Tamsulosin
As with the use of other alpha1-blockers, during treatment with tamsulosin, in some cases a decrease in blood pressure may be observed, which can sometimes lead to fainting. At the first signs of orthostatic hypotension (dizziness, weakness), the patient should sit or lie down and remain in this position until the signs disappear.
Before prescribing tamsulosin therapy, it is necessary to exclude the presence of other diseases in the patient that can cause the same symptoms as benign prostatic hyperplasia.
Before starting treatment and regularly during therapy, a digital rectal examination and, if necessary, determination of prostate specific antigen (PSA) should be performed.
Treatment with tamsulosin in patients with severe renal failure (creatine clearance less than 10 ml/min) requires caution, because No studies have been conducted in this category of patients.
In some patients taking or previously taking tamsulosin. During surgery for cataracts or glaucoma, it is possible to develop intraoperative instability syndrome of the iris (narrow pupil syndrome), which can lead to complications during surgery or in the postoperative period. The advisability of discontinuing tamsulosin therapy 1-2 weeks before surgery for cataracts or glaucoma has not been proven. Cases of intraoperative instability of the iris occurred in patients who stopped taking the drug earlier before surgery. It is not recommended to initiate tamsulosin therapy in patients scheduled for cataract or glaucoma surgery. During the preoperative examination of patients, the surgeon and ophthalmologist should consider whether the patient is taking or has taken tamsulosin. This is necessary to prepare for the possibility of developing intraoperative iris instability syndrome during surgery. If angioedema develops, drug therapy should be discontinued immediately. Repeated administration of tamsulosin is contraindicated.
In case of renal failure, as well as in case of mild and moderate liver failure, no dosage adjustment is required.
There are reports of cases of the development of prolonged erection and priapism during therapy with alpha1-blockers. If an erection persists for 4 hours, you should immediately seek medical help. If priapism therapy is not carried out immediately, it can lead to damage to the tissue of the penis and irreversible loss of potency.
Tamsulosin Bacter, 0.4 mg, enteric capsules with prolonged release, 30 pcs.
As with the use of other alpha-1-blockers, when treated with Tamsulosin Canon, in some cases a decrease in blood pressure may be observed, which can sometimes lead to fainting. At the first signs of orthostatic hypotension (dizziness, weakness), the patient should sit or lie down and remain in this position until these symptoms disappear.
Before starting tamsulosin therapy, the patient should be examined to exclude the presence of other diseases that may cause the same symptoms as benign prostatic hyperplasia. Before starting treatment and regularly during therapy, a digital rectal examination and, if required, a prostate specific antigen (PSA) determination should be performed.
There are reports of cases of the development of prolonged erection and priapism during therapy with alpha1-blockers. If an erection persists for more than 4 hours, you should immediately seek medical help. If priapism therapy is not carried out immediately, it can lead to damage to the tissue of the penis and irreversible loss of potency.
Treatment with Tamsulosin Canon in patients with severe renal failure (creatinine clearance).
Some patients taking or previously taking tamsulosin during surgery for cataracts or glaucoma may develop intraoperative iris instability syndrome (narrow pupil syndrome), which can lead to complications during surgery or in the postoperative period. The advisability of discontinuing tamsulosin therapy 1-2 weeks before surgery for cataracts or glaucoma has not been proven. Cases of intraoperative iris instability occurred in patients who stopped taking the drug and earlier before surgery. It is not recommended to initiate tamsulosin therapy in patients scheduled for cataract or glaucoma surgery. During the preoperative examination of patients, the surgeon and ophthalmologist should consider whether the patient is taking or has taken tamsulosin. This is necessary to prepare for the possibility of developing intraoperative iris instability syndrome during surgery.
If angioedema develops, drug therapy should be discontinued immediately. Repeated administration of tamsulosin is contraindicated.
Impact on the ability to drive vehicles and machinery.
Caution must be exercised when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions, due to the fact that dizziness may develop when taking tamsulosin.
