From the Research
Flomax (tamsulosin) should be discontinued at least 3-5 days before cardiac catheterization due to the risk of intraoperative floppy iris syndrome (IFIS) and potential hypotensive effects. Tamsulosin is an alpha-1 adrenergic receptor antagonist that relaxes smooth muscle in the prostate and bladder neck, but it can also affect vascular smooth muscle and the iris dilator muscle. During cardiac catheterization, the combination of sedatives and tamsulosin may cause excessive hypotension, as discussed in the context of orthostatic hypotension management 1, 2, 3. Additionally, if the procedure involves any ophthalmic interventions, IFIS can complicate the procedure by causing poor pupil dilation, iris billowing, and iris prolapse.
The most recent and highest quality study on evidence-based practices in the cardiac catheterization laboratory highlights the importance of considering the patient's medication regimen before the procedure 4. After the catheterization, tamsulosin can typically be resumed within 24-48 hours once the patient is hemodynamically stable and no complications have occurred. The cardiologist should be informed about the patient's tamsulosin use before the procedure, and alternative medications for benign prostatic hyperplasia such as finasteride might be considered during this perioperative period if urinary symptoms need to be managed.
Some key considerations in managing patients with orthostatic hypotension, which may be relevant in this context, include non-pharmacologic interventions, volume expansion with fludrocortisone, and sympathetic enhancement with midodrine, droxidopa, and norepinephrine reuptake inhibitors 2. However, the primary concern in this scenario is the potential risk of IFIS and hypotensive effects associated with tamsulosin use during cardiac catheterization.