DOCSLIB.ORG

Comparative Effect of Alfuzosin and Tamsulosin on the Contractile

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comparative Effect of Alfuzosin and Tamsulosin on the Contractile LABORATORY SCIENCE Comparative effect of alfuzosin and tamsulosin on the contractile response of isolated rabbit prostatic and iris dilator smooth muscles Possible model for intraoperative floppy-iris syndrome Stefano Palea, PhD, David F. Chang, MD, Moez Rekik, PhD, Alain Regnier, VD, Philippe Lluel, PhD PURPOSE: To compare the pharmacologic properties of tamsulosin and alfuzosin in isolated pros- tatic and iris dilator smooth muscle from pigmented rabbits. SETTING: UROsphere Laboratories, Universite´ Paul Sabatier, Toulouse, France. METHODS: Prostatic and iris dilator smooth muscle strips were placed in organ baths. A con- centration-response curve to phenylephrine was compared before and after incubation with tamsu- losin or alfuzosin. RESULTS: Both drugs were approximately 30 times less potent in iris dilator than prostatic smooth muscle. In the iris, tamsulosin acted as a competitive antagonist starting at the 0.03 mM concentra- tion (pA2 Z 7.96). This is in the same range as the maximum plasma concentration after a 0.4 mg dose of tamsulosin in humans (0.025 mM). The antagonistic effect of alfuzosin in the iris was weaker (calculated mean pA2 value of 5.63 G 0.19). Concentrations with an equipotent antagonistic effect on rabbit iris dilator muscle (3.0 and 10.0 mM) were approximately 100 to 300 times higher than the maximum plasma concentrations after a 10.0 mg dose of alfuzosin in humans (0.032 mM). CONCLUSIONS: Tamsulosin was more effective than alfuzosin at blocking adrenergic contraction of the iris dilator muscle in pigmented rabbits. Both drugs were less potent in the iris than in the prostate, which suggests that an additional iris receptor could be involved. If valid in humans, our results sug- gest that attainable plasma concentrations of tamsulosin are able to antagonize iris dilator smooth muscle contraction, whereas those of alfuzosin are not. This could explain the higher frequency of intraoperative floppy-iris syndrome in patients treated with tamsulosin than with alfuzosin. J Cataract Refract Surg 2008; 34:489–496 Q 2008 ASCRS and ESCRS Accepted for publication October 31, 2007. Since it was first reported in 2005 by Chang and Camp- bell,1 intraoperative floppy-iris syndrome (IFIS) has From UROsphere (Palea, Rekik, Lluel), Faculte´ des Sciences Phar- become a major concern for cataract surgeons. This maceutiques, and the Department of Clinical Sciences (Regnier), Ecole Nationale Ve´te´rinaire de Toulouse, Toulouse, France; and small-pupil syndrome of variable severity is most a private practice (Chang), Los Altos, California, USA. commonly associated with tamsulosin, a systemic a1- adrenoceptor (a1-ADR) blocker that is selective for No author has a financial or proprietary interest in any material or the a1a-receptor subtype that predominates in the method mentioned. prostate. The uroselectivity resulting from this sub- Supported by Sanofi-Aventis, Paris, France. type specificity has made tamsulosin the most com- monly prescribed medication for the lower urinary The staff of the National Veterinary School of Toulouse provided tract symptoms of benign prostatic hyperplasia technical assistance in dissecting rabbit iris dilator muscles. (BPH).2 Severe IFIS is characterized by iris billowing, 1 Corresponding author: David F. Chang, MD, 762 Altos Oaks Drive, iris prolapse, and progressive intraoperative miosis. Suite 1, Los Altos, California 94024, USA. E-mail: dceye@earthlink. Poor preoperative pupil dilation is common.1 The in- net. traoperative iris behavior is consistent with deficient Q 2008 ASCRS and ESCRS 0886-3350/08/$dsee