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# Tamsulosin
## Overview
Tamsulosin is an alpha-1 adrenergic receptor antagonist selective for alpha-1A and alpha-1D receptors, primarily found in the prostate, bladder base, bladder neck, and urethra.
## Primary Indications
* Benign Prostatic Hyperplasia (BPH): To improve symptoms of BPH.
* Off-label: Medical expulsive therapy for ureteral stones in conjunction with increased fluid intake and analgesics.
## Adult Dosing
* **BPH:** 0.4 mg orally once daily. May be increased to 0.8 mg orally once daily after 2-4 weeks if symptoms are not adequately controlled.
* **Ureteral Stones (Off-label):** 0.4 mg to 0.8 mg orally once daily.
## Pediatric Dosing
Tamsulosin is not indicated for use in pediatric patients.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally needed in patients with mild to moderate renal impairment. Caution is advised in severe renal impairment (CrCl < 30 mL/min), though specific dose adjustments are not established; efficacy and safety have not been systematically studied.
* **Hepatic Impairment:** No dose adjustment is generally needed in patients with mild to moderate hepatic impairment. The drug is contraindicated in severe hepatic impairment due to lack of data.
## Contraindications
* Hypersensitivity to tamsulosin or any component of the formulation.
* History of angioedema related to tamsulosin.
* Severe hepatic impairment.
## Adverse Effects
Common adverse effects include dizziness, headache, somnolence, abnormal ejaculation (including retrograde ejaculation and ejaculatory failure), rhinitis, and blurred vision. Hypotension, including orthostatic hypotension, can occur.
## Key Drug Interactions
* **CYP3A4 inhibitors (e.g., ketoconazole, ritonavir):** May increase tamsulosin exposure. Caution and potential dose reduction may be warranted.
* **Alpha-blockers (e.g., prazosin, terazosin):** Concomitant use may cause additive hypotensive effects. Avoid coadministration.
* **Erectile dysfunction agents (PDE5 inhibitors):** Caution due to potential additive hypotensive effects. Administer tamsulosin at least 4 hours apart from PDE5 inhibitors.
## Monitoring
* Monitor for symptoms of BPH.
* Assess for signs and symptoms of hypotension, especially orthostatic hypotension, particularly with dose increases and in patients with cardiovascular disease.
* Monitor for adverse effects such as dizziness, headache, and ejaculatory dysfunction.
## Clinical Pearls
* Tamsulosin is available in extended-release capsules. These should be swallowed whole and **never** crushed, chewed, or opened.
* Take tamsulosin approximately 30 minutes after the same meal each day (typically breakfast) to ensure consistent absorption.
* Due to alpha-1 receptor blockade in the iris, there is a risk of Intraoperative Floppy Iris Syndrome (IFIS) during cataract surgery. Inform the ophthalmologist prior to surgery if the patient is taking or has taken tamsulosin.
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*This information is intended for healthcare professionals. Always consult the current prescribing information for complete details and to verify information before making clinical decisions.*
