a doctor and a patient getting for a prostate checkup

A lot of men who never contemplated problems peeing are now taking drugs to help them urinate: tamsulosin (Flomax, Jalyn), alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura) and terazosin (Hytrin). Aging baby boomers are discovering that they too are experiencing the ailments of their fathers and grandfathers. What they may not realize is that there could be unexpected problems with prostate drugs.

History and Complications from Alpha-Blockers:

If your drug has “OSIN” at the end of its name there is a good chance you are taking what is called an alpha blocker. The first-generation drugs in this class (doxazosin and terazosin) were originally developed to lower blood pressure. Their predecessor, prazosin (Minipress), was approved in the early 1980s to help control hypertension. Hytrin got the green light in 1987 for high blood pressure.

Alpha blockers are thought to work to lower blood pressure by relaxing smooth muscles that surround blood vessels. By blocking the action of the neurotransmitter norepinephrine (aka noradrenaline) small arteries cannot constrict as they normally would. This leads to enhanced vasodilation, improved blood flow and lower blood pressure.

It was once thought that relaxing smooth muscle in the prostate with alpha blockers would make peeing easier. Researchers now think there are other mechanisms in play but they haven’t completely figured out what they might be.

Side Effects of Alpha Blockers:

Orthostatic Hypotension, Falls and Fractures:

One of the more common and worrisome side effects of these drugs is low blood pressure (hypotension). That’s not so surprising, given that they work in part by relaxing blood vessels. Where it gets problematic is when a man stands suddenly. That’s because under normal conditions the blood vessels constrict to adjust for standing. Constriction allows for blood to be shunted to the brain and the rest of the body.

By preventing normal vasoconstriction and interfering with blood pressure regulation men sometimes feel dizzy or faint when they stand suddenly. That’s called orthostatic hypotension. Many physicians have assumed that this problem was primarily related to older alpha blockers but not the second-generation drugs like tamsulosin or alfuzosin (Uroxatral). This assumption may need reexamination.

A Canadian Study of Alpha Blockers:

A study published in the BMJ (Oct. 26, 2015) analyzed data from older men living in Ontario, Canada who were prescribed tamsulosin, alfuzosin or silodosin between 2003 and 2013. Nearly 150,000 men received one of these drugs to ease symptoms of prostate enlargement and difficult urination (weak stream and frequent nighttime pee trips to the bathroom). These men were matched with an equal number of guys who did not take such medications. The authors found that:

“Prostate-specific alpha antagonists [alpha blockers], which are commonly used to treat lower urinary tract symptoms among older men, are associated with a small but significant increase in the risk of hospitalization or emergency room assessment for a fall, and an increase in the risk of fracture by 16% and of head trauma by 15% during the first 90 days of use.”

Needless to say, falls, fractures and head trauma are serious complications, even if they occur relatively rarely. The Canadian researchers point out that older people have a 50% mortality rate within one year if they experience a fall that leads to hospitalization. A head injury can lead to cognitive decline. Any drug that increases the risk of dizziness, falls and fractures needs to be monitored very closely.

Other Problems with Prostate Drugs:

Alpha blockers have several other  side effects that are also worrisome.

Terazosin has been linked to: fatigue, lack of energy and loss of strength. In addition to dizziness this drug could cause sleepiness, nasal congestion and erectile dysfunction (ED). Other symptoms may include fluid retention in extremities like ankles, headache, shortness of breath, arrhythmias and anxiety.

Tamsulosin can lower libido and affect ejaculation. In addition to dizziness and lack of energy this alpha antagonist can also cause nasal congestion, runny nose, sore throat and sinusitis. Irregular heart rhythms have also been reported.

Doxazosin, like other alpha blockers can cause dizziness, fatigue, sleepiness, fluid retention, shortness of breath, nausea, headache, and irregular heart rhythms. In addition, it may contribute to a dry mouth and blurred vision.

Alfuzosin, one of the newer alpha blockers, may be a bit better tolerated, though it too can cause dizziness, headache and fatigue. And like every drug in the class it can cause orthostatic hypotension. Standing up quickly can cause some men to feel dizzy, disoriented and fall.