front matter 489 Published by Elsevier Inc. doi:10.1016/j.jcrs.2007.10.045 490 LABORATORY SCIENCE: ALFUZOSIN AND TAMSULOSIN CONTRACTILE RESPONSE IN RABBIT PROSTATIC AND IRIS DILATOR SMOOTH MUSCLES iris dilator smooth muscle tone, caused by the systemic following composition (in millimolars): NaCl 114, KCl 4.7, 1 a CaCl2 2.5, MgSO4 1.2, KH2PO4 1.2, NaHCO3 25, glucose 1-ADR antagonist. Retrospective studies affirm that when the surgeon 11.7 (pH 7.4, gassed with 95% O2 and 5% CO2 at 37 C). Pro- pranolol (1.0 mM), desipramine (0.1 mM), deoxycorticoster- is not anticipating IFIS, the unexpected iris prolapse one (3.0 mM), and atropine (1.0 mM) were added to the and miosis increase the rate for surgical complications Krebs-Henseleit solution to block b-ADRs, neuronal and ex- such as posterior capsule rupture.3–5 Unfortunately, traneuronal monoamine reuptake, and muscarinic receptors, simply stopping tamsulosin does not seem to reduce respectively. Contractile responses were measured using iso- the incidence or severity of IFIS.1,4 However, when metric tension transducers (type IT-1, EMKA Technologies) and recorded using a data acquisition system (MacLab 8e). the surgeon is forewarned of the likelihood of IFIS For prostate and iris, N-nitro-L-arginine methyl ester (L- by the medication history, specific surgical strategies NAME) was added to organ baths at the final concentration can be used.4 The high prevalence of BPH and cata- of 0.1 mM for 30 minutes before the first and second concen- racts in aging men makes IFIS secondary to systemic tration-response curve (CRC) to the a1-ADR agonist PE was performed. a1-ADR antagonists a significant problem for cataract surgeons and their patients. 1 Protocol 1 (Prostatic Smooth Muscle) Chang and Campbell reported a strong association between IFIS and tamsulosin but could not retrospec- Transverse preparations of the prostate were suspended tively identify cases of iris prolapse in patients taking vertically in 25 mL glass organ baths under a loading tension nonspecific a -ADR blockers. Although subsequent of 1g. After 60 minutes of equilibration, the smooth muscle 1 strips were exposed to 30 mM PE to measure their viability. experience has shown anecdotally that IFIS can occur Strips having a contractile response of less than 0.5 g were in association with nonspecific a1-ADR blockers, the discarded. Following a 30-minute washout period, the first severity and frequency are not as severe as with tam- CRC to PE (control curve) was obtained using sequential sulosin.5–9 A recent retrospective study5 comparing half-log unit concentration increments (range 0.1 to 100 m the rates of IFIS in tamsulosin and alfuzosin patients M) until the maximum contractile response was reached. Following a 60-minute washout period, tissues were incu- shows that the incidence of IFIS with alfuzosin, bated for 60 minutes with tamsulosin (0.001, 0.003, 0.01, a non-subtype–selective a1-ADR antagonist, was sig- 0.1 mM sequential concentration increments), alfuzosin (0.1, nificantly lower. Since alfuzosin also demonstrates 0.3, 1.0 mM), or the inactive solvent before the second CRC clinical uroselectivity, this finding has important ram- to PE (treatment curve) was obtained. Only 1 antagonist con- ifications for the pharmacologic treatment of BPH in centration was tested on each single tissue. patients who might later have cataract surgery. Protocol 2 (Iris Dilator Muscle) About 70% of a1-ADR in the human prostate are of 10 the a1a subtype. Recent studies demonstrate that the Under a surgical microscope, iris was dissected in ice-cold a -ADR subtype, activated by phenylephrine (PE), oxygenated Krebs solution. A strip of iris dilator muscle (ap- 1a proximately 2.0 mm wide and 4.0 mm long) was carefully also mediates iris dilator