few days. Studies show it works as well as tamsulosin after 12 months.

Rezum uses steam injections to shrink prostate tissue. It’s effective for larger prostates. Symptoms improve over weeks. Sexual side effects are rare, but some men report temporary urinary discomfort.

Cost? Both cost £3,000-£5,000 in the UK. NHS access is limited. Most get them privately. But if you hate pills or can’t tolerate side effects, these are better than lifelong medication.

How to Choose the Right Option

There’s no single best drug. The right choice depends on your symptoms, prostate size, age, other meds, and what you care about most.

Here’s a simple decision guide:

• Best for quick relief with low sexual side effects: Alfuzosin (Uroxatral)
• Best for mild symptoms and low cost: Tamsulosin (Flomax)
• Best for severe symptoms and you don’t mind ejaculation changes: Silodosin (Rapaflo)
• Best for long-term protection with large prostate: Alfuzosin + Finasteride
• Best if you want to stop pills entirely: UroLift or Rezum
• Best if you’re on blood pressure meds: Avoid doxazosin/terazosin - stick to tamsulosin or alfuzosin

What to Do Next

Don’t switch medications on your own. Talk to your GP or urologist. Bring this list. Ask:

• Is my prostate size known? (An ultrasound can tell you)
• Am I at risk for urinary retention?
• Could I benefit from a combo treatment?
• Are there cheaper generic versions available?
• Would a procedure like UroLift make sense for me?

Many men stay on Uroxatral because it works - and they don’t know alternatives exist. But if you’re dealing with dizziness, low energy, or sexual side effects, there are better paths. You don’t have to accept discomfort just because it’s "normal for your age."

Final Thoughts

Uroxatral is a solid choice for managing BPH. But it’s not the only one - and it’s not always the best. The right alternative depends on your body, your goals, and your tolerance for side effects. Whether you’re looking to save money, avoid sexual side effects, or stop taking pills altogether, there’s a path forward. Talk to your doctor. Ask questions. And don’t settle for discomfort just because it’s "what’s usually prescribed." Your quality of life matters more than the brand on the bottle.