Can Alfuzosin (Uroxatral) and Gemtesa (Vibegron) cause dizziness?

Dizziness Associated with Alfuzosin and Gemtesa (Vibegron)

Yes, both Alfuzosin (Uroxatral) and Gemtesa (Vibegron) can cause dizziness, though with different frequencies and mechanisms.

Alfuzosin and Dizziness

• Alfuzosin, an alpha-1 adrenergic receptor antagonist used for benign prostatic hyperplasia (BPH), commonly causes dizziness as a side effect due to its vasodilatory properties 1, 2
• Dizziness/postural dizziness is reported in approximately 3.1% of patients taking alfuzosin 10 mg once daily 2
• The dizziness is primarily related to orthostatic hypotension that occurs when changing positions quickly 3, 4
• Patients may experience frequent episodes of dizziness after starting alfuzosin therapy, which can be concerning especially in patients with other risk factors 4
• In clinical studies, dizziness was the most common adverse event with alfuzosin treatment (5% vs 0% with placebo) 5

Gemtesa (Vibegron) and Dizziness

• While specific data on Gemtesa (vibegron) is more limited in the provided evidence, medications can generally be a cause of dizziness as noted in clinical practice guidelines 6
• Medication side effects are listed as a potential cause of dizziness in differential diagnosis of vertigo and dizziness 6
• Several medications, including cardiovascular medications and antihypertensives, may produce side effects of dizziness and/or vertigo 6

Risk Factors and Special Considerations

• Elderly patients are at higher risk for experiencing dizziness with these medications 3, 2
• Patients with pre-existing cardiovascular conditions, particularly those with hypertension, may experience more pronounced dizziness 2, 7
• Patients taking multiple medications that can cause hypotension are at increased risk for dizziness 6
• Patients with glaucoma may be more vulnerable to the hypotensive effects of alfuzosin, potentially leading to more severe consequences 4

Management Recommendations

• For patients experiencing mild dizziness with alfuzosin:

  • Taking the medication at bedtime may help reduce symptoms 2
  • Ensuring adequate hydration can help minimize orthostatic hypotension 3
  • Rising slowly from sitting or lying positions can reduce the risk of dizziness 3, 4

• For patients with more severe symptoms:

  • Consider switching to alternative medications with potentially fewer vasodilatory effects 4
  • In patients with BPH, tamsulosin may have a lower risk of orthostatic hypotension compared to other alpha-blockers including alfuzosin 3
  • Dose adjustment may be necessary in patients with hepatic impairment 1

• For all patients:

  • Monitor blood pressure regularly, especially when initiating therapy 2, 7
  • Avoid concurrent use of medications that can enhance hypotensive effects, such as PDE5 inhibitors or other antihypertensives, if possible 1
  • Caution patients about the risk of falls, especially in elderly patients 3

Important Precautions

• Patients should be warned about the potential for dizziness when driving or operating machinery 3
• Patients with cardiovascular disease should be monitored more closely when taking alfuzosin 2, 7
• Alfuzosin should be taken with food to enhance bioavailability of the extended-release formulation 1
• Concurrent use of CYP3A4 inhibitors (e.g., ketoconazole, diltiazem, cimetidine) can significantly elevate serum concentrations of alfuzosin and enhance its side effects, including dizziness 1

By understanding these medication-related side effects and taking appropriate precautions, patients can better manage the risk of dizziness while receiving treatment with alfuzosin or Gemtesa.