amsulosin (Flomax) is described as a selective alpha (α) 1A -adrenergic antagonist (or blocker) that has been shown to improve lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH). [1][2][3][4][5][6][7][8][9] Other (α)-blockers are also effective and available for treating patients with symptomatic BPH (e.g., terazosin, prazosin, doxazosin), [10][11][12][13][14][15][16][17][18][19][20][21] all of which are available by generic name, at lower cost. The effectiveness of tamsulosin and other α-blockers appear to be similar in the reduction of symptoms of BPH. 22 Information from well-designed studies to support the use of tamsulosin in patients with BPH who have not responded to an adequate trial with terazosin, prazosin, or doxazosin is lacking.Tamsulosin differs from the other α-blockers in selectively blocking the α receptors in the genitourinary area with a minimal effect on the smooth muscle vasculature. Hence, the effect of tamsulosin on blood pressure is negligible. The incidence of orthostatic hypotension has been reported to be approximately 1% with tamsulosin (and alfuzosin, a clinically uroselective α-blocker) compared with 2% to 8% with terazosin or doxazosin in placebo-controlled studies. 22 Moreover, symptomatic postural hypotension has reportedly been lower with tamsulosin (3%) than with doxazosin (4%) and terazosin (6%, P<0.05). 23 In addition to being effective in patients with symptomatic BPH, the α-blockers-terazosin, prazosin, and doxazosin-are approved for the management of patients with hypertension. In contrast to the other α-blockers, tamsulosin is not indicated for the management of patients with hypertension. 24 A data collection form for medical record abstraction was designed to capture the patient's diagnosis, reported indication for tamsulosin, history of previous α-blocker use, tamsulosin follow-up evaluation, and the individual facility's method of implementation of criteria for nonformulary use. Patients receiving a prescription for tamsulosin during a 3-month period preceding the posting of national criteria, and patients with a first-time prescription for tamsulosin during a 3-month period after the national criteria were posted were randomly selected by the PBM and assigned for chart review at each site.
T F O R M U L A RY M A N A G E M E N TRESULTS: Data for 332 patients were collected from 6 different sites over a 6-month period for each pregroup and postgroup beginning August 2001 and January 2002, respectively. Tamsulosin was prescribed for appropriate indications in 66% of patients, potentially appropriate indications in 4% of patients, and inappropriate indications in 30% of patients. Of the 206 patients (62%) who were prescribed tamsulosin as a result of a reported adverse event with a previous α-blocker, only 29% of the cases (N = 59) showed evidence that an attempt was made to reduce the dose of the first α-blocker to abate the side effects. Followup monitoring was conducted in 78% of tamsulosin patients, of whom 55% reported effectiveness of...