Drug Topics - November 10, 2008 - (Page 34)

BPH TREATMENTS allowing muscles at the bladder neck to loosen and permit more complete voiding. Patients can expect an average 4- to 6-point improvement in AUA Symptom Score with these agents. The most common side effects of these agents are orthostatic hypotension, dizziness, tiredness, retrograde ejaculation, and nasal congestion. Alfuzosin is associated with fewer ejaculatory problems, but it has been linked to a dose-dependent, mild QTinterval prolongation, which increases the risk of the condition known as torsade de pointes (an uncommon variant of ventricular tachycardia). Therefore, alfuzosin should not be administered to patients taking potent CYP3A4 inhibitors including ketoconazole, itraconazole, or ritonavir in or- der to minimize the risk of increased alfuzosin blood levels. Cardiac safety trials reported by Watson Pharmaceuticals Inc., the manufacturer of silodosin, showed that neither the recommended dose of 8 mg nor a supertherapeutic dose of 24 mg coadministered with moxiﬂoxacin, an agent known to slightly increase QT interval, caused any delay in cardiac repolarization. Silodosin also is associated with ejaculatory dysfunction in some patients. Patients can be counseled to minimize the annoyance of alpha blocker side effects, Messing said. If hypotension and dizziness are problematic, patients can take the medication before they go to bed, since they will be lying down anyway, he suggested, adding that for patients requiring antihypertensive treatment beyond an alpha blocker, “there are other blood pressure medicines they could take that may make it less of a problem.” As for retrograde ejaculation, patients can be told to stop the medication if they are planning to have sexual activity and restart it the next day. “There are very selective antihistamines that may help with nasal congestion, but generally that doesn’t go away,” he said. 5 alpha-reductase inhibitors Finasteride and dutasteride are hormonal therapies appropriate only for patients with demonstrated prostate enlargement. These agents don’t relieve LUTS symptoms as well as alpha blockers do, but they may slow disease progression, reduce prostate size, and increase the rate of peak urinary ﬂow. Patients using them can expect an average 3-point improvement in AUA Symptom Score. Messing said that if erectile dysfunction occurs, patients can be assured that function will return to normal if the medication is discontinued. “Breast tenderness usually gets better, as well, with discontinuation, but that may take a while.” Combination therapy Current AUA treatment guidelines recommend a combination of an alpha blocker and a 5 alpha-reductase inhibitor for relief of LUTS symptoms in BPH patients with prostate enlargement. One 5-year study showed the combination to be more effective than alpha blocker monotherapy in preventing symptom progression. Combination therapy may reduce the risk of acute urinary retention. http://www.apothecary.com http://www.apothecary.com

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Drug Topics - November 10, 2008 Contents Up Front Up Front in Depth Letters Rx Care Government Community Practice First Responders Clinical Practice Self-Care FDA Safety Page Weighing the Complications of Obesity New Products Viewpoint

Drug Topics - November 10, 2008

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