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: