What is the recommended treatment for prostatic urgency due to Benign Prostatic Hyperplasia (BPH) using Alfuzosin (Alfuzosin Hydrochloride) 10MG Oral Tablet, Extended Release?

Alfuzosin Hydrochloride 10mg Extended Release for Prostatic Urgency in BPH

Alfuzosin hydrochloride 10mg extended-release tablet once daily is recommended as an effective treatment for prostatic urgency symptoms associated with benign prostatic hyperplasia (BPH). 1, 2

Treatment Algorithm for BPH with Urinary Urgency

Patient Assessment

• Determine symptom severity using AUA Symptom Score:
  • Mild symptoms (AUA score <7): Watchful waiting is recommended 2
  • Moderate to severe symptoms (AUA score >8) without bother: Watchful waiting 2
  • Moderate to severe symptoms (AUA score >8) with bother: Consider active treatment 2

Medical Therapy with Alfuzosin

• Alfuzosin works by inhibiting alpha1-adrenergic-mediated contraction of prostatic smooth muscle, relieving bladder outlet obstruction 3, 4
• Recommended dosage: One 10mg extended-release tablet once daily 1
• Administration requirements:
  • Must be taken immediately after the same meal each day (bioavailability is 50% lower under fasting conditions) 1
  • Tablets should not be chewed or crushed 1

Clinical Benefits

• Alfuzosin provides significant improvement in urinary symptoms with:
  • Increased urinary flow rate 5, 6
  • Decreased symptom scores 5, 6
  • Reduced residual urinary volume 4
  • Improved quality of life index 5, 6
• Clinical benefits are maintained for up to 12 months of treatment 5, 6

Important Considerations

Contraindications

• Moderate or severe hepatic impairment (Childs-Pugh categories B and C) 1
• Concomitant use with potent CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) 1
• Known hypersensitivity to alfuzosin or any component of the tablets 1

Advantages of Extended-Release Formulation

• Once-daily dosing improves patient compliance 7, 5
• No dosage titration required, unlike some other alpha-blockers 8, 5
• Fewer vasodilatory adverse events compared to immediate-release formulations 5
• Small variations in peak and trough serum levels may contribute to lower frequency of cardiovascular adverse effects 8

Adverse Effects

• Most common: dizziness, upper respiratory tract infection, headache, and fatigue 7
• Vasodilatory-related effects are most common but occur at rates similar to placebo 4, 5
• Low incidence of ejaculatory disorders (<1%) 5
• Hypotension and syncope reported rarely 7

Drug Interactions

• CYP3A4 inhibitors can significantly elevate serum concentrations of alfuzosin 1, 7
• Examples include ketoconazole, diltiazem, cimetidine, and atenolol 7

Monitoring and Follow-up

• Patients should be monitored for orthostatic hypotension, especially with first dose 3
• Annual follow-up evaluations are recommended for patients on long-term therapy 3

Alternative Treatments

• For patients who fail medical therapy with alfuzosin, consider:
  • Other alpha-blockers (tamsulosin, doxazosin, terazosin) 2, 3
  • 5-alpha reductase inhibitors (finasteride, dutasteride) for enlarged prostates 2, 3
  • Combination therapy with an alpha-blocker and 5-alpha reductase inhibitor 2
  • Minimally invasive or surgical therapies for refractory cases 2