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Tamsulosin

Medically reviewed on Nov 15, 2018

Pronunciation

(tam SOO loe sin)

Index Terms

  • Tamsulosin HCl
  • Tamsulosin Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral, as hydrochloride:

Flomax: 0.4 mg [contains fd&c blue #2 (indigotine)]

Generic: 0.4 mg

Brand Names: U.S.

  • Flomax

Pharmacologic Category

  • Alpha1 Blocker

Pharmacology

Tamsulosin is an antagonist of alpha1A-adrenoreceptors in the prostate. Smooth muscle tone in the prostate is mediated by alpha1A-adrenoreceptors; blocking them leads to relaxation of smooth muscle in the bladder neck and prostate causing an improvement of urine flow and decreased symptoms of BPH. Approximately 75% of the alpha1-receptors in the prostate are of the alpha1A subtype.

Absorption

>90%

Distribution

Vd: 16 L

Metabolism

Hepatic (extensive) via CYP3A4 and 2D6; metabolites undergo extensive conjugation to glucuronide or sulfate

Excretion

Urine (76%, <10% as unchanged drug); feces (21%)

Time to Peak

Fasting: 4 to 5 hours; With food: 6 to 7 hours

Steady-state: By the fifth day of once-daily dosing

Half-Life Elimination

Healthy volunteers: 9 to 13 hours; Target population: 14 to15 hours

Protein Binding

94% to 99%, primarily to alpha-1 acid glycoprotein (AAG)

Special Populations: Elderly

AUC is 40% higher in subjects 55 to 75 years of age compared with subjects 20 to 32 years of age.

Use: Labeled Indications

Benign prostatic hyperplasia: Treatment of signs and symptoms of benign prostatic hyperplasia (BPH)

Limitations of use: Not indicated for the treatment of hypertension.

Off Label Uses

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in males

Data from a meta-analysis and clinical experience suggests the utility of tamsulosin, in combination with antibiotics, for improvement in symptoms (eg, pain, urinary symptoms) associated with CP/CPPS [Anothaisintawee 2011], [Pontari 2018].

Lower urinary tract symptoms (LUTS) in males

Data from a prospective, randomized, controlled study in males with lower urinary tract symptoms suggestive of bladder outlet obstruction (BOO) and concomitant detrusor instability receiving tamsulosin in combination with an anticholinergic agent showed an improvement in quality of life [Athanasopoulos 2003].

Ureteral calculi expulsion

Use of alpha-1 blockers, including tamsulosin, for treating ureteral calculi is recommended by US and European guidelines and is supported by data from meta-analyses as well as numerous controlled trials. Tamsulosin has been shown to be effective in facilitating expulsion of ureteral stones (less than 10 mm) as medical therapy alone or as an adjunct to shock wave lithotripsy and ureteroscopy. Some trials indicate a class effect of alpha-1 adrenergic blockers, with tamsulosin reported to be equally effective as terazosin, doxazosin, and alfuzosin.

Ureteral stent-related urinary symptoms, treatment

Data from prospective, randomized trials and a meta-analysis support the use of tamsulosin for improvement in stent-related urinary symptoms and quality of life in patients undergoing ureteral stent placement [Damiano 2008], [Wang 2009a], [Wang 2009b], [Yakoubi 2011].

Contraindications

Hypersensitivity (eg, angioedema, rash, urticaria, pruritus, respiratory symptoms) to tamsulosin or any component of the formulation

Canadian labeling: Additional contraindications (not in US labeling): Concomitant use with strong CYP3A4 inhibitors (including ketoconazole)

Dosing: Adult

Note: Tamsulosin capsules should be administered ~30 minutes following the same meal each day. The controlled-release (oral controlled absorption system [OCAS]) tablet formulation [Canadian product] should be administered at the same time each day with or without food.

Benign prostatic hyperplasia (BPH): Oral:

Capsule: Initial and Maintenance: 0.4 mg once daily. If response is inadequate after 2 to 4 weeks, may increase to 0.8 mg once daily. If therapy is discontinued or interrupted for several days, restart with 0.4 mg once daily.

