Flomax


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Related to Flomax: alpha blocker, Proscar

tamoxifen citrate

Apo-Tamox, Gen-Tamoxifen, Nolvadex, Nolvadex-D, Novo-Tamoxifen, PMS-Tamoxifen, Soltamox, TamofenBazetham, Contiflo XL, Flomax, Flomax CR, Flomaxtra, Novo-Tamsulosin, Omnic MR, Ran-TamsulosinW, Ratio-Tamsulosin, Sandoz Tamsulosin, Stronazon, Tabphyn

Pharmacologic class: Nonsteroidal antiestrogen

Therapeutic class: Antineoplastic

Pregnancy risk category D

Pharmacologic class: Alpha-adrenergic blocker

Therapeutic class: Anti-adrenergic

Pregnancy risk category B

FDA Box Warning

For women with ductal carcinoma in situ or high risk of breast cancer, serious and life-threatening events associated with drug use in riskreduction setting include stroke, pulmonary embolism, and uterine cancer. Some of these events were fatal. Discuss potential benefits versus potential risks of these events with these patients. In women already diagnosed with breast cancer, drug's benefits outweigh risks.

Action

Competes with estrogen receptors in tumor cells for binding to target tissues (such as breast); reduces DNA synthesis and estrogen response

Availability

Oral solution: 10 mg/5 ml

Tablets: 10 mg, 20 mg

Tablets (enteric-coated): 20 mg

Indications and dosages

Adjunctive treatment of breast cancer

Adults: 20 to 40 mg P.O. daily for 5 years. Daily dosages of 20 mg may be taken as a single dose; daily dosages above 20 mg should be divided and taken b.i.d. (morning and evening).

To reduce breast cancer incidence in high-risk women; treatment of ductal carcinoma in situ

Adults: 20 mg P.O. daily for 5 years

Off-label uses

• Mastalgia
• Ovulation stimulation

Contraindications

• Hypersensitivity to drug
• Concurrent warfarin use
• Women with a history of deep-vein thrombosis or pulmonary embolism
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• decreased bone marrow reserve, leukopenia, thrombocytopenia, cataracts, hyperlipidemia
• females of childbearing age.

Administration

• Don't break or crush enteric-coated tablets.
• Know that drug is indicated for reducing breast cancer risk only in high-risk women, defined as those older than age 35 who have at least a 1.67% chance of developing breast cancer over 5 years.

Adverse reactions

CNS: confusion, depression, headache, weakness, fatigue, light-headedness

CV: chest pain, deep-vein thrombosis

EENT: blurred vision, ocular lesion, retinopathy, corneal opacity

GI: nausea, vomiting, abdominal cramps, anorexia

GU: vaginal bleeding, discharge, or dryness; irregular menses; amenorrhea; oligomenorrhea; ovarian cyst; pruritus vulvae; endometrial or uterine cancer

Hematologic: leukopenia, thrombocytopenia

Metabolic: hypercalcemia, fluid retention

Musculoskeletal: bone pain

Respiratory: cough, pulmonary embolism

Skin: skin changes, hair thinning or partial hair loss

Other: altered taste, weight loss, tumor flare, tumor pain, hot flashes, edema

Interactions

Drug-drug. Aminoglutethimide, estrogens: decreased tamoxifen effects

Antineoplastics: increased risk of thromboembolic events

Bromocriptine: increased tamoxifen blood level

Warfarin: increased anticoagulant effect

Drug-diagnostic tests. Aspartate aminotransferase, bilirubin, calcium, creatinine, hepatic enzymes: increased levels

Platelets, white blood cells: decreased counts

Patient monitoring

• Monitor lipid panel, calcium level, mammography results, and gynecologic exam results.

Watch for signs and symptoms of thromboembolic events, including cerebrovascular accident and pulmonary embolism.
• Monitor menstrual cycle pattern for changes that may signal endometrial or uterine cancer.

Patient teaching

• Tell patient to swallow enteric-coated tablets whole without breaking or crushing.

Instruct patient to immediately report leg or calf pain, swelling, or tenderness; unexpected shortness of breath; sudden chest pain; coughing up blood; new breast lumps; vaginal bleeding; menstrual irregularities; changes in vaginal discharge; pelvic pain or pressure; and vision changes.
• Inform patient that increase in bone or tumor pain usually means drug will be effective. Advise her to discuss pain management with prescriber.
• Stress importance of undergoing regular blood tests, mammograms, and gynecologic exams to identify early signs of serious adverse reactions.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.


tamsulosin hydrochloride

Bazetham, Contiflo XL, Flomax, Flomax CR, Flomaxtra, Novo-Tamsulosin, Omnic MR, Ran-TamsulosinW, Ratio-Tamsulosin, Sandoz Tamsulosin, Stronazon, Tabphyn


Pharmacologic class: Alpha-adrenergic blocker

Therapeutic class: Anti-adrenergic

Pregnancy risk category B

 

Action

Decreases smooth muscle contractions of prostate by binding to alpha1-adrenergic receptors. This action increases urine flow and reduces symptoms of benign prostatic hyperplasia (BPH).

Availability

Capsules: 0.4 mg

Indications and dosages

BPH

Adults: 0.4 mg/day P.O. after a meal. After 2 to 4 weeks, may increase to 0.8 mg/day.

