Tamsulosin

Class
Adrenergic receptor blockers
Subclass
Selective α1-blockers
Substance name
Tamsulosin hydrochloride
Brand names
Flomax®
Common formulations
Capsule
Dosage and administration
Adults patients
BPH
•
Start at: 0.4 mg PO daily
•
Maintenance: 0.4-0.8 mg PO daily
Consider increasing dose to 0.8 mg if there is no response at 2-4 weeks. Restart therapy at 0.4 mg if discontinued for several days.
Neurogenic bladder in males with spinal cord injury • Off-label
•
0.4-0.8 mg PO daily
Other off-label uses
•
Treatment of chronic prostatitis/chronic pelvic pain syndrome
•
Treatment of ureteral stones
Indications for use
Labeled indications
Adults
•
Treatment of BPH
Off-label indications
Adults
•
Treatment of chronic prostatitis/chronic pelvic pain syndrome
•
Treatment of neurogenic bladder in males with spinal cord injury
•
Treatment of ureteral stones
Safety risks
Contraindications
Hypersensitivity to tamsulosin or its components
Concomitant use of other α-adrenergic blockers
Concomitant use of potent CYP3A4 inhibitors
•
Do not use tamsulosin with potent CYP3A4 inhibitors, such as ketoconazole.
Warnings and precautions
Drug hypersensitivity reaction
•
Use extreme caution in patients with a history of sulfa allergy.
Hypotension
•
Use caution in patients taking PDE5 inhibitors.
Increased serum tamsulosin levels
•
Use caution in patients taking moderate CYP3A4 inhibitors (such as erythromycin), strong (such as paroxetine) or moderate (such as terbinafine) CYP2D6 inhibitors, and in patients known to be CYP2D6 poor metabolizers.
Intraoperative floppy iris syndrome
•
Use caution in patients undergoing cataract or glaucoma surgery.
Orthostatic hypotension, priapism
•
Maintain a high level of suspicion, as tamsulosin is associated with an increased incidence of these adverse events.
Specific populations
Renal impairment
CrCl ≥ 10 mL/min
•
Use acceptable. No dose adjustment required.
CrCl < 10 mL/min
•
No guidance available.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use acceptable. No dose adjustment required.
Child-Pugh C (severe)
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2
•
Not intended for use in females.
Breastfeeding
Not intended for use in females.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Anejaculation, arthralgia, dizziness, ejaculation difficulties, headache, rhinitis
Common 1-10%
•
Pharyngitis, asthenia, back pain, blurred vision, chest pain, cough, ↓ libido, diarrhea, insomnia, myalgia, nausea, skin rash, somnolence, vertigo, sinusitis
Uncommon < 1%
•
Orthostatic hypotension, priapism, syncope
Unknown frequency
•
Atrial fibrillation, intraoperative floppy iris syndrome, angioedema, cardiac arrhythmias, erythema multiforme, exfoliative dermatitis, floppy eyelid syndrome, ↑ intraocular pressure, retinal detachment, constipation, dry mouth, dyspnea, nosebleed, palpitations, hypotension, pruritus, visual disturbances, vomiting, Stevens-Johnson syndrome, tachycardia, urticaria
Interactions
Drug(s)
Check Interactions
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