muscle contraction and mydri- 11 12 isolated and mounted vertically in a 5 mL glass organ baths asis in rats and rabbits. It might therefore be ex- under an initial tension of 50.0 mg. After 90 minutes of equil- pected that other a1-ADR antagonists used for the ibration, the smooth muscle strip was exposed to 30.0 mMPE treatment of BPH, such as alfuzosin, would inhibit iris to measure viability. Following a 30-minute washout period, dilator smooth muscle contraction, causing IFIS with the first cumulative CRC to PE (control curve) was obtained using sequential half-log unit concentration increments a frequency and severity equal to the frequency and se- (range 0.1 to 100 mM) until the maximum contractile re- verity with tamsulosin. The reason behind the clinical sponse was reached. Following a 60-minute washout period, finding of a much stronger association of IFIS with the tissues were incubated for 60 minutes with tamsulosin tamsulosin has not been explained.5–9 The pharmacol- (0.01, 0.03, 0.1, 1.0 mM), alfuzosin (3.0, 10.0, 30.0 mM) or the ogy of a -ADR antagonists such as tamsulosin and alfu- inactive solvent before the second PE CRC (treatment curve) 1 was obtained. Only 1 antagonist concentration was tested on zosin in the iris has not been examined experimentally. each single tissue. This study compared the antagonistic properties of tamsulosin and alfuzosin on PE-induced contractions Analysis and Expression of Results in isolated prostatic and iris dilator smooth muscle G from male rabbits. The investigations were performed Data are expressed as mean SEM. The contractile re- sponses to PE in the absence and presence of the antagonist in pigmented rabbits because a previous study showed (first and second CRC) were expressed as the percentage of similar a1-ADR pharmacology in humans and pig- the initial contraction induced by 30.0 mM PE. mented rabbits compared with albino rabbits.13 Using mean values, CRCs to PE were fitted by nonlinear regression using the GraphPad Prism version 4.0 software to obtain the following parameters: (1) Emax Z maximum MATERIALS AND METHODS Z contraction induced by PE; (2) EC50 PE concentration, Male pigmented rabbits (CEGAV) were killed and exsangui- which induces 50% of the maximum effect, expressed as nated. Both eyes and the ventral prostate were immediately pEC50 (Àlog EC50). Mean CRCs for the control and treated dissected and placed in oxygenated Krebs solution with the strips were fit in parallel and statistically compared.
Load more

Recommended publications
  • Appendix A: Potentially Inappropriate Prescriptions (Pips) for Older People (Modified from ‘STOPP/START 2’ O’Mahony Et Al 2014)
    Appendix A: Potentially Inappropriate Prescriptions (PIPs) for older people (modified from ‘STOPP/START 2’ O’Mahony et al 2014) Consider holding (or deprescribing - consult with patient): 1. Any drug prescribed without an evidence-based clinical indication 2. Any drug prescribed beyond the recommended duration, where well-defined 3. Any duplicate drug class (optimise monotherapy) Avoid hazardous combinations e.g.: 1. The Triple Whammy: NSAID + ACE/ARB + diuretic in all ≥ 65 year olds (NHS Scotland 2015) 2. Sick Day Rules drugs: Metformin or ACEi/ARB or a diuretic or NSAID in ≥ 65 year olds presenting with dehydration and/or acute kidney injury (AKI) (NHS Scotland 2015) 3. Anticholinergic Burden (ACB): Any additional medicine with anticholinergic properties when already on an Anticholinergic/antimuscarinic (listed overleaf) in > 65 year olds (risk of falls, increased anticholinergic toxicity: confusion, agitation, acute glaucoma, urinary retention, constipation). The following are known to contribute to the ACB: Amantadine Antidepressants, tricyclic: Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline, Trimipramine and SSRIs: Fluoxetine, Paroxetine Antihistamines, first generation (sedating): Clemastine, Chlorphenamine, Cyproheptadine, Diphenhydramine/-hydrinate, Hydroxyzine, Promethazine; also Cetirizine, Loratidine Antipsychotics: especially Clozapine, Fluphenazine, Haloperidol, Olanzepine, and phenothiazines e.g. Prochlorperazine, Trifluoperazine Baclofen Carbamazepine Disopyramide Loperamide Oxcarbazepine Pethidine
