From the FDA Drug Label
Tamsulosin Hydrochloride Capsules 0.4 mg once daily is recommended as the dose for the treatment of the signs and symptoms of BPH. It should be administered approximately one-half hour following the same meal each day. For those patients who fail to respond to the 0.4 mg dose after 2 to 4 weeks of dosing, the dose of Tamsulosin Hydrochloride Capsules can be increased to 0.8 mg once daily. If Tamsulosin Hydrochloride Capsules administration is discontinued or interrupted for several days at either the 0.4 mg or 0.8 mg dose, therapy should be started again with the 0.4 mg once-daily dose.
The patient's current dosage of Flomax (tamsulosin) is 0.8 mg QAM. The patient is requesting to change the dosage to 0.4 mg BID. The FDA drug label does not support a twice-daily dosing regimen of 0.4 mg BID. The recommended dosing regimen is 0.4 mg once daily, which can be increased to 0.8 mg once daily if the patient fails to respond to the initial dose.
Regarding the patient's request to change the dosage, it is not recommended to change the dosage to 0.4 mg BID. Instead, the patient should continue with the current dosage of 0.8 mg QAM or consider decreasing the dosage to 0.4 mg QAM if necessary.
As for the patient's ran out Pantoprazole, there is no information in the provided drug labels that addresses this issue. However, it is essential to ensure that the patient has a sufficient supply of their medications, including Pantoprazole. The patient should be advised to contact their pharmacy or healthcare provider to obtain a refill or discuss alternative options. 1
From the Research
I do not recommend changing the Flomax (tamsulosin) dosage from 0.8 mg once daily in the morning to 0.4 mg twice daily, as the standard therapeutic dosing for tamsulosin is 0.4 mg once daily, which can be increased to 0.8 mg once daily if needed for symptom control of benign prostatic hyperplasia (BPH) 2. Taking the full 0.8 mg dose once daily in the morning is appropriate and supported by the medication's pharmacokinetics, as tamsulosin has a half-life of 9-15 hours allowing for once-daily dosing. Splitting the dose to twice daily doesn't provide additional benefit and may increase the risk of side effects like orthostatic hypotension, especially with the second evening dose.
Regarding the Pantoprazole that has run out,
- this should be refilled promptly to avoid rebound acid hypersecretion
- Pantoprazole is a proton pump inhibitor that suppresses gastric acid production
- sudden discontinuation can lead to worsening heartburn or reflux symptoms
- the patient should contact their healthcare provider for a prescription renewal or consider using an over-the-counter acid reducer temporarily until the prescription can be refilled. The most recent study 2 supports the use of 0.8 mg tamsulosin daily for patients with BPH who have not responded to the standard 0.4 mg dose, indicating that the current dosage is effective and safe for the patient.