An Unusual but Long-Lasting Complication of Alpha Blockers:

Although alpha blockers have been on the market for more than 30 years it wasn’t until 2005 that eye surgeons started reporting an odd condition linked to these drugs. During cataract surgery they discovered that some men experienced serious complications. The problems with prostate drugs in this alpha blocker class turned out to be something called “intraoperative floppy-iris syndrome” (IFIS). Even after numerous warnings, many doctors are still not aware of the condition. They often prescribe a drug like tamsulosin without thinking that in a few years their patients may need cataract surgery.

IFIS is caused by alpha blockers. It makes the iris of the eye “floppy” or flacid. This makes it harder to dilate the pupil, a critical initial step in cataract surgery. Without proper dilation the pupil may constrict during the cataract removal procedure, making it much harder for the surgeon to do her delicate work smoothly.

Tamsulosin seems to be especially problematic, but some other alpha blockers may also trigger IFIS. What makes these problems with prostate drugs so disconcerting is that the effect can last a very long time. Even after the medication has been stopped for many months, floppy-iris syndrome can complicate cataract surgery. There are even reports that patients who stopped a drug like tamsulosin for several years had complications during cataract surgery because of IFIS.

What this means practically is that anyone who has ever used an alpha blocker for urinary problems or treatment of high blood pressure must inform the eye surgeon well in advance of a cataract operation. Make sure the physician has had experience with floppy-iris syndrome and knows how to deal with it successfully before agreeing to surgery.

To read more about floppy-iris syndrome here is a link from The People’s Pharmacy:

Prostate Drug Complicates Cataract Surgery

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  1. Linda
    Reply

    My husband had his 90 gram prostate reduced by surgery because he was retaining about 300cc of urine. They took about 7 biopsies during the operation which came back clear with no cancer. This happened in January 2016 at the Viet Franco Hospital in Saigon, a beautiful, modern, hospital that specializes in treating foreigners and has multi-language help for its patients, although everyone there seems to speak English. They did the most amazingly thorough physical exam (took the better part of the day) before giving the go-ahead for the operation. He was in the hospital 3 days because they wanted his urine to run clear, etc, before releasing him. The care was excellent. The entire bill was $3000. I stayed in a nearby $11 per night hotel. I am very happy that he didn’t take any of the drugs mentioned in the above article and if we ever need another elective surgery, I would certainly consider flying back to the same hospital in Saigon.

  2. Wayne
    Oregon
    Reply

    For all you guys with BPH, be careful. I had a PSA and a DRE for probably 15 years and everything was fine, so the doctors said. I had back surgery and to release me I had to show the hospital that I could evacuate the bladder and bowels. The nurses decided that I didn’t pee enough. They did an ultra sound on my bladder and I had 500cc of urine retention.

    From there I went to a urologist. My PSA was good, but he didn’t like the DRE. I got a biopsy and lo and behold I had Prostate Cancer. Mind you, I had been tested (PSA) for 15 years, the doctors missed it. So, if you have BPH, don’t mess around, see a urologist. It might save your life. I was 72 then, now I’m 80.

  3. John Y.
    Oklahoma
    Reply

    I a male in my 70’s. I also have hypotension, then I was put on Tamsulosin for BPH. I started having strokes. The Dr’s discovered that my BP was dropping into 83/70 at times.. I was taken off Tamsulosin and haven’t had another stroke in the last nine months.

  4. Oldetimer
    Baltimore, MD
    Reply

    I have been treated for an enlarged prostate (BPH) for at least ten years. We’ve experimented with various alpha blockers, but none were any better than the Terazosn (combined with Finasteride). When I went for follow-up with other urologists in the same practice, the outcome was always the same: no changes although over time my pee rate varied between 2 or 3 and 8-10 times a night.

