What is the use of Flomax (Tamsulosin)?

From the Guidelines

Flomax (tamsulosin) is a recommended treatment option for symptoms of benign prostatic hyperplasia (BPH) in men, with a standard dose of 0.4 mg taken once daily, and may be adjusted to 0.8 mg daily if needed, as it has been shown to be effective in improving symptoms, with a mean difference of -2.13 in the International Prostate Symptom Score (IPSS) 1.

Key Points to Consider

• The medication works by blocking alpha-1 receptors in the prostate tissue, helping to relax smooth muscle and improve urine flow.
• Common side effects include dizziness, headache, abnormal ejaculation, and postural hypotension (drop in blood pressure when standing up) 1.
• It is essential to start this medication when the patient can remain seated or lying down for several hours after the first dose to avoid falls from dizziness.
• Flomax is primarily prescribed for men with BPH, but it is occasionally used off-label for urinary retention in women or to help pass kidney stones in both men and women.

Important Considerations

• The use of alpha-blockers, such as tamsulosin, has been extensively investigated for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH, and has been shown to be effective in relieving symptoms 1.
• The 2021 AUA guideline recommends considering 5-alpha-reductase inhibitors (5-ARIs) as a treatment option to reduce intraoperative bleeding and peri- or postoperative need for blood transfusion after transurethral resection of the prostate (TURP) or other surgical intervention for BPH 1.
• When prescribing Flomax, it is crucial to counsel patients on the potential side effects and the importance of taking the medication as directed to minimize adverse events.
• The patient's prostate volume and PSA threshold should be considered when deciding on treatment with 5-ARIs, with a minimum prostate volume of >30cc or PSA >1.5ng/mL necessary for a reliable response 1.

From the FDA Drug Label

Tamsulosin Hydrochloride Capsules is an alpha 1 adrenoceptor antagonist indicated for treatment of the signs and symptoms of benign prostatic hyperplasia (1) Tamsulosin Hydrochloride Capsules are not indicated for the treatment of hypertension (1) Tamsulosin Hydrochloride Capsules is a prescription alpha-blocker medicine used to treat the signs and symptoms of benign prostatic hyperplasia (BPH), a condition your doctor may refer to as an enlarged prostate. The symptoms associated with benign prostatic hyperplasia (BPH) are related to bladder outlet obstruction, which is comprised of two underlying components: static and dynamic. Blockade of these adrenoceptors can cause smooth muscles in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and a reduction in symptoms of BPH

Flomax (Tamsulosin) Use:

• Tamsulosin is used to treat the signs and symptoms of benign prostatic hyperplasia (BPH), also known as an enlarged prostate.
• It is an alpha 1 adrenoceptor antagonist that works by relaxing the muscles in the prostate and bladder neck, making it easier to urinate.
• The medication is not indicated for the treatment of hypertension.
• It is essential to take Tamsulosin Hydrochloride Capsules exactly as prescribed by your doctor, about 30 minutes after the same meal each day 2, 2, 2.

From the Research

Flomax Use

• Flomax, also known as tamsulosin, is an alpha 1-adrenoceptor antagonist used to treat benign prostatic hyperplasia (BPH) symptoms 3, 4.
• Tamsulosin can be administered once daily and has specificity for alpha 1A-receptors, which means no dosage titration is needed 3.
• The efficacy of tamsulosin lies between that of transurethral resection of the prostate (TURP) and medical therapy, and it can be used in patients with moderate symptoms of BPH 3.
• Tamsulosin lacks significant effects on blood pressure, making it a suitable option for patients with BPH who do not have hypertension 3.
• Combination therapy with dutasteride, a 5α-reductase inhibitor, and tamsulosin has been shown to improve lower urinary tract symptoms (LUTS) and reduce the risk of disease progression in men with BPH and an enlarged prostate 5.

Comparison with Other Treatments

• Finasteride, another 5α-reductase inhibitor, has been compared to tamsulosin in several studies, with results showing that finasteride is less effective than tamsulosin in improving urinary symptoms in the short term, but equally effective in the long term 6.
• Doxazosin, an alpha-blocker, has been shown to be more effective than finasteride in improving urinary symptoms, but combination therapy with doxazosin and finasteride has been found to be more effective than either drug alone in reducing the risk of clinical progression of BPH 7, 6.
• Tamsulosin has been found to have a lower risk of adverse effects, such as asthenia, dizziness, and postural hypotension, compared to doxazosin and terazosin, but a higher risk of impotence, erectile dysfunction, decreased libido, and ejaculation disorder 6.

Clinical Use

• Tamsulosin is typically used to treat moderate to severe BPH symptoms, and its efficacy has been demonstrated in several clinical trials 4, 5.
• The drug is generally well tolerated, but patients should be monitored for potential adverse effects, such as hypotension and ejaculatory disorders 3, 6.
• Combination therapy with tamsulosin and other drugs, such as dutasteride or finasteride, may be considered for patients with more severe BPH symptoms or those who do not respond to monotherapy 5, 7.