What is the recommended treatment and dosage for benign prostatic hyperplasia (BPH) using Alfuzosin?

Alfuzosin for Benign Prostatic Hyperplasia (BPH) Treatment

The recommended treatment for BPH using alfuzosin is 10 mg once daily, taken immediately after the same meal each day, with no need for dose titration. 1

Patient Selection

Alfuzosin is appropriate for patients with:

• Moderate to severe lower urinary tract symptoms (LUTS) due to BPH
• Bothersome symptoms affecting quality of life
• Patients with or without demonstrable prostatic enlargement

Mechanism and Efficacy

• Alfuzosin is a selective alpha1-adrenergic receptor antagonist that inhibits alpha1-adrenergic-mediated contraction of prostatic smooth muscle, relieving bladder outlet obstruction 2
• It provides rapid symptom relief within days to weeks
• Clinical improvement includes:
  • 4-6 point improvement in AUA Symptom Index/IPSS (vs. 2-4 points with placebo) 2, 3
  • Increased maximum urinary flow rate by 2.3-3.2 ml/s 4
  • Improved quality of life index

Dosage and Administration

• Dosage: 10 mg extended-release tablet once daily 1
• Must be taken immediately after the same meal each day (absorption is 50% lower under fasting conditions) 1
• Tablets should not be chewed or crushed 1
• No dosage titration is required 5

Pharmacokinetics

• The prolonged-release formulation provides 24-hour coverage with sustained drug release over 20 hours 5
• Mean values for area under the plasma concentration-time curve over 24 hours (AUC24) are similar between:
  • Prolonged-release alfuzosin 10 mg once daily
  • Immediate-release alfuzosin 2.5 mg three times daily 5

Safety Profile and Adverse Effects

• Overall incidence of adverse events is similar to placebo 5
• Primary adverse events include:
  • Orthostatic hypotension (less common than with non-uroselective agents) 2, 3
  • Dizziness
  • Tiredness (asthenia)
  • Nasal congestion 2
• Incidence of ejaculatory dysfunction is <1% 5
• Vasodilatory adverse events appear less frequent with once-daily formulation compared to thrice-daily dosing (6.3% vs. 9.4%) 4

Contraindications

Alfuzosin is contraindicated in:

• Patients with moderate or severe hepatic impairment (Child-Pugh categories B and C) 1
• Patients taking potent CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) 1
• Patients with known hypersensitivity to alfuzosin or any component of the tablets 1

Special Considerations

• Alfuzosin is not indicated for the treatment of hypertension 1
• In men with hypertension and cardiac risk factors, use of an alpha blocker for LUTS should not be assumed to constitute optimal management of hypertension 2
• No first-day effect has been reported with alfuzosin once daily 4

Treatment of Acute Urinary Retention (AUR)

• Alpha blockers like alfuzosin can be prescribed for AUR related to BPH 2
• Patients should complete at least three days of therapy before attempting trial without catheter (TWOC) 2
• Patients who successfully pass a TWOC should be informed they remain at increased risk for recurrent urinary retention 2

Combination Therapy Options

For patients with inadequate response to alfuzosin monotherapy:

• Alpha blocker + 5-alpha-reductase inhibitor (5-ARI) combination is recommended for patients with moderate to severe symptoms and demonstrable prostatic enlargement (>30cc) 3
• Alpha blocker + anticholinergic may be considered for patients with predominant storage symptoms 3

Alfuzosin provides effective symptom relief with a favorable safety profile and convenient once-daily dosing, making it an excellent option for BPH treatment.