From the Guidelines
Flomax (tamsulosin) can be considered for an 89-year-old male experiencing nighttime urination (nocturia), but only after ruling out other causes and considering the patient's overall health and potential drug interactions, as suggested by the most recent study 1. When evaluating the patient, it's essential to consider the possibility of one or more medical conditions that can affect salt and water handling or sleep quality, as highlighted in the study 1. The initial assessment should include a comprehensive medical history, physical examination, and laboratory tests to identify any underlying conditions that may be contributing to nocturia. Some key indicators to consider include:
- Excessive evening fluid intake
- Sleep apnea
- Heart failure
- Diabetes
- Other medical conditions that can affect salt and water handling or sleep quality If the patient has predominant significant nocturia and gets out of bed to void 2 or more times per night, a frequency volume chart (FVC) for 3 days may be recommended to diagnose nocturnal polyuria, as suggested by the study 1. In terms of treatment, lifestyle modifications should be considered first, including:
- Limiting fluids 2-3 hours before bedtime
- Avoiding caffeine and alcohol in the evening
- Elevating legs in the afternoon to mobilize fluid If pharmacological treatment is considered, the patient should be started on the lowest dose of Flomax (0.4 mg) and taken consistently, with regular follow-up to assess treatment success or failure and possible adverse events, as recommended by the study 1. It's crucial to prioritize the patient's safety and well-being, particularly given their advanced age, and to consider the potential therapeutic conflict between treating the medical condition and the nocturia symptom, as highlighted in the study 1.
From the FDA Drug Label
The primary efficacy assessments included: 1) total American Urological Association (AUA) Symptom Score questionnaire, which evaluated irritative (frequency, urgency, and nocturia), and obstructive (hesitancy, incomplete emptying, intermittency, and weak stream) symptoms, where a decrease in score is consistent with improvement in symptoms; Mean changes from baseline to Week 13 in total AUA Symptom Score were significantly greater for groups treated with Tamsulosin Hydrochloride Capsules 0.4 mg and 0.8 mg once daily compared to placebo in both U. S. studies
Tamsulosin may be effective in reducing nocturia (night time urination) in an 89-year-old male, as it has been shown to improve irritative symptoms, including nocturia, in patients with BPH 2.
- The improvement in total AUA Symptom Score was significant for both the 0.4 mg and 0.8 mg dose groups compared to placebo.
- However, the specific effect of Tamsulosin on nocturia in an 89-year-old male cannot be directly determined from the provided information.
From the Research
Treatment of Nocturia in Elderly Males
The treatment of nocturia in elderly males, such as an 89-year-old male, can be managed through various approaches.
- Flomax, also known as tamsulosin, is an alpha-blocker that can help improve nocturia associated with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) 3.
- Studies have shown that tamsulosin can significantly reduce nocturnal frequency and improve quality of life in patients with LUTS/BPH 3, 4.
- Combination therapy with tamsulosin and other medications, such as desmopressin or zolpidem, may also be effective in treating nocturia in patients with BPH 5, 6.
Mechanism of Action
The mechanism of action of tamsulosin in improving nocturia is thought to be related to its ability to relax the smooth muscle in the prostate and bladder neck, thereby improving urine flow and reducing the frequency of nocturnal voiding 3.
- Tamsulosin has also been shown to decrease nocturnal urine volume and improve the quality of life in patients with LUTS/BPH 3.
Alternative Treatments
Other treatments for nocturia in elderly males may include:
- Transurethral resection of the prostate (TURP), which has been shown to be superior to tamsulosin in improving nocturia in patients with BPH 4.
- Behavioral therapies, such as scheduled voiding and fluid restriction, may also be effective in managing nocturia 7.
- Desmopressin nasal spray or tablets may be useful alternatives for the control of nocturic symptoms in elderly patients with nocturnal polyuria syndrome 7.