Controlled-release tablet [Canadian product]: Initial and maximum dose: 0.4 mg once daily

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in males (off-label use): Oral: Initial: 0.4 mg once daily in combination with antibiotic treatment; antibiotic is given for initial 6 weeks (Pontari 2018). If response to initial therapy is inadequate, referral to a urologist is recommended (Anothaisintawee 2011; Nickel 2012; Pontari 2018).

Lower urinary tract symptoms (LUTS) in males (off-label use): Bladder outlet obstruction (BOO) and low postvoid residual (PVR): Oral: Initial: 0.4 mg once daily; may combine with an anticholinergic agent if symptoms of overactive bladder persist (Athanasopoulos 2003; Dimitropoulos 2015; Drake 2015; Van Kerrebroeck 2013).

Ureteral calculi expulsion (off-label use):

Medical expulsive therapy (MET) for distal (lower) ureteral calculi to facilitate spontaneous stone passage: Stones ≤10 mm: Oral: 0.4 mg once daily until stone passage occurs or for up to 30 days (Ahmed 2010; Campschroer 2014; Hollingsworth 2006; Pickard 2015).

Adjunctive therapy following shock wave lithotripsy to facilitate clearance of residual stones: Oral: 0.4 mg once daily; initiate therapy immediately after extracorporeal shock wave lithotripsy; duration of therapy in trials ranged from 14 days to 3 months (Agrawal 2009; Chen 2015; Falahatkar 2011; Vicentini 2011).

Ureteral stent-related urinary symptoms, treatment (off-label use): Oral: 0.4 mg once daily; treatment was initiated following stent placement and duration of therapy in trials ranged from 1 to 6 weeks (Damiano 2008; Wang 2009a; Wang 2009b; Yakoubi 2011); may also be given in combination with an anticholinergic agent (Dellis 2017).

Dosing: Geriatric

Refer to adult dosing.

Administration

Oral: Administer capsules 30 minutes after the same mealtime each day. Capsules should be swallowed whole; do not crush, chew, or open. The controlled-release tablet [Canadian product] should be administered at the same time each day with or without food, and should be swallowed whole.

Storage

Store at 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F).

Drug Interactions

Alpha-/Beta-Agonists: Alpha1-Blockers may diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy

Alpha1-Agonists: Alpha1-Blockers may diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy

Alpha1-Blockers: May enhance the antihypertensive effect of other Alpha1-Blockers. Avoid combination

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy

Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Beta-Blockers: May enhance the orthostatic hypotensive effect of Alpha1-Blockers. The risk associated with ophthalmic products is probably less than systemic products. Exceptions: Levobunolol; Metipranolol. Monitor therapy

Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Bosentan: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Bromperidol: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. Avoid combination

Calcium Channel Blockers: Alpha1-Blockers may enhance the hypotensive effect of Calcium Channel Blockers. Monitor therapy

Ceritinib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of ceritinib with a narrow therapeutic index CYP3A substrate (eg, alfentanil, cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, tacrolimus) should be avoided when possible. Exceptions are discussed separately. Monitor therapy

Cimetidine: May increase the serum concentration of Tamsulosin. Monitor therapy

Conivaptan: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination

CYP2D6 Inhibitors (Moderate): May increase the serum concentration of Tamsulosin. Monitor therapy

CYP2D6 Inhibitors (Strong): May increase the serum concentration of Tamsulosin. Monitor therapy

CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy

CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification

CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Tamsulosin. Monitor therapy

CYP3A4 Inhibitors (Strong): May increase the serum concentration of Tamsulosin. Avoid combination

Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Consider therapy modification

Dapoxetine: May enhance the orthostatic hypotensive effect of Alpha1-Blockers. Monitor therapy

Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy

Duvelisib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy

Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Consider therapy modification

Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy

Fosnetupitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Idelalisib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination

Ivosidenib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy

Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Mitotane: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Consider therapy modification

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Netupitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification

Palbociclib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Phosphodiesterase 5 Inhibitors: Alpha1-Blockers (Uroselective) may enhance the hypotensive effect of Phosphodiesterase 5 Inhibitors. Monitor therapy

Pitolisant: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant. Consider therapy modification

