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Urology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Alpha-blockers (tamsulosin) → relax prostate smooth muscle. Offer if IPSS ≧8 Side effects include postural hypotension and retrograde ejaculationIf symptoms persist despite treatment with an alpha-blocker (and there is not a significant postvoid residual) then consider adding an antimuscarinic medication (e.g. tolterodine). Side effects include dryness and constipation and potentially urinary retention
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Recognized curative treatment for localized carcinoma of the prostate includes primarily surgery, radiation therapy, and proton therapy. Alternative treatments (hormonal therapy, chemotherapy, cryosurgery, and high-intensity focused ultrasound (HIFU)) can halt the progression of disease but not provide a cure. Tamsulosin is an α1a-selective alpha-blocker used in the symptomatic treatment of benign prostatic hyperplasia (BPH).
Acute pain and medical disorders
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
The distal ureter contains specific adrenoceptor subtypes that produce smooth muscle relaxation. Medical (renal calculus) expulsive therapy, using the specific alpha blocker tamsulosin for up to two weeks, significantly reduced calculus expulsion time, hospitalizations for recurrent colic, and possibly analgesia requirements, although further research is ongoing.111 Tamsulosin was superior to comparative smooth muscle relaxants such as phloroglucinol or nifedipine in terms of increased stone expulsion and a reduction in analgesia requirements, surgical interventions, duration of hospital stay, and days off work.112[II] There are no clear data on the effects of urgent lithotripsy or surgical interventions on acute renal colic.
Chemical pharmacotherapy for the treatment of orthostatic hypotension
Published in Expert Opinion on Pharmacotherapy, 2019
Numerous medications can cause or exacerbate OH. These include nitrates, calcium channel blockers, and other vasodilators, diuretics, angiotensin-converting enzyme inhibitors, and other antihypertensive agents, α-receptor antagonists, and tricyclic antidepressants [30,31]. For example, tamsulosin, which is used to treat benign prostatic hypertrophy, preferentially blocks α1A receptors and relaxes smooth muscle in the prostate gland but in susceptible patients also blocks α1B receptors in the peripheral vasculature and can cause orthostatic hypotension. Hypotension from tamsulosin is dose-dependent, with a 12% and 17% incidence in patients receiving 0.4 mg and 0.8 mg daily, respectively [32]. Among the tricyclic antidepressants, amitriptyline, which is used to treat painful sensory neuropathies, also is a frequent offender [33].
Efficacy and safety of tamsulosin 0.4 mg single pills for treatment of Asian patients with symptomatic benign prostatic hyperplasia with lower urinary tract symptoms: a randomized, double-blind, phase 3 trial
Published in Current Medical Research and Opinion, 2018
Jae Hoon Chung, Cheol Young Oh, Jae Heon Kim, U-Syn Ha, Tae Hyo Kim, Seung Hwan Lee, Jun Hyun Han, Jae Hyun Bae, In Ho Chang, Deok Hyun Han, Tag Keun Yoo, Jae Il Chung, Sae Woong Kim, Jina Jung, Yong-Il Kim, Seung Wook Lee
Tamsulosin is widely used for patients with LUTS/BPH worldwide because of less chance of adverse reactions and better improvement of urination symptoms. In Western countries, tamsulosin 0.4 mg is prescribed as an initial dose for patients with LUTS/BPH, and the dose can be increased up to 0.8 mg, depending on the severity of symptoms8. On the contrary, tamsulosin 0.2 mg is a standard regimen for patients with LUTS/BPH in some Asian countries. This has been based on a double-blind, placebo-controlled, randomized trial9 and a phase 2 study10. These studies have reported that tamsulosin 0.2 mg and 0.4 mg improved urination symptoms, increased Qmax and decreased PVR without significant differences between the 0.2 mg and 0.4 mg groups. A meta-analysis of previous studies on tamsulosin 0.2 mg treatment of LUTS/BPH patients has shown sufficient effectiveness of tamsulosin 0.2 mg compared with that of other alpha-blockers11.
Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials
Published in Expert Review of Clinical Pharmacology, 2018
Kannan Sridharan, Gowri Sivaramakrishnan
The present network meta-analysis has the maximum number of studies compared to any other direct pairwise meta-analysis published till date. This is also the first meta-analysis in the field of MET in ureteral stones where trial sequential analysis for adjusting the pooled estimates according to the information size accrued till date was carried out. The study is limited in including studies with unclear or high risk of bias especially with regard to randomization, allocation concealment and blinding. We did not take into account the dose variation of tamsulosin as some of the included studies used 0.2 mg/day while most had used 0.4 mg/day. However, a recent review had shown no differences in the efficacy and safety of these two doses of tamsulosin [106]. We also did not analyze the severity of adverse events between the agents as the details were not available from the individual studies. Future studies should focus in expressing the adverse events including their severity using standardized medical terms to evaluate the differences in the safety profile of ABs.