Flomax scientific update |
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Ophthalmology. 2007 May;114(5):957-64.
Chang DF, Osher RH, Wang L, Koch DD.
Altos Eye Physicians, Los Altos, California, USA.
Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax).
PURPOSE: Intraoperative floppy iris syndrome (IFIS) caused by systemic alpha-blockers has been associated with an increased risk of cataract surgical
complications when the surgeon was unaware of the medication history and did not anticipate its occurrence. This study was undertaken to evaluate the
surgical outcomes and rate of complications when the ophthalmologist knew the patient was taking tamsulosin (Flomax, Boehringer-Ingelheim Pharmaceuticals,
Ridgefield, CT) and used 1 of several strategies to manage IFIS. DESIGN: Prospective multicenter nonrandomized observational series. PARTICIPANTS: A total of
167 consecutive eyes in 135 patients taking tamsulosin and undergoing cataract surgery. METHODS: Phacoemulsification was performed in conjunction with at
least 1 of 4 different IFIS management strategies, namely, topical atropine preoperatively, iris retractors, pupil expansion ring, or use of viscoadaptive
ophthalmic viscosurgical device with reduced fluidic parameters. MAIN OUTCOME MEASURES: Severity of IFIS, incidence of operative or postoperative
complications, and final visual acuity. RESULTS: The IFIS severity was rated as mild in 17%, moderate in 30%, and severe in 43% of the study eyes. No IFIS
was noted in 10% of the eyes. The rate of posterior capsule rupture and vitreous loss was 0.6% (1/167; 95% confidence interval, 0%-1.8%). Ninety-five percent
of eyes achieved a best-corrected visual acuity of at least 20/40. CONCLUSION: When experienced surgeons could anticipate IFIS and employ compensatory
surgical techniques, the complication rate from cataract surgery was low and the visual outcomes were excellent in eyes of patients with a history of
tamsulosin use.
Asian J Surg. 2007 Apr;30(2):131-7.
Pummangura N, Kochakarn W.
Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Efficacy of Tamsulosin in the Treatment of Lower Urinary Tract Symptoms (LUTS) in Women.
OBJECTIVE: We attempted to determine whether tamsulosin is an efficacious therapy for the treatment of lower urinary tract symptoms (LUTS) in women. METHODS:
A total of 140 women, aged 27-69 years old with LUTS entered a randomized double-blind study comparing tamsulosin (70) versus placebo (70) for 1 month. The
outcome variables were mean change from baseline of International Prostate Symptom Score (IPSS), mean change from baseline of mean and maximum urinary flow
rate and any adverse effects. RESULTS: Mean change from baseline of IPSS (standard deviation, SD) were -5.6 (6.3) in the tamsulosin group and -2.6 (6.1) in
the placebo group. The difference was statistically significant (p = 0.008). Mean change from baseline of mean urinary flow rate (SD) was 0.7 (2.7) mL/second
in the tamsulosin group and -0.5 (2.6) mL/second in the placebo group. The difference was also statistically significant (p = 0.013). However, the difference
in mean change from baseline of maximum urinary flow rate between the two groups was not statistically significant (p = 0.506). There were two patients in
the tamsulosin group who experienced dizziness and asthenia. No other adverse effect was detected. CONCLUSION: Tamsulosin is more efficacious than placebo in
the treatment of LUTS in women.
Urology. 2007 Apr;69(4):633-6.
Erturhan S, Erbagci A, Yagci F, Celik M, Solakhan M, Sarica K.
Department of Urology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
Comparative evaluation of efficacy of use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones.
OBJECTIVES: To evaluate the activity of the therapeutic agents (tamsulosin and/or tolterodine) used to accelerate the expulsion of stones and to reduce the
probable complications during observation of the medical treatment of distal ureteral stones to allow spontaneous passage. METHODS: A total of 120 patients
with distal ureteral stones were included in the study. Patients with stones less than 10 mm and allowing urinary flow were included in the study. The
patients were studied in four randomly divided groups. Group 1 patients received tamsulosin 0.4 mg/day, group 2 patients received tamsulosin 0.4 mg/day plus
tolterodine 2 mg (twice a day), group 3 patients received tolterodine 2 mg (twice a day), and group 4 patients did not receive any medical treatment (control
group). RESULTS: Differences among the four groups in patient age and stone dimension were not statistically significant (P >0.05). The stone expulsion rates
were greater (P <0.05) in groups 1 and 2 than in groups 3 and 4. A significant variation (P <0.05) regarding the time to stone expulsion was observed in
groups 1 and 2. CONCLUSIONS: In our study, the use of tamsulosin for the expulsion of distal ureteral stones was effective; however, the use of tolterodine
provided no additional advantages.
J Cataract Refract Surg. 2006 Oct;32(10):1611-4.
Manvikar S, Allen D.
From the Sunderland Eye Infirmary, Sunderland, United Kingdom.
Cataract surgery management in patients taking tamsulosin Staged approach.
PURPOSE: To demonstrate a progressive approach to the problems of intraoperative floppy-iris
syndrome (IFIS) in cataract surgery caused by tamsulosin. SETTING: Cataract Treatment Center,
Sunderland Eye Infirmary, Sunderland, United Kingdom. METHODS: Thirty-two eyes of 20 patients
who were using tamsulosin had cataract surgery by the same surgeon using the same technique.