    [Show full text]
  • Medication Dental Watch List Risk for Reflux Risk for Caries
    Risk for Stomatitis Risk for Xerostomia Generic and Trade Name Medication Dental Watch List Risk for Reflux Risk for Caries Abilify Celexa Exenatide Itraconazole Naproxen Sinequan Acamprosate Cetirizine Famotidine Ketorolac Neurontin Sporanox Accutane Chantix Feldene Kytril Nexium Strattera Actiq Chlorpromazine Felodipine Lamivudine Nifedipine Subutex Adalat Cholestryramine Fentanyl Lansoprazole Nitro-Bid Sulfamethoxazole Advair Cialis Fentanyl (transmucosal) Levalbuterol Nitro-Dur Sulfasalazine Aldomet Citalopram Flexeril Levbid Nitroglycerin Sulfatrim Alendronate Clarithromycin Flonase Levocarnitine Nitrostat Sumatriptan Alfuzosin Claritin Flovent Levocetirizine Nortriptyline Tacrine Aliskiren Clomipramine Fluoxetine Levodopa Oxybutynin Tadalafil Alprazolam Clonidine Fluticasone Lexapro Pamelor Tegretol Amitriptyline Clozapine Fluvoxamine Lioresal Pentasa Tekturna Anafranil Clozaril Fosamax Lisdexamfetamine Pepcid Tenex Antivert Cognex Fosinopril Lisinopril Periactin Thorazine Aripiprazole Combivir Gabapentin Lithium Piroxicam Tofranil Asacol Copegus Gemfibrozil Locholest Plaquenil Toprol Aspirin Cozaar Granisetron Loperamide Plendil Toradol Atarax Cyclobenzaprine Guanfacine Lopid Prevacid Trexall Atomoxetine Cymbalta Haldol Lopressor Prevalite UroXatral Atrovent Cyproheptadine Haloperidol Loratadine Prinivil Varenicline Azulfidine Cytotec Hydroxychloroquine Losartan ProAmatine Vasotec Baclofen Darifenacin Hydroxyzine Luvox Procardia Versed Biaxin Diflunisal Hyoscyamine Meclizine Propranolol Vistaril Budesonide Ditropan Ibuprofen Mesalamine
    [Show full text]
  • Department of Health
    DEPARTMENT OF HEALTH National Drug Policy - Pharmaceutical Management Unit 50 National Formulary Committee Philippine National Drug Formulary EssentialEssential MedicinesMedicines ListList Volume I, 7th Edition ( 2008 ) Published by: The National Formulary Committee National Drug Policy ‐ Pharmaceutical Management Unit 50 DEPARTMENT OF HEALTH Manila, Philippines All rights reserved 2008 The National Formulary Committee National Drug Policy‐Pharmaceutical Management Unit 50 (NDP‐PMU 50) Department of Health San Lazaro Cmpd., Rizal Ave., Sta. Cruz, Manila, Philippines 1003 ISBN 978‐971‐91620‐7‐0 Any part or the whole book may be reproduced or transmitted without any alteration, in any form or by any means, with permission from DOH provided it is not sold commercially. ii PHILIPPINE NATIONAL DRUG FORMULARY Volume I, 7th Edition 2 0 0 8 Francisco T. Duque III, MD, MSc Secretary of Health Alexander A. Padilla Undersecretary of Health, Office for External Affairs Robert Louie P. So, MD Program Manager, NDP-PMU 50 Dennis S. Quiambao, MD Proj. Mgmt. Operating Officer & Coordinator (PMOOC) NDP-PMU 50 NATIONAL FORMULARY COMMITTEE Estrella B. Paje-Villar, MD, DTM & H Chairperson Jose M. Acuin, MD, MSc Alma L. Jimenez, MD Alejandro C. Baroque II, MD Marieta B. de Luna, MD Bu C. Castro, MD Nelia P. Cortes-Maramba, MD Dina V. Diaz, MD Yolanda R. Robles, PhD Pharm Mario R. Festin, MD, MS, MHPEd Isidro C. Sia, MD BFAD Representative SECRETARIAT Luzviminda O. Marquez, RPh, RMT Mary Love C. Victoria, RPh Michael D. Junsay, RPh Ermalyn M. Magturo iii Republic of the Philippines DEPARTMENT OF HEALTH OFFICE OF THE SECRETARY 2/F Bldg. 1, San Lazaro Cmpd., Rizal Avenue, Sta.