    More recently I saw another urologist for the first time in the same practice, and he told me I do NOT have BPH and that my nocturia is a result of other factors leading to increased volume of urine in my system when I lie down horizontally at night. (I do not adequately understand exactly what he told me). He also advised me I no longer need the Finasteride. (Because I have become very skeptical of urologists I continue to take it). When I told him that for over ten years I’ve been treated for BPH by his colleagues in the same practice, he became visibly upset and seemed not to know what to say. I plan to visit a different practice and see a specific urologist who has been recommended to me. I often wonder about how much of my tiredness is due to all the interrupted sleep.

    I have thought about minimally invasive surgery but decided against it. To me, it’s a form of overkill with questionable consequences.

    If any readers have any advice or suggestions I would certainly welcome them.

    • Anthony
      North Carolina
      Reply

      I just read Oldetimer your comment that, you have been the happiest with the use of a drug for BPH over the questionable consequences of an operation. Oldetimer, if you are taking a prostrate drug for your solution I am sorry to say your bowel is not emptying out as you may think.

      To prove what I say is correct, take an ultrasound after you just peed and you will see on the two corners of your bladder “pee.” Sooner or later you will need an operation. Here is the operation I suggest: If you research the Neotrac Urolift Implant you will find an operation that isn’t questionable. I am living proof. I had the Neotrac Urolift Implant. It works! I am 100% cured. Believe me!

  5. Kenneth
    Illinois
    Reply

    After five years on Hytrin and Tamsulosin, I concluded I really was not getting as good benefit as I should be getting and announced to my urologist that I was read for transurethral prostatectomy. Although he had never offered the option of surgery, he seemed unsurprised at my request and two weeks later I underwent the out patient procedure.

    My recovery was somewhat tumultuous, but I did recover and six months later have good urine stream (so nice not to be dribbling down my leg), rare episodes of urgency that seem to be getting more rare as time goes on, and I think I’m regaining some of the IQ points that I thought I had lost due to ageing. In retrospect, I wish that I had asked for the surgical option two years earlier.

  6. Ron D.
    NY
    Reply

    I have taken some of these drugs while the urologists were trying different things to figure out a urinary bleeding problem. I had a lot of problems with the side effects, but the biggest issues were urinary frequency and nighttime urination, which weren’t problems before I took these medications.

  7. rob
    Reply

    Excellent article that explains alot of the problems I’ve suffered over the past 10 years with prostate medication, Hytrin, and now on Tamsulosin and Finasteride.

    1. I had cataract surgery that failed and required retina surgery that cleared up the hundreds of floaters but never gave me better vision than I had before the surgery.

    2. When on Hytrin I did fall and injured a vertabrae near my neck and when playing senior softball I began to have serious neck pain (cervical spondylosis) that eventually required having 2 steroid shots in my neck.

    So far so good but had to give up senior baseball and the thought of re-occurence prevents activities I enjoyed.

    Lastly, taking finasteride has ruined my sex life and other side affects. Drugs may be useful but also harmful and doctors have the responsibility of understanding more about what the patient should also know. I believe all my issues could have been prevented.

  8. Gerald
    Texas
    Reply

    I’ve been on Tamsulosin for a year and am finally feeling the side effects of some incontinence, sinus swelling, eye or pupil discomfort, no ejaculation, no interest in sex, and discomfort when I try to urinate, still getting up three times a night. My appointment with a urologist is in a few hours, and I hope to start something else. I’m 59.

    • Wayne
      Reply

      It is very interesting to hear about the sinus problem. I take tamsulosin and have nothing but sinus trouble. I’ve fought this sinus problem for years, and guess what, I’ve taken tamsulosin for years. The reason I take tamsulosin is for BPH. Thanks for the tip, I’ll try something else.

  9. Mary
    Florida
    Reply

    What about women? I was given tamsulosin for a kidney stone. Is it safe to assume since my regimen was short term (one prescription when diagnosed and one after lithotripsy) the above mentioned cautions are not pertinent? I am being evaluated for possible hyperparathyroidism, which may have caused the stone, and recent hypertension so I’m hoping that treating the hyperparathyroidism will take care of other issues and I can reduce the number of medications I need.

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