From the Guidelines
Tamsulosin is the safest option in the alpha-1 blocker class for treating benign prostatic hyperplasia (BPH) due to its better urinary selectivity and lower risk of orthostatic hypotension compared to other alpha blockers like doxazosin or terazosin. The recommended dose is 0.4 mg taken once daily, about 30 minutes after the same meal each day 1. This selective action makes it particularly suitable for elderly patients or those with cardiovascular concerns.
Key Points to Consider
- Tamsulosin has a lower probability of orthostatic hypotension but a higher probability of ejaculatory dysfunction compared to other alpha blockers like doxazosin or terazosin 1.
- Side effects are typically mild and may include retrograde ejaculation, dizziness, headache, or nasal congestion.
- Patients should be aware that orthostatic hypotension (blood pressure drop when standing) can occur, especially with the first dose, so it's advisable to take the initial dose at bedtime.
- Tamsulosin works by relaxing smooth muscles in the prostate and bladder neck, improving urine flow without significantly affecting blood pressure in most patients 1.
Important Considerations
- In men with hypertension and cardiac risk factors, doxazosin monotherapy was associated with a higher incidence of congestive heart failure than seen with other antihypertensive agents 1.
- The use of an alpha blocker to manage a patient’s LUTS should not necessarily be assumed to constitute optimal management of the patient’s concomitant hypertension, and patients with hypertension may require separate management of their hypertension 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Safety of Tamsulosin
- Tamsulosin is a subtype-selective alpha(1A)- and alpha(1D )-adrenoceptor antagonist, which relaxes smooth muscle in the prostate and bladder neck, thereby enhancing bladder emptying 2.
- The most common adverse events associated with tamsulosin are dizziness, abnormal ejaculation, asthenia, postural hypotension, and palpitations, with an incidence of 1 to 2% 2.
- Tamsulosin has not been associated with clinically significant changes in blood pressure in clinical trials 2.
- The safety profile of tamsulosin in women and children seems to be generally consistent with the profile in men, with adverse events including abdominal pain, asthenia, constipation, dizziness, dry mouth, drowsiness, dyspepsia, headache, incontinence, nasal congestion, nausea, orthostatic hypotension, and somnolence 3.
Efficacy of Tamsulosin
- Tamsulosin improves symptoms and peak urine flow relative to placebo, with a weighted mean difference of -1.1 points for the Boyarsky symptom score and 1.1 mL/sec for peak urine flow 4.
- Tamsulosin is as effective as other alpha antagonists and the phytotherapeutic agent Permixon in improving symptoms and flow rates 4.
- Long-term treatment with tamsulosin is safe and well tolerated, with sustained improvement in maximum urine flow and total Boyarsky symptom score over 4 years 5.
Comparison with Other Alpha-Blockers
- Tamsulosin has a lower potential for hypotensive effects compared to other alpha-blockers, such as alfuzosin 2.
- Tamsulosin does not require initial dosage titration and has a fast onset of action, making it a convenient alternative to other alpha-blockers 6.
- Tamsulosin is more costly than some other alpha-blockers, but its efficacy and safety profile make it a valuable therapeutic option for the management of lower urinary tract symptoms associated with benign prostatic hyperplasia 6.