Functional: Pharmacological Management of LUTS: Difference between revisions
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===== Contraindications ===== | ===== Contraindications ===== | ||
* Absolute[https://www.ncbi.nlm.nih.gov/books/NBK556066/ §] | * '''Absolute (1)[https://www.ncbi.nlm.nih.gov/books/NBK556066/ §]''' | ||
** Hypersensitivity to alpha-blockers or any other component of the drug formulation | ** '''Hypersensitivity to alpha-blockers or any other component of the drug formulation''' | ||
* '''<span style="color:#ff0000">Caution</span>''' | * '''<span style="color:#ff0000">Caution (4):</span>''' | ||
* | *# '''<span style="color:#ff0000">Planned cataract surgery[https://pubmed.ncbi.nlm.nih.gov/34384237/ ★]</span>''' | ||
* | *#* Can complicate cataract surgery by inducing sudden iris prolapse and pupil constriction during the surgery, known as "intraoperative floppy iris syndrome[https://www.ncbi.nlm.nih.gov/books/NBK556066/ §] | ||
* | *#** Tamsulosin has the highest risk for IFIS (40x that of alfusozin), but all alpha blockers increase the risk of IFIS to some degree.[https://pubmed.ncbi.nlm.nih.gov/34384237/ §] | ||
* | *#** For every 255 men receiving tamsulosin in the immediate preoperative cataract surgical period, one serious complication (e.g., retinal detachment, lost lens or lens fragment, endophthalmitis) would result.[https://pubmed.ncbi.nlm.nih.gov/34384237/ §] | ||
* | *#* '''<span style="color:#ff0000">When initiating alpha blocker therapy, patients with planned cataract surgery should be informed of the associated risk of intraoperative floppy iris syndrome risk and be advised to discuss these risks with their ophthalmologists, ideally with delay of medication initiation until after planned procedures.[https://pubmed.ncbi.nlm.nih.gov/34384237/ ★]''' | ||
* | *#* '''Discontinuation of tamsulosin 4 to 7 days prior to cataract surgery is routine practice, but it does not completely eliminate intraoperative floppy iris syndrome risk.[https://pubmed.ncbi.nlm.nih.gov/34384237/ ★]''' | ||
** '''<span style="color:#ff0000">Concomitant use of a PDE5[https://pubmed.ncbi.nlm.nih.gov/34384237/ ★]</span>''' | *# '''<span style="color:#ff0000">Patients on several antihypertensives, or with orthostatic hypotension[https://pubmed.ncbi.nlm.nih.gov/34384237/ ★]</span>''' | ||
* | *#* '''When treating patients on several antihypertensives, or with orthostatic hypotension, it is best to select an alpha blocker that exhibits minimal impact on blood pressure (eg, the highly selective alpha 1a blocker silodosin)[https://pubmed.ncbi.nlm.nih.gov/34384237/ §]''' | ||
* | *#'''<span style="color:#ff0000">Concomitant use of a PDE5[https://pubmed.ncbi.nlm.nih.gov/34384237/ ★]</span>''' | ||
* | *#*'''<span style="color:#ff0000">The hypotensive effects of terazosin and doxazosin can be potentiated by concomitant use of a PDE5, such as sildenafil or vardenafil.[https://pubmed.ncbi.nlm.nih.gov/34384237/ ★]</span>''' | ||
* | *#*'''Tamsulosin at a dose of 0.4 mg/day, however, does not appear to significantly potentiate the hypotensive effects of sildenafil.[https://pubmed.ncbi.nlm.nih.gov/34384237/ §]''' | ||
*#*'''Regardless, patients utilizing both these medications should be counselled appropriately regarding the risk for drops in blood pressure and symptoms associated with this.[https://pubmed.ncbi.nlm.nih.gov/34384237/ §]''' | |||
*#'''<span style="color:#ff0000">With tamsulosin, caution may be required in patients with serious sulfonamide allergy[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831305/ §]</span>''' | |||
=== Decreasing Outlet Resistance at a Site of Anatomic Obstruction === | === Decreasing Outlet Resistance at a Site of Anatomic Obstruction === | ||