From the Guidelines
Alfuzosin is recommended at a dosage of 10 mg once daily for the management of Benign Prostatic Hyperplasia (BPH) symptoms, with the option to combine it with 5-alpha reductase inhibitors like finasteride for enhanced effectiveness in men with larger prostates, as supported by the AUA guideline on management of BPH 1. The treatment approach with Alfuzosin involves taking the extended-release formulation immediately after the same meal each day for consistent absorption, and it should be swallowed whole, not crushed or chewed.
Key Considerations
- Improvement in BPH symptoms is often noticeable within 2-4 weeks of starting treatment with Alfuzosin 1.
- Alfuzosin works by relaxing smooth muscle in the prostate and bladder neck, improving urinary flow and reducing symptoms like weak stream, hesitancy, incomplete emptying, frequency, and nocturia.
- Unlike some other alpha-blockers, Alfuzosin has minimal blood pressure effects and doesn't typically require dose titration, making it convenient for most patients.
- Patients should be monitored for potential side effects including dizziness, headache, and retrograde ejaculation, though these are generally less common than with other alpha-blockers.
- Alfuzosin is contraindicated in patients taking potent CYP3A4 inhibitors and those with severe hepatic insufficiency.
Combination Therapy
- The combination of Alfuzosin with a 5 alpha-reductase inhibitor is an effective treatment for patients with LUTS associated with demonstrable prostatic enlargement, as it can reduce the long-term risk of acute urinary retention and the need for BPH-related surgery 1.
- The safety of specific combinations other than finasteride plus doxazosin, terazosin, and alfuzosin has not been assessed, but the Panel assumes that the combination of any effective alpha blocker and 5 alpha-reductase inhibitor probably produces a comparable benefit.
Patient Selection
- Patients most likely to benefit from combination therapy are those in whom baseline risk of progression is significantly higher, in general, than in patients with larger glands and higher PSA values.
- The overall probability of these risks, their relative reduction over time by therapy, and their impact on quality of life, though, must be weighed against the cost of combination therapy in an individual patient.
From the FDA Drug Label
The recommended dosage is one 10 mg UROXATRAL (alfuzosin HCl) extended-release tablet once daily. The extent of absorption of Uroxatral is 50% lower under fasting conditions Therefore, Uroxatral should be taken immediately after the same meal each day. The tablets should not be chewed or crushed.
The recommended dosage of Alfuzosin for managing symptoms of Benign Prostatic Hyperplasia (BPH) is one 10 mg extended-release tablet once daily, taken immediately after the same meal each day. The treatment approach involves administering the tablet whole, without chewing or crushing, to ensure optimal absorption. Key considerations include:
- Taking the medication with food to maximize absorption
- Avoiding potent CYP3A4 inhibitors
- Contraindications in patients with moderate or severe hepatic impairment or known hypersensitivity to alfuzosin hydrochloride 2
From the Research
Dosage and Treatment Approach
The recommended dosage of Alfuzosin for managing symptoms of Benign Prostatic Hyperplasia (BPH) is:
- 2.5 mg twice or thrice daily of the immediate-release (IR) formulation 3
- 5 mg of extended-release (ER) Alfuzosin twice daily or 10 mg of ER Alfuzosin once daily 3
Efficacy and Safety
Alfuzosin has been shown to:
- Improve urinary voiding symptoms and increase urinary flow rates while causing few cardiovascular adverse effects 3
- Improve patients' perception of quality of life, allowing patients to increase their physical activities and improve their ability to handle day-to-day activities 3
- Reduce the risk of symptom deterioration and overall clinical progression of BPH 4
- Significantly improve the International Prostate Symptom Score (IPSS), quality of life, and peak flow rate compared with placebo 4
Administration and Onset of Action
- No dosage titration is needed for ER Alfuzosin 3
- The onset of peak action is within days of the start of treatment 3
- Alfuzosin can be administered once daily, with a 10 mg dose being effective and well-tolerated 5, 4, 6
Comparison with Other Treatments
- Alfuzosin is at least as effective as prazosin in the treatment of symptomatic patients with BPH, with a lower incidence of adverse events related to vasodilatory properties 7
- Alfuzosin 10 mg once daily is associated with a low incidence of sexual and vasodilatory side effects compared with other alpha(1)-blockers 6