Patients received standard preoperative eyedrops consisting of topical cyclopentolate,
phenylephrine, and diclofenac. When necessary, intracameral phenylephrine, iris hooks, or both
were used. All cases were videotaped and analyzed for surgical complications. RESULTS: The
degree of IFIS manifested varied widely in the patients: Seventeen of 32 eyes (53%) had good
mydriasis preoperatively (type 1 and type 2 pupils); however, in 7 of the 17 eyes (43%), the
pupils constricted later during surgery (type 2 pupils). Twelve eyes (38%) had a mid-dilated
pupil that sometimes constricted later (type 3 pupils), and 3 eyes (9%) had poor dilation at
the beginning of surgery (type 4 pupils). There were no surgical complications attributed to
IFIS. Full IFIS manifestation varied between eyes of the same patient. Some eyes required no
intervention. Intraoperative pupil constriction was reversed with intracameral phenylephrine,
which also prevented iris prolapse and billowing and further pupil constriction in patients
who had medium to small pupils preoperatively. CONCLUSION: A staged approach in managing
pupils in IFIS and using phenylephrine intracamerally when necessary effectively prevented
serious intraoperative complications.
BJU Int. 2005 Feb;95(3):354-7.
Lucas MG, Stephenson TP, Nargund V.
Morriston Hospital, Swansea, UK.
Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia.
OBJECTIVE: To evaluate the efficacy of tamsulosin compared to placebo for treating catheterized patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH), by comparing the numbers of patients who voided successfully after removing their catheter. PATIENTS AND METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group, multicentre study. Men with AUR secondary to BPH were catheterized and then, if they fulfilled the entry criteria, were randomly assigned to receive either 0.4 mg tamsulosin hydrochloride in a modified-release capsule once daily, or a placebo. After up to eight doses the catheter was removed and the ability to void unaided assessed. RESULTS: In all, 149 men (mean age 69.4 years) were randomly assigned to receive tamsulosin (75) or placebo (74); eight were not evaluable, so the intent-to-treat population was 141 men. Thirty-four men taking tamsulosin and 18 taking placebo did not require re-catheterization on the day of the trial without catheter (48% and 26% respectively, P = 0.011; odds ratio 2.47, 95% confidence interval, CI, 1.23-4.97). Success using free-flow variables was also higher in the men who received tamsulosin, at 37 (52%) vs 24 (34%) on placebo (P = 0.019; odds ratio 2.34, 95% CI 1.15-4.75). Withdrawals were high (120 men, 81%), mostly because of a need for re-catheterization (89 men, 60%). Dizziness and somnolence occurred in seven (10%) and four (6%) men who received tamsulosin, and two (3%) who received placebo, but overall the incidence of adverse events was similar in the two groups. One patient died from carcinomatosis. CONCLUSION: Men catheterized for AUR can void more successfully after catheter removal if treated with tamsulosin, and are less likely to need re-catheterization. The side-effect profile was similar for tamsulosin and placebo, and consistent with known pharmacology. From these results tamsulosin can be recommended for treating men after catheterization for AUR, and can reduce the likelihood of the need for re-catheterization.
Eur Urol. 2005 Mar;47(3):361-5. Epub 2004 Dec 16.
Barnas J, Parker M, Guhring P, Mulhall JP.
Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, 525 E 68th Street, Starr 900, NY 10021, USA.
The utility of tamsulosin in the management of orgasm-associated pain: a pilot analysis.
INTRODUCTION:: Orgasmic pain is an infrequently reported but distressing problem for the patients who experience it. No consensus exists as to its etiology however bladder neck/pelvic floor spasm may play a role. This analysis was conducted to assess the effect of the alpha-blocking medication, tamsulosin on post-orgasmic pain. METHODS:: In a prospective, non-placebo controlled study, patients with orgasmic pain were interviewed and administered tamsulosin 0.4mg po qhs for at least 4 weeks. Outcome measures included libido, pain and continence and these were evaluated using the International Index of Erectile Function (IIEF), a visual analog scale (VAS) for pain and an incontinence scale respectively pre and post treatment. Patients were separated into groups based on etiology of the problem (radical prostatectomy, radiation therapy, and other) for statistical analysis. RESULTS:: 98 patients were enrolled. Pain was located predominantly in the penis (72%), with other sites including testis, rectum and abdomen. Most patients (52%) experienced pain for less than 5minutes post-orgasm. 76/98 (77%) patients reported significant improvement in pain (>/=2 points on pain VAS) and 12/98 (12%) noted complete resolution of their pain. The VAS for pain reflected a statistically significant decrease in pain for all groups in response to tamsulosin treatment. The entire group had a decrease of 2.7 points between pre and post-treatment phases. The IIEF libido domain increased significantly (mean of 2.4 points) for all treatment groups. CONCLUSION:: Tamsulosin decreases orgasmic pain intensity in patients with orgasmic pain. These data support the hypothesis that orgasmic pain is related to bladder neck and/or pelvic floor muscle spasm.
Flomax description...
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Drug category:Benign prostatic hyperplasia therapy agents
 Flomax scientific update
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