    [Show full text]
  • New Zealand Data Sheet 1. Product Name
    NEW ZEALAND DATA SHEET 1. PRODUCT NAME Norvir 100 mg tablets. 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each film-coated tablet contains 100 mg ritonavir. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM White film-coated oval tablets debossed with the corporate Abbott "A" logo and the Abbott-Code “NK”. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications NORVIR is indicated for use in combination with appropriate antiretroviral agents or as monotherapy if combination therapy is inappropriate, for the treatment of HIV-1 infection in adults and children aged 12 years and older. For persons with advanced HIV disease, the indication for ritonavir is based on the results for one study that showed a reduction in both mortality and AIDS defining clinical events for patients who received ritonavir. Median duration of follow-up in this study was 6 months. The clinical benefit from ritonavir for longer periods of treatment is unknown. For persons with less advanced disease, the indication is based on changes in surrogate markers in controlled trials of up to 16 weeks duration (see section 5.1 Pharmacodynamic properties). 4.2 Dose and method of administration General Dosing Guidelines Prescribers should consult the full product information and clinical study information of protease inhibitors if they are co-administered with a reduced dose of ritonavir. The recommended dose of NORVIR is 600 mg (six tablets) twice daily by mouth, and should be given with food. NORVIR tablets should be swallowed whole and not chewed, broken or crushed. NORVIR DS 29 April 2020 Page 1 of 37 Version 35 Paediatric population Ritonavir has not been studied in patients below the age of 12 years; hence the safety and efficacy of ritonavir in children below the age of 12 have not been established.
    [Show full text]
  • Guideline for Preoperative Medication Management
    Guideline: Preoperative Medication Management Guideline for Preoperative Medication Management Purpose of Guideline: To provide guidance to physicians, advanced practice providers (APPs), pharmacists, and nurses regarding medication management in the preoperative setting. Background: Appropriate perioperative medication management is essential to ensure positive surgical outcomes and prevent medication misadventures.1 Results from a prospective analysis of 1,025 patients admitted to a general surgical unit concluded that patients on at least one medication for a chronic disease are 2.7 times more likely to experience surgical complications compared with those not taking any medications. As the aging population requires more medication use and the availability of various nonprescription medications continues to increase, so does the risk of polypharmacy and the need for perioperative medication guidance.2 There are no well-designed trials to support evidence-based recommendations for perioperative medication management; however, general principles and best practice approaches are available. General considerations for perioperative medication management include a thorough medication history, understanding of the medication pharmacokinetics and potential for withdrawal symptoms, understanding the risks associated with the surgical procedure and the risks of medication discontinuation based on the intended indication. Clinical judgement must be exercised, especially if medication pharmacokinetics are not predictable or there are significant risks associated with inappropriate medication withdrawal (eg, tolerance) or continuation (eg, postsurgical infection).2 Clinical Assessment: Prior to instructing the patient on preoperative medication management, completion of a thorough medication history is recommended – including all information on prescription medications, over-the-counter medications, “as needed” medications, vitamins, supplements, and herbal medications. Allergies should also be verified and documented.
    [Show full text]
  • First Dose Efficacy of Alfuzosin Once Daily in Men with Symptomatic Benign Prostatic Hyperplasia
    ADULT UROLOGY FIRST DOSE EFFICACY OF ALFUZOSIN ONCE DAILY IN MEN WITH SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA LEONARD S. MARKS, CLAUS G. ROEHRBORN, MARC GITTELMAN, DANIEL KIM, JOHN FORREST, AND SHARON JACOBS ABSTRACT Objectives. To evaluate the onset of action of alfuzosin once daily (OD) as determined by uroflowmetry early after initial dosing. Alfuzosin OD is an extended-release formulation of a uroselective, alpha1-adrenorecep- tor-blocking agent (alpha-blocker) used in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Methods. This was a randomized, placebo-controlled, two-way Latin square crossover study. Forty-nine patients were selected for this study on the basis of their symptomatic improvement during previous treatment with alpha-blockers and significant decreases in urinary flow rate when that treatment was withdrawn. Results. Our analysis showed that significant increases in the maximal urinary flow rate (Qmax) in 34 assessable patients occurred as soon as 8 hours after the initial dose of medication and persisted for at least 4 days. The ⌬Qmax for alfuzosin 10 mg OD was 3.2 mL/s and for placebo it was 1.1 mL/s. The difference of means for the assessable population was 2.1 (95% confidence interval 0.8 to 3.4, P ϭ 0.002). The overall incidence of adverse events was low. Only dizziness, experienced by 3 patients treated with alfuzosin compared with 1 patient treated with placebo, appeared to be related to the study drug. Conclusions. Together, our findings suggest that alfuzosin OD exhibits a urodynamically measurable effect on bladder outlet obstruction due to benign prostatic hyperplasia in men with lower urinary tract symptoms within hours of the first administration.
