Alfuzosin for Benign Prostatic Hyperplasia (BPH)
The recommended treatment for BPH using alfuzosin is a 10 mg extended-release tablet taken once daily immediately after the same meal each day, with no need for dose titration. 1
Mechanism and Efficacy
Alfuzosin is a selective alpha-1 adrenergic receptor antagonist that works by relaxing the smooth muscle in the prostate and bladder neck, thereby improving urinary flow and reducing BPH symptoms. It distributes preferentially in the prostate compared to plasma, making it functionally uroselective 2.
Key benefits include:
- Improves International Prostate Symptom Score (IPSS) by approximately 6.4 points (33.4% reduction) 3
- Increases maximum urinary flow rate
- Improves quality of life scores
- Provides symptom relief that is maintained for up to 3 years 3
Administration Guidelines
- Dosage: 10 mg once daily 1
- Timing: Must be taken immediately after the same meal each day (absorption is reduced by 50% under fasting conditions) 1
- Administration: Tablets should not be chewed or crushed 1
- No titration required: Unlike some other alpha blockers, alfuzosin does not require dose titration 4, 2
Patient Selection Considerations
Alfuzosin may be particularly suitable for:
- Younger sexually active men concerned about ejaculatory function (lower rates of ejaculatory dysfunction compared to other alpha blockers like tamsulosin) 4
- Patients with cardiovascular concerns (causes only slight, clinically insignificant decreases in blood pressure) 2
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
Adverse Effects
Alfuzosin has a favorable side effect profile:
- Overall incidence of adverse events similar to placebo 2
- Dizziness is the most common adverse event (4.5%) 3
- Very low incidence of ejaculatory disorders (<1%) 2, 3
- Minimal impact on blood pressure, even in elderly patients (≥65 years) and those on antihypertensive medications 3
Long-Term Efficacy and Safety
- Clinical benefits are maintained for up to 3 years with continued treatment 3, 5
- Alfuzosin significantly reduces the risk of overall clinical progression of BPH (16.3% vs 22.1% with placebo) 6
- While it doesn't reduce the risk of acute urinary retention (AUR), it tends to reduce the risk of BPH-related surgery 6
Clinical Pearls and Caveats
- Monitor patients with hypertension separately for their blood pressure management, as alpha blockers should not be assumed to constitute optimal management of concomitant hypertension 7
- Patients with high PSA values and symptom worsening during treatment may be at higher risk for AUR and BPH-related surgery 3
- Alfuzosin is not indicated for the treatment of hypertension 1
- Patients should inform their ophthalmologist about alfuzosin use due to potential intraoperative complications 4
By following these guidelines, alfuzosin can provide effective symptom relief for BPH patients while minimizing adverse effects, particularly those related to sexual function and blood pressure.