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Rilmenidine: Alpha1-Blockers may enhance the hypotensive effect of Rilmenidine. Monitor therapy

Sarilumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy

Siltuximab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy

Simeprevir: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy

St John's Wort: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification

Stiripentol: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. Consider therapy modification

Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy

Adverse Reactions

>10%:

Cardiovascular: Orthostatic hypotension (first dose: 6% to 19%; symptomatic orthostatic hypotension (chronic therapy) <1%)

Central nervous system: Headache (19% to 21%), dizziness (15% to 17%)

Genitourinary: Ejaculation failure (8% to 18%)

Infection: Infection (9% to 11%)

Respiratory: Rhinitis (13% to 18%)

1% to 10%:

Central nervous system: Drowsiness (3% to 4%), insomnia (1% to 2%), vertigo (≤1%)

Endocrine & metabolic: Loss of libido (2%)

Gastrointestinal: Diarrhea (6%), nausea (4%)

Neuromuscular & skeletal: Weakness (8% to 9%), back pain (7% to 8%)

Ophthalmic: Blurred vision (≤2%)

Respiratory: Pharyngitis (6%), cough (3% to 5%), sinusitis (4%)

<1%, postmarketing, and/or case reports: Constipation, decreased visual acuity, epistaxis, erythema multiforme, exfoliation of skin, exfoliative dermatitis, hypersensitivity reaction, hypotension, intraoperative floppy iris syndrome, palpitations, priapism, syncope, vomiting, xerostomia

Warnings/Precautions

Concerns related to adverse effects:

• Angina: Discontinue if symptoms of angina occur or worsen.

• Floppy iris syndrome: Intraoperative floppy iris syndrome (IFIS) is characterized by a combination of flaccid iris that billows with intraoperative currents, progressive intraoperative miosis despite dilation, and potential iris prolapse. IFIS has been observed in cataract and glaucoma surgery patients who were on or were previously treated with alpha1-blockers, particularly with tamsulosin use (Abdel-Aziz 2009); in some cases, patients had discontinued the alpha1-blocker 5 weeks to 9 months prior to the surgery. The benefit of discontinuing alpha-blocker therapy prior to cataract or glaucoma surgery has not been established. IFIS may increase the risk of ocular complications during and after surgery. May require modifications to surgical technique; instruct patients to inform ophthalmologist of current or previous alpha1-blocker use when considering eye surgery. Initiation of tamsulosin therapy in patients with planned cataract or glaucoma surgery is not recommended.

• Orthostatic hypotension/syncope: May cause significant orthostatic hypotension and syncope, especially with first dose; anticipate a similar effect if therapy is interrupted for a few days, if dosage is rapidly increased, or if another antihypertensive drug (particularly vasodilators) or a PDE-5 inhibitor (eg, sildenafil, tadalafil, vardenafil) is introduced. “First-dose” orthostatic hypotension may occur 4 to 8 hours after dosing; may be dose related. Patients should be cautioned about performing hazardous tasks, driving, or operating heavy machinery when starting new therapy or adjusting dosage upward.

• Priapism: Priapism has been associated with use (rarely).

• Sulfonamide allergy: Rarely, patients with a sulfa allergy have also developed an allergic reaction to tamsulosin; avoid use when previous reaction has been severe or life-threatening.

Disease-related concerns:

• Heart failure: In a scientific statement from the American Heart Association, tamsulosin has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: moderate) (AHA [Page 2016]).

• Prostate cancer: It is recommended to rule out prostatic carcinoma with screening before beginning therapy and then screen at regular intervals.

Concurrent drug therapy issues:

• Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Other warnings/precautions:

• Limitation of use: Not intended for use as an antihypertensive drug.

Monitoring Parameters

Blood pressure; urinary symptoms

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events were not observed in animal reproduction studies. For pregnant women with kidney stones, other treatments such as stents or ureteroscopy, are recommended if stone removal is needed (Preminger 2007; Tan 2013).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience headache, sexual dysfunction, back pain, diarrhea, rhinorrhea, or loss of strength and energy. Have patient report immediately to prescriber severe dizziness, passing out, chills, pharyngitis, or priapism (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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