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alpha-1 adrenergic receptor antagonist; prostate-selective alpha blocker

Indications: - benign prostatic hypertrophy - hypertension* - urinary calculus - PTSD, nightmares - pheochromocytoma [3] - angina pectoris * use for treating hypertension declined after the ALLHAT study Adverse effects: 1) orthostatic hypotension - falls in the elderly (RR=1.1) [4] - fractures (RR=1.2) [4] - syncope [5] 2) tamsulosin (Flomax) least likely to cause orthostatic hypotension 3) alfuzosin (Uroxatral) least likely to cause abnormal ejaculation 4) adverse ocular effects a) blurred vision b) eye pain c) risk of intraoperative floppy-iris syndrome during cataracts surgery (most frequent with tamsulosin) 5) none are likely to cause erectile dysfunction 6) worsening chronic renal failure with progression to ESRD [5] * not associated with increased risk of cardiovascular events in contrast to findings of ALLHAT study [5]

Interactions

drug interactions drug adverse effects (more general classes)

Related

alpha-1 adrenergic receptor

Specific

alfuzosin (Uroxatral) doxazosin (Cardura) prazosin (Minipress, Deprazolin) silodosin (Rapaflo) tamsulosin (Flomax, Urolosin) terazosin (Hytrin, Hydracin, Hytrinex, Vasocard)

General

alpha adrenergic receptor antagonist

References

  1. Prescriber's Letter 10(9):53 2003
  2. Prescriber's Letter 17(4): 2010 Detail-Document#: 260402 (subscription needed) http://www.prescribersletter.com
  3. Deprecated Reference
  4. Welk B et al The risk of fall and fracture with the initiation of a prostate- selective alpha antagonist: a population based cohort study. BMJ 2015;351:h5398 PMID: 26502947 http://www.bmj.com/content/351/bmj.h5398
  5. Hundemer GL, Knoll GA, Petrcich W et al. Kidney, cardiac, and safety outcomes associated with alpha-blockers in patients with CKD: A population-based cohort study. Am J Kidney Dis 2021 Feb; 77:178. PMID: 32920153 https://www.ajkd.org/article/S0272-6386(20)30937-9/fulltext