Tamsulosin in the form of Okas: unobvious advantages
Within the framework of educational on-line programs, Doctor of Medical Sciences, Professor of the Institute of Urology and Human Reproductive Health of Sechenov University, Chairman of the Board of the Association of Specialists in Conservative Therapy in Urology “ASPECT”, Consultant urologist of the network of Family Clinics and Yusupov Hospital, specialist in conducting clinical drug research Leonid Grigorievich Spivak answered pressing questions from colleagues regarding the treatment of urological patients with urinary disorders.
Speaking about the multifactorial etiology of symptoms of impaired urination, Leonid Grigorievich noted that 49% of men aged 61 to 70 years go to the doctor with complaints of moderate or severe symptoms, while the majority of these patients are men with benign prostatic hyperplasia (BPH) . “Thanks to numerous studies, urologists have become well aware that if left untreated, patients with BPH experience significant deterioration,” the speaker recalled, “hence the logical conclusion that the earlier treatment is started, the better results can be achieved. As for the time to start therapy, there is no clear limit in this regard related to the patient’s age. However, in this regard, there are obvious trends, which are confirmed by an epidemiological study of patients with urinary disorders, conducted in 2021 under the leadership of Academician D.Yu. Pushkar in various medical centers in Russia. This work showed that symptoms do worsen as men age. At the same time, patients aged 60 to 70 years had severe symptoms of urinary disorders, and the number of patients with moderate symptoms (45%) did not differ in the age groups from 50 to 60 and from 60 to 70 years. It follows from this that in such a situation there is no point in leaving men with moderate symptoms without treatment and waiting until the symptoms worsen and there is a need for surgical intervention and installation of a cystostomy.”
In this case, what should be done in case of just emerging manifestations and mild symptoms? Answering this question, Professor L.G. Spivak said: “As follows from the recommendations of the European Society of Urology, the first thing to do is non-drug treatment, namely behavioral therapy methods. As for the latest Russian recommendations for the treatment of patients with BPH, they also note the leading role of behavioral therapy, which includes reducing fluid intake to reduce the frequency of urination (for example, before traveling or going to bed), eliminating caffeine and alcohol from the diet, using relaxation and double urination, massage of the bulbous urethra for the prevention of post-micturic dripping and other techniques. However, in practice, it is not easy to apply these recommendations, especially to patients who have concomitant therapy, incl. with the use of diuretics. And here the important task of the urologist is to optimize these prescriptions, review them together with the therapist, cardiologist and other specialists, which in reality is quite difficult to do. Moreover, unfortunately, even if these difficult tasks are performed, our patients do not receive the expected results. This is confirmed by the results of one of the studies, which showed that active surveillance, discussed above, is not always able to correct symptoms in patients with BPH. This work involved 400 men with risk factors for progression of BPH, who were actively monitored for four years. During this time, the number of patients with moderate and severe symptoms increased almost 5 times. This further reinforces the fact that BPH is a progressive condition. Therefore, no matter how the patient limits himself in fluids and coffee consumption, no matter how he massages the prostate, if the progression of BPH is not stopped, sooner or later behavioral therapy will cease to be effective in terms of the manifestation of symptoms. And this means that the man’s quality of life will deteriorate, and the urologist will be faced with a patient who already has clearly expressed symptoms, which will prevent him from achieving a significant effect. Therefore, non-drug treatment methods must be combined with medicinal ones, as stated in the 2021 European guidelines for the treatment of patients with BPH.”
Next, the speaker drew the attention of his colleagues to the statistics of prescriptions for patients with BPH: “It is no coincidence that monotherapy with α-blockers prevails today in the prescriptions of urologists both in Russia and throughout the world when treating patients with BPH, because at the start of therapy, such therapy allows you to quickly alleviate the symptoms of the disorder. urination. At the same time, according to research, the best balance between effectiveness and safety is the use of tamsulosin.”
Professor L.G. Spivak also noted that, according to statistics, half of all tamsulosin prescriptions are made up of the Omnic® Ocas® dosage form, which has a unique delivery technology that allows for a continuous release of the active substance throughout the entire gastrointestinal tract. “This is very important, since symptoms of impaired urination in our patients are constantly present, so the effectiveness of the drug used must demonstrate itself at any time of the day, throughout 24 hours,” the speaker emphasized.
