TAMSULOSIN CAP,ORAL

Clinical Criteria Summary

Benign prostatic hypertrophy/hyperplasia (BPH) with moderate to severe symptoms
Patients currently receiving alpha-blocker monotherapy at maintenance doses (e.g., alfuzosin 10 mg qd) or highest tolerated dose if maintenance dose was not achieved
Alpha-blocker naive patients presenting with BPH symptoms

Large prostate volume (typically >40ml, approximately the size of a golf ball)
Clinical progression of BPH symptoms evidenced by:
Increase in AUA symptom score ≥4 points from baseline
History of acute urinary retention
Persistently bothersome symptoms despite adequate alpha-blocker therapy
Baseline AUA symptom score ≥12 for patients not previously treated with alpha-blockers
High risk for intervention or urinary retention due to large prostate volume (>40ml)

Discuss risks and benefits of long-term finasteride therapy with the patient prior to initiation
Finasteride is not recommended for prevention of prostate cancer based on the Prostate Cancer Prevention Trial
Patients must be reevaluated on a regular basis
Monitor PSA levels; double values after more than 6 months of finasteride therapy to approximate actual off-therapy levels
Referral to a local expert is strongly advised for severe unrelenting symptoms, very large prostates, or smaller prostate mass with poor response to alpha-blockers

Alpha-blockers: dizziness, postural hypotension, asthenia
Finasteride (monotherapy or combination): erectile dysfunction, decreased libido, abnormal ejaculation
Combination therapy: increased frequency of abnormal ejaculation, peripheral edema, dyspnea; breast cancer diagnosed in a small number of patients

Sildenafil: Do not administer within 4 hours of an alpha-blocker; 25mg dose may be taken at any time
Tadalafil: Concomitant administration with alpha-blockers other than tamsulosin 0.4mg is not recommended
Vardenafil: Concomitant administration with any alpha-blocker is contraindicated

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