    [Show full text]
  • Comparison of Different Alpha-Blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms
    대한남성과학회지：제 29 권 제 3 호 2011년 12월 Korean J Androl. Vol. 29, No. 3, December 2011 http://dx.doi.org/10.5534/kja.2011.29.3.242 Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms Keon Cheol Lee1, Jong Gu Kim2, Sung Yong Cho1, Joon Sung Jeon1, In Rae Cho1 Department of Urology, 1Inje University Ilsanpaik Hospital, Goyang, 2Happy Urology Clinic, Ansan, Korea =Abstract= Purpose: We compared the efficacy and safety profiles of dose increase, traditional combination methods, and combining different alpha blockers in hypertensive males with lower urinary tract symptom (LUTS) refractory to an initial dose of 4 mg doxazosin. Materials and Methods: Between 2000 and 2005, 374 male patients with LUTS and hypertension unresponsive to 4 weeks of 4 mg doxazosin were enrolled. The subjects were randomly classified into 3 groups, 8 mg/day of doxazosin (D group), 4 mg of doxazosin plus 0.2 mg/day of tamsulosin (DT group), and 4 mg doxazosin plus 5 mg/day finasteride (DF group). Patients were evaluated based on their International Prostate Symptom Score (IPSS), quality of life (QOL), uroflowmetry and blood pressure (BP) and adverse events (AEs) at the baseline and 3 and 12 months after treatment. Results: The 269 patients (71.9%) were followed for at least 1 year (D group n=84, DT group n=115, and DF group n=70). The clinical parameters before and after initial 4 mg/day doxazosin were not different among the 3 groups. IPSS improvement after 3 months and maximal flow rate (Qmax) improvement after 3 and 12 months were significantly higher in the D and DT groups than the DF group (p＜0.05).
    [Show full text]
  • Otorhinolaryngological Adverse Effects of Urological Drugs ______
    REVIEW ARTICLE Vol. 47 (4): 747-752, July - August, 2021 doi: 10.1590/S1677-5538.IBJU.2021.99.06 Otorhinolaryngological adverse effects of urological drugs _______________________________________________ Nathalia de Paula Doyle Maia 1, Karen de Carvalho Lopes 2, Fernando Freitas Ganança 2 1 Programa de Pós-Graduação em Medicina, Otorrinolaringologia da Universidade Federal de São Paulo - Escola Paulista de Medicina - UNIFESP, São Paulo, SP, Brasil; 2 Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Universidade Federal de São Paulo - Escola Paulista de Medicina - UNIFESP, São Paulo, SP, Brasil ABSTRACT ARTICLE INFO Purpose: To describe the otorhinolaryngological adverse effects of the main drugs used Fernando Gananca in urological practice. http://orcid.org/0000-0002-8703-9818 Materials and Methods: A review of the scientific literature was performed using a combination of specific descriptors (side effect, adverse effect, scopolamine, Keywords: sildenafil, tadalafil, vardenafil, oxybutynin, tolterodine, spironolactone, furosemide, Cholinergic Antagonists; hydrochlorothiazide, doxazosin, alfuzosin, terazosin, prazosin, tamsulosin, Adrenergic alpha-1 Receptor desmopressin) contained in publications until April 2020. Manuscripts written in Antagonists; Deamino Arginine Vasopressin English, Portuguese, and Spanish were manually selected from the title and abstract. The main drugs used in Urology were divided into five groups to describe their Int Braz J Urol. 2021; 47: 747-52 possible adverse effects: alpha-blockers, anticholinergics, diuretics, hormones, and phosphodiesterase inhibitors. Results: The main drugs used in Urology may cause several otorhinolaryngological _____________________ adverse effects. Dizziness was most common, but dry mouth, rhinitis, nasal congestion, Submitted for publication: epistaxis, hearing loss, tinnitus, and rhinorrhea were also reported and varies among June 24, 2020 drug classes.
    [Show full text]
  • Benign Prostatic Hyperplasia
    Benign Prostatic Hyperplasia (BPH) Treatments Therapeutic Class Review (TCR) November 18, 2019 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected].
