Drugs also used for LUTS not listed here:

• Finasteride (See 6.4.2 5-alpha reductase inhibitors)

7.4.1.1 Alpha blockers for urinary conditions

Specific treatment guidance is available for:

• Management of lower urinary tract symptoms (LUTS) in men

Risk of first-dose hypotension and postural hypotension. Initial dose should be taken at bedtime; advise lying down if symptoms such as dizziness, fatigue, or sweating develop (remain lying down until they abate completely).

Slower titration may be required in elderly, or patients taking other drugs with a hypotensive effect.

Tamsulosin has been associated with floppy iris syndrome (an intraoperative complication during cataract surgery). The possibility of a class effect with other alpha blockers cannot be excluded. Avoid use in patients who are scheduled for cataract surgery (or who may require cataract surgery in the future). Cataract surgeons should check past or current use of any alpha-blocker for prostatic hypertrophy before surgery (see MHRA drug safety update).

Tamsulosin hydrochloride

• Modified-release capsules 400micrograms (£1.52 = 400micrograms daily)

Indications and dose

• Lower urinary tract symptoms (LUTS) in men:
  • 400micrograms once daily.

Notes

1. Tamsulosin is available to buy over the counter (OTC) from community pharmacies for the treatment of functional symptoms of benign prostatic hyperplasia in men aged 45-75 years. Medical review is required for the diagnosis of BPH. Patients must see their doctor within 6 weeks of starting treatment, for assessment of their symptoms and confirmation that they can continue to take tamsulosin OTC from their Pharmacist.

Alfuzosin hydrochloride

• Tablets 2.5mg (£1.82 = 2.5mg three times a day)
• Modified-release tablets 10mg (£11.68 = 10mg daily)

Indications and dose

• Lower urinary tract symptoms (LUTS) in men:
  • Immediate-release: 2.5mg three times a day, adjusted according to response, maximum dose 10mg daily. Lower initial dose (2.5mg twice daily) for elderly.
  • Modified-release: 10mg once daily. Only indicated where alfuzosin immediate-release tablets are effective but not tolerated.
• Acute urinary retention associated with benign prostatic hyperplasia:
  • Modified-release: 10mg once daily for 2-3 days during catheterisation and for one day after removal (maximum treatment duration of 4 days).