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• concurrent use of other alpha-adrenergic blockers or strong CYP3A4 inhibitors (avoid use)
• concurrent use of moderate CYP3A4 inhibitors, strong or moderate CYP2D6 inhibitors, other cytochrome P450 inhibitors, warfarin, and in patients who are poor CYP2D6 metabolizers
• patients at increased risk for prostate cancer.

Administration

• Give 30 minutes after same meal each day.

Adverse reactions

CNS: dizziness, headache, asthenia, insomnia, drowsiness, syncope, vertigo

CV: orthostatic hypotension, chest pain

EENT: rhinitis, amblyopia, pharyngitis, sinusitis

GU: retrograde or diminished ejaculation, decreased libido

Musculoskeletal: back pain

Respiratory: increased cough

Other: tooth disorder, infection

Interactions

Drug-drug. Cimetidine: increased tamsulosin blood level, greater risk of toxicity

Doxazosin, prazosin, terazosin: increased risk of hypotension

Ketoconazole (strong CYP3A4 inhibitor), paroxetine (strong CYP2D6 inhibitor): increased tamsulosin Cmax and area under the curve

Drug-behaviors. Alcohol use: increased risk of hypotension

Patient monitoring

• Monitor blood pressure. Stay alert for orthostatic hypotension.

Patient teaching

• Tell patient to take 30 minutes after same meal each day.
• Instruct patient not to chew or open capsule. Advise him to swallow it whole.
• Tell patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from sudden blood pressure decrease.
• Caution patient to avoid hazardous activities on first day of therapy.
• Inform patient that drug may cause abnormal ejaculation. Advise him to discuss this issue with prescriber.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.

tamsulosin

(tam-soo-loe-sin) ,

Flomax

(trade name)

Classification

Therapeutic: none assigned
Pharmacologic: peripherally acting antiadrenergics
Pregnancy Category: B

Indications

Management of outflow obstruction in male patients with prostatic hyperplasia.

Action

Decreases contractions in smooth muscle of the prostatic capsule by preferentially binding to alpha1-adrenergic receptors.

Therapeutic effects

Decreased symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia).

Pharmacokinetics

Absorption: Slowly absorbed after oral administration.
Distribution: Widely distributed.
Protein Binding: 94–99%.
Metabolism and Excretion: Extensively metabolized by the liver; <10% excreted unchanged in urine.
Half-life: 14 hr.

Time/action profile (↑ in urine flow)

ROUTEONSETPEAKDURATION
POunknown2 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: Patients at risk for prostate carcinoma (symptoms may be similar);Patients undergoing cataract surgery (↑ risk of intraoperative floppy iris syndrome);Sulfa allergy.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • headache (most frequent)

Ear, Eye, Nose, Throat

  • rhinitis

Cardiovascular

  • orthostatic hypotension

Genitourinary

  • priapism
  • retrograde/diminished ejaculation

Interactions

Drug-Drug interaction

Cimetidine may ↑ blood levels and the risk of toxicity.↑ risk of hypotension with other peripherally acting anti-adrenergics (doxazosin, prazosin, terazosin ); concurrent use should be avoided.↑ risk of hypotension with sildenafil, tadalafil, and vardenafil.Strong CYP3A4 inhibitors and CYP2D6 inhibitors may ↑ blood levels (concurrent use should be avoided.

Route/Dosage

Oral (Adults) 0.4 mg once daily after a meal; may be ↑ after 2–4 wk to 0.8 mg/day.

Availability (generic available)

Capsules: 0.4 mg Cost: Generic — $26.89 / 100
In combination with: dutasteride (Jalyn); see combination drugs.

Nursing implications

Nursing assessment

  • Assess patient for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, interruption of urinary stream, impairment of size and force of urinary stream, terminal urinary dribbling, straining to start flow, dysuria, urgency) before and periodically during therapy.
  • Assess patient for first-dose orthostatic hypotension and syncope. Incidence may be dose related. Observe patient closely during this period and take precautions to prevent injury.
  • Monitor intake and output ratios and daily weight, and assess for edema daily, especially at beginning of therapy. Report weight gain or edema.
  • Rectal exams prior to and periodically throughout therapy to assess prostate size are recommended.

Potential Nursing Diagnoses

Risk for injury (Side Effects)
Impaired urinary elimination (Indications)

Implementation

  • Oral: Administer daily dose 30 min after the same meal each day. Swallow capsules whole; do not open, crush, or chew.
    • If dose is interrupted for several days at either the 0.4-mg or 0.8-mg dose, restart therapy with the 0.4-mg/day dose.

Patient/Family Teaching

  • Emphasize the importance of continuing to take this medication, even if feeling well. Instruct patient to take medication at the same time each day. If a dose is missed, take as soon as remembered unless almost time for next dose. Do not double doses.
    • May cause dizziness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
    • Caution patient to change positions slowly to minimize orthostatic hypotension.
    • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially cough, cold, or allergy remedies.
    • Emphasize the importance of follow-up visits to determine effectiveness of therapy.

Evaluation/Desired Outcomes

  • Decrease in urinary symptoms of benign prostatic hyperplasia.

Flomax®

Tamsolusin Urology An alpha blocker used to manage BPH, which can be used with antihypertensives, to manage hyperlipidemia Adverse effects Headache, infection, asthenia, dizziness. See Benign prostatic hypertrophy.

Patient discussion about Flomax

Q. Should FloMax & Avodart be taken together? Been on Avodart for 5 Mos.FloMax 3yrs.

A. Does one need to have a prescription to buy Flomax and Avodart or are they OTC?

More discussions about Flomax
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