alfuzosin
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alfuzosin
Pharmacologic class: Alpha1-adrenergic receptor blocker
Therapeutic class: Benign prostatic hyperplasia agent
Pregnancy risk category B
Action
Selectively inhibits alpha1-adrenergic receptors in lower urinary tract, relaxing smooth muscle in bladder neck and prostate
Availability
Tablets (extended-release): 10 mg
Indications and dosages
➣ Signs and symptoms of benign prostatic hyperplasia
Adults: 10 mg P.O. once daily with food, given at same meal each day
Contraindications
• Hypersensitivity to drug or its components
• Moderate or severe hepatic impairment
• Concomitant use of potent CYP-4503A4 inhibitors (such as itraconazole, ketoconazole, or ritonavir)
Precautions
Use cautiously until prostate cancer is ruled out. Also use cautiously in:
• severe renal impairment
• mild hepatic impairment
• angina pectoris, orthostatic hypotension, syncope, or concomitant treatment with phosphodiesterase-5 (PDE-5) inhibitors, antihypertensives or nitrates
• concomitant use of other alpha blockers (use not recommended)
• QT prolongation, concomitant use of drugs that prolong QT interval
• cataract surgery.
Administration
• Administer with food.
• Don't crush or break tablet.
• Be aware that prostate carcinoma should be ruled out before starting therapy.
Adverse reactions
CNS: dizziness, headache, fatigue
EENT: sinusitis, pharyngitis
GI: nausea, constipation, abdominal pain, dyspepsia
GU: priapism
Respiratory: upper respiratory tract infection, bronchitis
Other: pain
Interactions
Drug-drug. Alpha adrenergic antagonists, antihypertensives, PDE-5 inhibitors: increased risk of symptomatic hypotension, orthostatic hypotension, or syncope CYP3A4 inhibitors (such as itraconazole, ketoconazole, ritonavir): increased alfuzosin blood level
Other alpha adrenergic antagonists: increased antagonistic effect
Drug-food. Any food: increased alfuzosin absorption
Patient monitoring
☞ Discontinue drug if signs or symptoms of angina pectoris appear or worsen.
Patient teaching
• Instruct patient to take drug with food at same time each day.
• Tell patient not to break, chew, or crush tablet.
• Caution patient to avoid driving and other hazardous activities until he knows if drug makes him dizzy.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above.
alfuzosin
(al-fyoo-zo-sin) ,Uroxatral
(trade name),Xatral
(trade name)Classification
Therapeutic: urinary tract antispasmodicsPharmacologic: peripherally acting antiadrenergics
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO-ER | within hr | 8 hr | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- fatigue
- headache
Ear, Eye, Nose, Throat
- intraoperative floppy iris syndrome
Respiratory
- bronchitis
- sinusitis
- pharyngitis
Cardiovascular
- postural hypotension
Gastrointestinal
- abdominal pain
- constipation
- dyspepsia
- nausea
Genitourinary
- erectile dysfunction
- priapism
Hematologic
- thrombocytopenia
Interactions
Drug-Drug interaction
Ketoconazole, itraconazole, and ritonavir ↓ metabolism and significantly ↑ levels and effects (concurrent use contraindicated).Levels are ↑ by cimetidine, atenolol, and diltiazem.May ↑ levels and effects of atenolol and diltiazem (monitor BP and heart rate).↑ risk of hypotension with antihypertensives, nitrates, phosphodiesterase type 5 inhibitors (including sildenafil, tadalafil, and vardenafil ) and acute ingestion of alcohol.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Assess for symptoms of benign 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 for orthostatic reaction and syncope. Monitor BP (lying and standing) and pulse frequently during initial dose adjustment and periodically thereafter. May occur within a few hr after initial doses and occasionally thereafter.
- Rule out prostatic carcinoma before therapy; symptoms are similar.
Potential Nursing Diagnoses
Risk for injury (Side Effects)Noncompliance (Patient/Family Teaching)
Implementation
- Oral: Administer with food at the same meal each day. Tablets must be swallowed whole; do not crush, break, or chew.
Patient/Family Teaching
- Instruct patient to take medication with the same meal each day. Take missed doses as soon as remembered. If not remembered until next day, omit; do not double doses.
- May cause dizziness or drowsiness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
- Caution patient to avoid sudden changes in position to decrease orthostatic hypotension.
- Advise patient to consult health care professional before taking any cough, cold, or allergy remedies.
- Instruct patient to notify health care professional of medication regimen before any surgery, especially cataract surgery.
- Advise patient to notify health care professional if priapism, angina, frequent dizziness, or fainting occurs.
- Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
- Geriatric: Assess risk for falls; implement fall prevention program and instruct patient and family in preventing falls at home.
Evaluation/Desired Outcomes
- Decreased symptoms of benign prostatic hyperplasia.