a dripping faucet

Q. Because of an enlarged prostate gland I have to get up at night to pee. Initially it was once or twice. Now it is three or four times. Getting back to sleep is challenging. My primary care physician recently prescribed tamsulosin (Flomax). I can’t say it made a huge difference in my bathroom trips, but I think it gave me a terrible case of sinusitis.

A week or so after I started the drug my sinuses were totally blocked. My head felt like a beach ball. When that happens I can’t focus on work or anything else for that matter.

How can a drug for my prostate mess up sinuses?

What other side effects should I be aware of regarding tamsulosin? I can more or less deal with the peeing problem. Sinus congestion, on the other hand, makes me feel like a zombie.

Is there anything else that might work for BPH?

A. It is understandable that you would be confused about the sinusitis side effect. Physicians and pharmacists may consider nasal congestion, stuffy nose, runny nose or sinusitis a “minor side effect.” For those suffering, however, it can have a major impact on their quality of life. All these nasal symptoms are linked to tamsulosin (Flomax). And we completely get your confusion. Why would a drug that is supposed to make urination easier affect the nose?

Tamsulosin is considered an alpha-blocker (also known as an alpha-adrenergic antagonist). That means it binds to alpha receptors in smooth muscles found in blood vessels, prostate and bladder and relaxes them. The result of this action is vasodilation and lower blood pressure as well as better urine flow. Other drugs in the category include:

  • Alfuzosin (Uroxatral)
  • Doxazosin (Cardura)
  • Prazosin (Minipress)
  • Silodosin (Rapaflo)
  • Tamsulosin (Flomax)
  • Terazosin (Hytrin)

Not surprisingly, some of these medications (prazosin, terazosin) are used to treat high blood pressure. Others, like tamsulosin, are prescribed more often for prostate problems.

But here’s the catch. Vasodilation can cause nasal congestion (stuffy nose or even sinusitis). Consider for a moment that nasal decongestants work by causing vasoconstriction or narrowing of blood vessels. Since these drugs work in the opposite direction, the side effects actually make sense. They include:


  • Dizziness (especially upon standing suddenly), vertigo, lightheadedness, fainting
  • Heart palpitations
  • Nasal congestion, stuffiness, sinusitis, runny nose, sore throat, cough, infection
  • Headache, drowsiness, fatigue, weakness
  • Fluid retention, edema, swollen hands or feet
  • Urinary incontinence
  • Back pain
  • Digestive distress, heartburn, nausea, diarrhea
  • Lower libido, abnormal ejaculation (reduced semen or retrograde ejaculation into the bladder)
  • Prolonged and/or painful penile erections (priapism)
  • Intraoperative Floppy Iris Syndrome (IFIS) [this can cause problems during cataract surgery!], blurred vision
  • Rash, itching or hives [notify your doctor immediately!]

Such side effects quickly overwhelm you, especially if the voice-over announcer on a television commercial is reading them quickly while the video is showing happy people doing fun things. Here are some stories from visitors to our website to help you understand what it is like to experience some of these complications.

“Flomax has played havoc with my sex life. The doctor has advised for me to skip a dose when I believe the chance may arise.

“I really do not like stopping medication and it does cause me urinary problems while I am missing that dose and getting it back in my system.

“On top of Flomax being expensive and me on Medicare the donut hole comes up and makes the medical cost unbearable.” John

“I had a cataract surgery while I was taking tamsulosin for urinary problems. The surgery went bad and in time it lead to me losing the sight in my right eye. At that time there was NO warning of the problems with Flomax and cataract surgery.” Ralph

“I have just been put on tamsulosin because of difficulty peeing. I wake up with a painful erection which can only be relieved by peeing. My GP prescribed the drug over the phone without any warning of this. This has only started since I started on the drug.

“I do not want to cause permanent damage.  I wonder if there are there alternatives?” Richard

“I am 52 and wake up 3-4 times a night with these uncomfortable erections. I’m convinced I would have them for hours if I don’t get up and walk around, have a pee, etc, as this is the only way they go away.  Unfortunately, even after it goes away, it seems in another hour or so, it comes back. I’ll be seeing the urologist next week, but I don’t expect much sleep until then. Hoping for an answer…” J.M.

