Clinical uroselectivity: evidence from patients treated with slow‐release alfuzosin for symptomatic benign prostatic obstruction

Abstract

Objective To assess the safety profile of slow-release (SR)The eÂect on supine blood pressure was minimal. In the subgroups of elderly and hypertensive patients alfuzosin in the treatment of benign prostatic obstruction (BPO), with special attention to orthostatic blood treated with SR alfuzosin, the cumulative incidence of asymptomatic orthostatic hypotension during the first pressure changes, postural symptoms and eÃcacy. Patients and methods Two placebo-controlled studies month of treatment was slightly higher than with placebo with no objective consequences on the inciinvolving 588 patients (292 receiving SR alfuzosin 5 mg twice daily and 296 a placebo) were pooled; dence of adverse events. The clinical eÃcacy of SR alfuzosin was confirmed by a significant improvement 51% of the patients were Á65 years of age and 43% had associated cardiovascular disease including hyperin urinary symptoms and a significant increase in maximum flow rates. tension and/or were receiving concomitant antihypertensive drugs.Conclusion SR alfuzosin (10 mg/day) can be administered safely without titration in patients with BPO, Results SR alfuzosin was very well tolerated with an overall incidence of adverse events similar to that of even in elderly and hypertensive patients. Its favourable benefit/risk ratio allows alfuzosin to be classified placebo (18.5% and 15.8% of patients, respectively) and an overall incidence of withdrawal from therapy as a clinically uroselective a 1 -blocker. Specific analysis of orthostatic changes in blood pressure is important for adverse events lower than that of placebo (3.4% and 5.7%, respectively). Adverse events potentially when assessing the safety profile of an a 1 -blocker in patients with BPO. related to vasodilatation were infrequent with SR alfuzosin (the same incidence as with placebo, i.e.Keywords Benign prostatic obstruction, slow-release alfuzosin, a 1 -blocker therapy, safety profile, clinical 2.7% of patients) and these adverse events occurred mainly during the first month of alfuzosin treatment.uroselectivity, orthostatic hypotension general practice [8]. In addition, besides improving LUTS Introduction and urodynamic variables, treatment with alfuzosin has a favourable impact on the quality of life of patients with The treatment of patients suÂering from benign prostatic obstruction (BPO) with a 1 -blocking agents is well estab-BPO [9]. Alfuzosin was initially available in Europe as an immediate-release formulation administered three lished and their eÂect on LUTS and urodynamics are assumed to be globally similar [1]. The main side-eÂects times daily. In fact, once-a-day and twice-a-day regimens have been shown to be associated with significantly associated with a 1 -blockers are postural symptoms relative to orthostatic hypotension, resulting from an impairbetter compliance (73% and 70%, respectively) than thrice-daily regimens (52%) [10]. In addition, the inciment of the compensatory reflex mechanism mediated by the sympathetic nervous system normally brought dence and severity of ...

Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

“…43 With alfuzosin, one study has found no incidence of abnormal ejaculation. 44 Doxazosin has been poorly studied with respect to ejaculatory dysfunction. 45 In contrast to these agents is tamsulosin, which is highly selective for the a 1A -adrenoreceptor subtype 4,46 and thus has been reported to produce symptomatic improvement of BPH without affecting blood pressure or heart rate and without requiring dose titration (although approximately 20% of patients do require the 0.8-mg dose).…”

The clinical uroselectivity of alfuzosin is not significantly affected by the age of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

“…Besides improving LUTS, treatment with alfuzosin improves the quality of life of patients with BPO [21,22,28]. Moreover, the incidence and severity of orthostatic hypotension is lower with an a 1 -blocker administered as a modi®ed-release formulation than as an immediate-release formulation [16]. Overall, the pro®les obtained for the decrease in LUTS and for safety were satisfactory.…”

“…Clinical uroselectivity is important because orthostatic hypotension, with its substantial morbidity from associated falls and syncope, has an increased prevalence with advancing age, primarily caused by the age-associated increase in systolic BP when standing [30], and associated medications and diseases, particularly hypertension [31]. Several previous studies have found a meaningful clinical uroselectivity of SR-alfuzosin shown by a good bene®t/risk ratio [11,16,18]. This clinical uroselectivity was in accord with the functional uroselectivity of alfuzosin, as re¯ected by a preferential effect on urethral pressure at doses which do not signi®cantly affect the cardiovascular or central nervous systems in animal models [32,33].…”

The Effects of Medical Treatments Used for Benign Prostatic Hyperplasia on Ejaculation

“…Prostat, mesane boynu ve üretrada düz kas gevşemesine bağlı olarak retrograd ejakülasyon oluşmaktadır (19). Ejakülatuvar disfonksiyon açısından alfa-1 blokörler incelendiğinde selektif alfa-1A blokajı yapan tamsulosinde ejakülatuvar fonksiyonları olumsuz yönde etkileme oranı (%5-10), terazosin, doksazosin ve alfuzosine (%1) göre daha yüksektir (20). Toplam 3076 hasta üzerinde yapılan ve alfuzosinin seksüel fonksiyonlar üzerine etkisini araştıran bir çalışmada bir yıl süre ile tedavi alan hastaların 'The International Prostate Symptom Score' Uluslararası Prostat Semptom Skoru (IPSS), ejakülat hacmi ve ejakülasyonda ağrı ölçütlerinde istatistiksel olarak anlamlı düzelme sağladığı ortaya çıkmıştır (21).…”