Professor L.G. Spivak explained that the use of Omnic Ocas in a dose of 0.4 mg allows one to avoid sharp increases in the concentration of the active substance in the blood plasma and then reduce it to a minimum level, because the improved pharmacokinetic profile of the drug maintains this concentration at a constant level. In addition, Omnic Okas has been proven to reduce the severity of nocturia by 57%, which is, according to the speaker, the most important aspect of the use of symptomatic therapy. Also important for patients is the fact that the pharmacokinetics of Omnic Okas 0.4 mg does not depend on food intake. As for the frequency of side effects, studies show: when taking Omnic Okas, it is significantly lower than when taking tamsulosin capsules, which is considered the safest of α-blockers.
Professor L.G. Spivak cited the results of a Russian observational program dedicated to studying the effectiveness and safety of using the drug Omnic Okas in patients with impaired urination due to BPH in routine clinical practice, conducted under the leadership of Academician of the Russian Academy of Sciences O.B. Lorana: “This study showed that Omnic Ocas more than halved the severity of bowel movements and improved the quality of life of patients.”
In conclusion of his report, Leonid Grigorievich about the bladder, whose role in the symptoms of impaired urination is the most important. Therefore, when a man has already developed serious symptoms (sluggish stream of urine, difficulty urinating, frequent urges, nocturnal pollakiuria 3 or more times, episodes of acute urinary retention with a large volume of the pancreas and a large amount of residual urine), it is possible to relieve him of pancreatic hyperplasia only with using surgical treatment. And, unfortunately, after transurethral resection of the pancreas, 55.1% of patients require drug therapy. That is why it is very important not to be late in treating patients with impaired urination, given that the first line of therapy allows for a quick and safe onset of a positive effect. And if we consider that in the arsenal of a modern urologist today there is a drug with a controlled form of absorption, which also costs half as much as before, then the possibilities of helping our patients have become much wider.”
Topics and tags
BPH
Magazine
Newspaper "Moscow Urologist" No. 4-2020
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Tamsulosin overdose, symptoms and treatment
Acute overdose of tamsulosin has not been described. Theoretically, after an overdose, there is a risk of developing acute arterial hypotension, which may require additional cardiotropic therapy. If the symptoms are not eliminated, you should replenish the blood volume by prescribing electrolyte solutions, or administer vasoconstrictor drugs. To prevent further absorption of tamsulosin, gastric lavage should be performed, activated charcoal and an osmotic laxative should be prescribed.
List of pharmacies where you can buy Tamsulosin:
- Moscow
- Saint Petersburg
Pharmacological properties of the drug Tamsulosin
A selective and competitive blocker of postsynaptic α1A-adrenergic receptors located in the smooth muscles of the prostate gland, bladder neck and prostatic urethra, reduces their tone and improves urine outflow. At the same time, it reduces the severity of symptoms of obstruction and irritation caused by benign prostatic hyperplasia. As a rule, the therapeutic effect develops 2 weeks after starting tamsulosin. The selectivity of tamsulosin for α1A-adrenergic receptors is 20 times greater than that for α1B-adrenergic receptors located in vascular smooth muscle. Due to its high selectivity, tamsulosin does not cause any clinically significant reduction in systemic blood pressure in both patients with hypertension (arterial hypertension) and in patients with normal baseline blood pressure. After oral administration, tamsulosin is quickly and almost completely absorbed from the digestive tract. Bioavailability is about 100%. After a single oral dose of 400 mcg, the maximum concentration in the blood plasma is achieved after 6 hours. At steady state (5 days after the start of treatment), the maximum concentration of the active substance in the blood plasma is 60–70% higher than after a single dose . 99% of tamsulosin binds to plasma proteins. The volume of distribution is insignificant and amounts to 0.2 l/kg. Slowly metabolized in the liver to form pharmacologically active metabolites that retain high selectivity for α1A-adrenergic receptors. Most tamsulosin is found in the blood unchanged. Excreted by the kidneys, 9% unchanged. The half-life for a single dose is 10 hours, the terminal half-life is 22 hours.
