From the Guidelines
Tamsulosin is not recommended for treating orthostatic hypotension, as it can worsen this condition by causing vasodilation and lowering blood pressure. Tamsulosin is an alpha-1 blocker primarily used to treat benign prostatic hyperplasia (BPH) by relaxing smooth muscles in the prostate and bladder neck. This medication works by blocking alpha-1 receptors in blood vessels, which can lead to orthostatic hypotension as a side effect, with patients experiencing dizziness, lightheadedness, or fainting when standing up quickly 1.
For someone already suffering from orthostatic hypotension, medications that might help include midodrine or fludrocortisone, which work to increase blood pressure through different mechanisms 1. Non-pharmacological approaches are also important, including:
- Adequate hydration
- Salt intake
- Compression stockings
- Rising slowly from sitting or lying positions
- Physical counter-pressure maneuvers, such as leg crossing or squatting, can be beneficial in patients with neurogenic OH with syncope 1
- Encouraging increased salt and fluid intake may be reasonable in selected patients with neurogenic OH 1
It's essential to consult with a healthcare provider for appropriate management rather than using tamsulosin, which would likely exacerbate the problem. The most recent guidelines recommend midodrine and droxidopa as approved treatments for orthostatic hypotension 1.
From the FDA Drug Label
The signs and symptoms of orthostasis (postural hypotension, dizziness, and vertigo) were detected more frequently in Tamsulosin Hydrochloride Capsules -treated patients than in placebo recipients. Possible side effects of Tamsulosin Hydrochloride Capsules may include: Decreased blood pressure when changing positions. Tamsulosin Hydrochloride Capsules may cause a sudden drop in blood pressure upon standing, especially after the first dose or when changing doses
Tamsulosin can worsen orthostatic hypotension. It is not recommended to use tamsulosin to help with orthostatic hypotension, as it may cause a sudden drop in blood pressure upon standing, leading to symptoms such as fainting, dizziness, and lightheadedness 2, 2.
From the Research
Tamsulosin and Orthostatic Hypotension
- Tamsulosin is a subtype-selective alpha(1A)- and alpha(1D)-adrenoceptor antagonist, primarily used to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH) 3.
- The drug has been shown to be effective in improving maximal urine flow and alleviating symptoms of BPH, without interfering with concomitant antihypertensive therapy 3.
- Studies have indicated that tamsulosin does not cause significant changes in blood pressure, including orthostatic hypotension, in most patients 3, 4, 5.
- However, one study reported a case of pronounced hypotension in a patient receiving treatment with sildenafil and tamsulosin during orthostatic testing, suggesting that tamsulosin may induce vasodilation and hypotension in susceptible patients 6.
Orthostatic Hypotension Treatment
- Fludrocortisone is a mineralocorticoid that increases blood volume and blood pressure, and is considered a first- or second-line pharmacological therapy for orthostatic hypotension 7.
- The evidence for the effectiveness of fludrocortisone in treating orthostatic hypotension is limited, and more research is needed to fully understand its benefits and harms 7.
- Tamsulosin is not typically used to treat orthostatic hypotension, and its use in this context is not supported by the available evidence 3, 4, 5, 6.
Key Findings
- Tamsulosin is not associated with significant changes in blood pressure, including orthostatic hypotension, in most patients 3, 4, 5.
- Fludrocortisone is a potential treatment option for orthostatic hypotension, but more research is needed to fully understand its effectiveness and safety 7.
- The combination of sildenafil and tamsulosin may induce vasodilation and hypotension in susceptible patients, and should be used with caution 6.