    [Show full text]
  • Drug Use and Torsades De Pointes Cardiac Arrhythmias in Sweden: a Nationwide Register-­Based Cohort Study
    Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-034560 on 12 March 2020. Downloaded from Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register- based cohort study Bengt Danielsson,1 Julius Collin,1 Anastasia Nyman,1 Annica Bergendal,1 Natalia Borg,1 Maria State,1 Lennart Bergfeldt,2 Johan Fastbom 1 To cite: Danielsson B, Collin J, ABSTRACT Strengths and limitations of this study Nyman A, et al. Drug use and Objective To study the occurrence of torsades de pointes torsades de pointes cardiac (TdP) ventricular tachycardia in relation to use of drugs ► This study used individual- based data from nation- arrhythmias in Sweden: a labelled with TdP risk, using two nationwide Swedish nationwide register- based wide registers on inpatient diagnoses and drug dis- registers. cohort study. BMJ Open pensations from pharmacies, making it possible to Design Prospective register- based cohort study. 2020;10:e034560. doi:10.1136/ estimate the incidence of TdP per 100 000 users of Setting Entire Sweden. bmjopen-2019-034560 prescribed individual drugs labelled with torsades Participants Persons aged ≥18 years prescribed and de pointes (TdP) risk. ► Prepublication history for dispensed any drug classified with TdP risk during ► To our knowledge, the study is, so far, the largest this paper is available online. 2006–2017, according to CredibleMeds. Persons with a To view these files, please visit in terms of number of patients with TdP diagnosis. registered TdP diagnosis during the study period, using the journal online (http:// dx. doi. ► One limitation is that the data on drug use do not in- drugs labelled with known (TdP 1), possible (TdP 2) org/ 10.
    [Show full text]
  • Alpha Blockers
    Alfuzosin, Silodosin, Tamsulosin/Clinically Uroselective Alpha1-Adrenergic Blockers: Recommendations for Use October 2010 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives The product information should be consulted for detailed prescribing information. Issue Is there a preference to using a clinically uroselective alpha1-adrenergic blocker over a non-uroselective alpha1-adrenergic blocker for the management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Background Of the available non-uroselective alpha1-adrenergic blockers, doxazosin, prazosin, and terazosin are listed on the VA National Formulary (VANF); alfuzosin, silodosin, and tamsulosin are considered clinically uroselective alpha1-blockers , of which tamsulosin is available on the VANF for use in patients with LUTS due to BPH. Summary of Clinical Evidence1-6 All alpha1-blockers have been shown to improve LUTS associated with BPH (recommended doses for BPH are doxazosin 4 to 8mg once daily, prazosin 2mg twice daily, terazosin 5 to 10mg once daily; lower doses have also been effective) although the American Urological Association (AUA) guidelines for BPH state there are insufficient data to support the use of prazosin in BPH. There is no evidence that alfuzosin, silodosin, or tamsulosin provide benefit in patients who have not responded to an adequate trial with a non-uroselective alpha1-blocker. It is unknown whether the clinically uroselective alpha1-blockers offer an advantage in patients who are at risk for falls. Based on meta-analyses by the AUA, alfuzosin and tamsulosin were found to have significantly less dizziness than terazosin but not doxazosin. In addition, the change in blood pressure with doxazosin or terazosin has been found to be clinically insignificant in patients with BPH who are either normotensive or have hypertension (HTN) that is well-controlled with pharmacologic agents.
    [Show full text]
  • Myasthenia Gravis Or Lambert-Eaton Myasthenia Syndrome – Medicines That May Affect Patients
    CLINICAL GUIDELINE Myasthenia Gravis or Lambert-Eaton Myasthenia Syndrome – Medicines that may affect patients A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments. Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty. If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient. Version Number: 1 Does this version include n/a changes to clinical advice: Date Approved: 11th July 2018 Date of Next Review: 30th July 2021 Lead Author: Lesley Murray Approval Group: Medicines Utilisation Subcommittee of ADTC Important Note: The Intranet version of this document is the only version that is maintained. Any printed copies should therefore be viewed as ‘Uncontrolled’ and as such, may not necessarily contain the latest updates and amendments. Information for healthcare professionals Medicines that may affect patients with Myasthenia Gravis or Lambert-Eaton Myasthenic Syndrome There are certain medicines that have been reported to worsen or induce myasthenia gravis (MG), often by increasing muscular weakness, and should be used with caution in patients with this condition. The list of medicines in table 1 has been compiled to assist prescribers in the decision making process when prescribing medicines for patients with myasthenia gravis. The medicines in this list have been classed according to those which should be: ▲ ▲Absolutely contraindicated ▲ Avoided Used with caution Probably safe with patient monitoring.
    [Show full text]