“I am 60 years old and take lisinopril and Flomax, alternating each day. I used to take each med before I went to bed. The nights I took the Flomax – about 4-6 hours afterward – I would wake up to very persistent, full erections. This would disrupt my sleep, and although sometimes getting up to urinate would alleviate the problem, I would often soon reawaken to another erection. If I did not need to urinate, masturbation and ejaculating would make my erection subside, as normal. Of course, that could wake me up even more (and sometimes my wife as well), but usually I’d get back to sleep. But then an hour later – another very stiff erection.

“Because of the lack of sleep I was experiencing from this, I began taking the Flomax and lisinopril in the morning. I get fewer, less persistent erections at night – or at least the ones I get are easier to sleep through or go back to sleep without urinating.

“If you are taking Flomax at night and are having problems with persistent, uncomfortable, annoying, sleep-disrupting, very stiff erections, try taking it in the mornings instead – if that is an option.” B.B.

So, what can a man do to deal with benign prostate enlargement (BPH) besides take an alpha blocker? Interestingly, the erectile dysfunction drug Cialis (tadalafil) has received approval from the FDA to treat BPH. It too has side effects including nasal congestion. Other possible adverse reactions include headache, heartburn, muscle pain, flushing and back pain. Priapism (prolonged erections) are another potential complication of Cialis, along with vision or hearing loss.

Research into saw palmetto has produced disappointing results. Nevertheless, some readers maintain that it too helps with BPH symptoms.

“I also have heard that saw palmetto does not work, but I have a different experience with it. I have an enlarged prostate and about 10 years ago I went to an urologist.  He wrote a prescription for Flomax but told me to try saw palmetto first. He said that many of his patients had had a lot of success with it and because Flomax had so many side affects that if I wanted to I could give it a try.

“I tried saw palmetto and gave it about 2 weeks to work {the doctor said it might take some time to help} and I have had great results. I have used it for all these years and the only time I have problems is when I run out and don’t get any for a few days. Then I have to start over. The only other time it is less effective is when I take the wrong kind of cold tablet.

“Just because a study says one thing does not make it so, the drug companies in the USA have a lot of power because we let them have power. Take control of your own health, exercise and eating right and watching what you put in your body.” Lloyd

One final natural product worth consideration is the herb stinging nettle (Urtica dioica). It has been used in Europe to relieve allergy symptoms and improve urinary flow in cases of benign prostate enlargement.

Please share your own story with treatments for BPH. Have the alpha-blockers worked for you? Did you experience any side effects such as nasal stuffiness? Did anything else help ease symptoms without unpleasant side effects? Let others know about your experience.

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  1. Kenneth

    What is saw palmetto, and how is it taken, please?

  2. Peter
    washington state

    After the first dose I experienced tiredness, dizziness upon standing up, very dry nose to the point that I am mouth breathing.

  3. Sedgwick

    I have been using Flowmax for some time. I will be looking for other options, tired of the side effects. They include:

    1) I have no libido. This really bothers me.
    2) Retrograde ejaculation.
    3) If and when I do ejaculate, the volume is greatly diminished.
    4) Erection not what it use depending to be.
    5) Nasal congestion is simply brutal. Can’t stand it.
    6) Tired all the time, this is very annoying as I was a very active person.
    7) Vision seems to have deteriorated.

    I am not getting up to pee anymore…so, I couldn’t sleep before and the peeing has stopped. But since I cant breath, I can’t sleep as a result. I am on a CPAP. I don’t handle the nasal congestion well.

    My quality of life has gone substantially due to this med. I am seeing eurologist next week. Have to try something else.

    Has anyone had any success with pumpkin seed oil?

