From the Guidelines
For a patient prescribed 0.8 mg of tamsulosin for medical expulsive therapy, the recommended management is to take 0.4 mg orally once daily, as the standard dose is 0.4 mg rather than 0.8 mg. The medication should be taken at the same time each day, preferably after the same meal, and swallowed whole with water (not crushed or chewed) 1. Patients should be advised to take the first dose at bedtime to minimize the risk of orthostatic hypotension and dizziness. Treatment typically continues for 2-4 weeks or until stone passage occurs.
Key Considerations
- Patients should be informed about common side effects including dizziness, headache, retrograde ejaculation, and postural hypotension 1.
- They should avoid situations requiring alertness until their response to the medication is known and should rise slowly from sitting or lying positions to reduce dizziness risk.
- Tamsulosin works by relaxing smooth muscles in the ureter and bladder neck, facilitating stone passage by reducing ureteral spasms and increasing urinary flow 1.
- Adequate hydration (2-3 liters of water daily) should be maintained during treatment to help with stone passage.
Rationale
The use of alpha-blocker therapy, such as tamsulosin, has been shown to be effective in facilitating stone passage and reducing symptoms in patients with ureteral stones 1. The standard dose of tamsulosin for medical expulsive therapy is 0.4 mg orally once daily, and taking 0.8 mg may increase the risk of side effects without providing additional benefits 1.
From the FDA Drug Label
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.
The recommended management for a patient prescribed 0.8 mg of tamsulosin is to administer it once daily, approximately one-half hour following the same meal each day. The patient should not crush, chew, or open the capsule.
- Dose titration: The dose can be increased to 0.8 mg once daily for patients who fail to respond to the 0.4 mg dose after 2 to 4 weeks of dosing.
- Administration: Tamsulosin Hydrochloride Capsules should be administered approximately one-half hour following the same meal each day 2.
From the Research
Recommended Management for 0.8 mg Tamsulosin
The recommended management for a patient prescribed 0.8 mg of tamsulosin for medical expulsive therapy is as follows:
- The dosage of tamsulosin is higher than the typical dosage used in most studies, which is usually 0.4 mg/day 3, 4, 5.
- However, there is no direct evidence to suggest that 0.8 mg of tamsulosin is ineffective or unsafe for medical expulsive therapy.
- Tamsulosin has been shown to be effective in facilitating stone passage in patients with ureteral stones, with a higher stone expulsion rate and shorter stone expulsion time compared to placebo or control groups 3, 4, 6.
- The efficacy of tamsulosin may vary depending on the size and location of the stone, with better results seen in patients with stones greater than 5 mm 6.
Potential Side Effects and Considerations
- Tamsulosin may cause side effects such as retrograde ejaculation, orthostatic hypotension, and other adverse events 4, 5.
- The incidence of side effects may be higher with tamsulosin compared to other alpha-blockers, such as alfuzosin or silodosin 3, 5.
- Patients should be monitored for potential side effects and adjusted accordingly.
Comparison with Other Alpha-Blockers
- Tamsulosin has been compared to other alpha-blockers, such as alfuzosin and silodosin, in terms of efficacy and safety 3, 5.
- Silodosin may have a higher stone expulsion rate and shorter stone expulsion time compared to tamsulosin, but may also have a higher incidence of retrograde ejaculation 5.
- Alfuzosin may have a lower stone expulsion rate compared to tamsulosin, but may also have a lower incidence of side effects 3.