Do Not Combine Tamsulosin with Alfuzosin (Xatral X)
Combining tamsulosin with alfuzosin is contraindicated and potentially dangerous—these are both alpha-1 adrenergic blockers with identical mechanisms of action, and using them together provides no additional therapeutic benefit while significantly increasing the risk of severe hypotension, dizziness, and syncope. 1
Why This Combination is Inappropriate
Pharmacologic Redundancy
- Both tamsulosin and alfuzosin work through the same mechanism: alpha-1 receptor blockade causing smooth muscle relaxation in the ureter and prostate 1
- The AUA guidelines classify alfuzosin, doxazosin, tamsulosin, and terazosin as having "equal clinical effectiveness" for treating lower urinary tract symptoms, confirming they are therapeutically equivalent 1
- Using two alpha-blockers simultaneously is pharmacologically irrational—it's like taking two different brands of the same medication 1
Increased Risk Without Benefit
- Alpha-blocker therapy carries known risks including orthostatic hypotension, dizziness, tiredness (asthenia), ejaculatory problems, and nasal congestion 1
- Combining two alpha-blockers would compound these adverse effects without improving stone passage rates 1
- Research directly comparing tamsulosin versus alfuzosin shows no significant difference in stone expulsion rates (RR: 0.90; 95% CI, 0.79-1.02; p = 0.09) or expulsion time, confirming they are equivalent agents 2
Correct Approach for Ureteral Stones
Choose ONE Alpha-Blocker Only
- For distal ureteral stones 5-10 mm, prescribe either tamsulosin 0.4 mg daily or alfuzosin 10 mg daily—never both 3, 2
- Tamsulosin increases stone passage rates to 81-87% compared to 61-79% with placebo for stones 5-10 mm 3
- Alfuzosin provides similar efficacy with stone-free rates of 75-76% versus 44-50% for no alpha-blocker 4, 5
Treatment Duration and Monitoring
- Continue the single alpha-blocker for maximum 4-6 weeks from initial presentation 3
- Monitor weekly for stone passage and complications during the first 2 weeks 3
- Discontinue immediately if infection/sepsis, declining renal function, or severe obstruction develops 3
Stone Size Considerations
- For stones ≤5 mm: alpha-blockers provide no clinically meaningful benefit due to spontaneous passage rates of 68-89% 3
- For stones >10 mm: consider urologic intervention (ureteroscopy or PCNL) rather than medical expulsive therapy 3
Common Pitfall to Avoid
Never prescribe two alpha-blockers together thinking it will "double the effect"—this only doubles the side effects while providing zero additional benefit. If the patient is already taking alfuzosin (Xatral X) for BPH, simply continue that medication alone for the ureteral stone rather than adding tamsulosin 1, 2.