  4. Peter

    I’m 67 and have had a little difficulty urinating for a few years, but not too bad; figured normal for my age and typical prostate enlargement. In recent months though, getting up several times during the night to pee has been agony; mostly dribbling, standing for several minutes trying to empty my bladder. Not too bad during the daytime, but I finally asked my doctor for a prescription for Flomax (had seen ads over the years, etc.). Started taking it 2 days ago and unbelievably, literally within about 6 hours or so after the first dose at around 8:00 PM, got up to pee and voila, it was like 20-30 years ago; strong stream and a fully emptied bladder. Downside: woke up the next morning (3/12/18) with stuffy nose and scratchy throat, similar to when I get allergies, etc. at this time of year typically. The lesser of the evils is peeing freely and a fully emptied bladder. Guess I’ll have to manage the allergy-like side effects.

  5. JACK M

    I am 65 I just started taken flomax because I was sick and tired of waking up with an erection and have urinate for the erection to go down. I would go back to sleep a couple hours later the same. I recently had sex and it was terrible because my ejaculation went into my bladder.

    I’ve taken medication for PTSD and I’m wondering if that’s the reason for the erections when I’m sleeping. I want to stop taken the flomax but it’s only been a week any suggestions.

  6. KP
    New England

    I already suffered from chronic sinus problems so you can imagine what happened when I went on Tamsulosin. Unbearable pressure in my head to the point where my hearing started to become compromised. Very scary. It’s a bummer because the Tamsulosin really helped with frequent urination at night, and I was so happy for that. Only been on it one week but I am going to have to stop and see if the sinus issues clear up. If so, I’ll have to find another medication for BPH.

  7. George

    I was prescribed Flomax at 68 years old for weak stream and waking up during the night for several bathroom trips. I must say the Flomax (Tamsulasin) increased my stream dramatically. I felt like boy wonder or a race horse. The trade off was a severely stuffed nose, eyes that hurt and dizziness.

    It is my hope there is something else on the table to help with BPH.

  8. Bill
    New York

    Sinusitis so bad from Tamsulson, I’d rather wear pad for my urinary problems, which is what is was prescribed for, than take it.

  9. Miroslav
    Zagreb, Croatia

    I have been taking Omnic, whch has been substituted by Flosin, (or Flomax for couple. of years. I suffer from:
    Fluid retention, edema, swollen feet, Urinary incontinence, Lower libido, abnormal ejaculation (reduced semen or retrograde ejaculation into the bladder), Blurred vision.

    Tell me, please, what other medication without these side effects can substitute Flosin.

    Thanks in advance

  10. Susan

    I’ve had a horrible time sleeping because my nasal cavity is so swollen. I have blood in my nose. I wake up multiple times at night not being able to breathe. I didn’t realize it was this medication until I tried taking allergy meds, and even using a humidifier! Then I realized I should check the side effects of this medication. It’s going in the garbage! I’m so excited to be able to sleep normally again!

  11. TOM


  12. David

    I attended a seminar today about a relatively new procedure called UROLIFT. It’s done in your urologist’s office in about an hour and results have been good with complications minimal. A small device is placed in the prostate to physically pull tissue away and relieve pressure from the urethra.
    Healing is fast. This might be a solution for those who can’t tolerate the Rx side effects.

  13. Jim

    I have been on Flomax or tamsulosin for 15 years. My libido disappeared, but I got relief for the BPH. I ran out a week ago and today I notice how much better I feel. I have experienced chronic fatique, headaches, dizziness and periodic depression, joint and muscle pain, blurred vision and irritability for years.

    I had no idea that some or all of this might be attributed to this drug. I am going to stop taking tamsulosin for a few months, deal with difficulty peeing, and see if my quality of life improves. I am seriously thinking of going to saw palmetto.

  14. Michael

    I took it for two days and got very stuffy-nosed, noticed difficulty with achieving full erections (achieving a partial one only after being dogged for a whole hour) and was already experiencing partial retrogade ejaculation with my emissions down to less than a third of its normal output, with cloudy urine to tell me where the rest had gone. Of course, my doctor left a message to stop taking it and see him three months time, so I left a message that I wanted this checked asap rather than let it become chronic.

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