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# Tamsulosin
## Overview
Tamsulosin is an alpha-1 adrenergic receptor antagonist.
## Primary Indications
* Benign prostatic hyperplasia (BPH) - To improve urine flow and reduce symptoms of BPH.
* Ureteral stones - To facilitate passage of kidney stones.
## Adult Dosing
* **BPH:** 0.4 mg orally once daily. If inadequate response after 2-4 weeks, may increase to 0.8 mg orally once daily. Take 30 minutes after the same meal each day.
* **Ureteral stones:** 0.4 mg orally once daily. Dosing duration varies based on stone size and location, typically 1-4 weeks.
## Pediatric Dosing
There is no established pediatric indication for tamsulosin.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed for mild to moderate renal impairment. Caution is advised in severe renal impairment, though no specific dose reduction is recommended.
* **Hepatic Impairment:** No dose adjustment is recommended for mild to moderate hepatic impairment. Avoid use in severe hepatic impairment.
## Contraindications
* Hypersensitivity to tamsulosin or any component of the formulation.
* Concomitant use with other alpha-1 adrenergic receptor antagonists.
## Adverse Effects
Commonly reported: Dizziness, headache, abnormal ejaculation (including retrograde ejaculation and anejaculation), rhinitis, blurred vision.
Less common: Hypotension, syncope, asthenia, nausea, diarrhea, somnolence.
## Key Drug Interactions
* **CYP3A4 Inhibitors (e.g., ketoconazole, ritonavir):** May increase tamsulosin exposure and the risk of adverse effects. Close monitoring is recommended.
* **CYP2D6 Inhibitors (e.g., paroxetine, fluoxetine):** May increase tamsulosin exposure.
* **Other Antihypertensives/Alpha-blockers:** Increased risk of additive hypotensive effects.
## Monitoring
* Blood pressure, especially upon initiation or dose increase, and in patients taking other antihypertensives.
* Symptoms of BPH.
* Signs of syncope or dizziness.
## Clinical Pearls
* Tamsulosin is formulated as a controlled-release capsule. Do not crush, chew, or open the capsules.
* May cause dizziness and affect the ability to drive or operate machinery. Advise caution.
* Intraoperative Floppy Iris Syndrome (IFIS) has been reported in cataract surgery patients. Inform ophthalmologists of tamsulosin use prior to surgery.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical advice. Always consult the most current prescribing information and local protocols before making clinical decisions.*
