- Alpha blockers in females: I remember a urologist getting frustrated with pharmacists who would always question why he was using Flomax (tamsulosin) in female patients. You will see alpha blockers used off label in females with bladder outlet obstruction/ureteral stones.
- Dosed at night: Why? Because of the risk of first dose syncope, it is recommended that these medications are dosed at night, right before bed.
- Tamsulosin 0.8 mg daily dose. Patient adherence is one of the greatest challenges facing the healthcare system in relation to medications. I’ve seen this dose restarted a couple times when the patient had not been taking it for a while. If patients are on tamsulosin 0.8 mg daily, and therapy gets interrupted for several days, it is recommended to start over at the lower dose (per Lexicomp).
- Alpha blockers drop blood pressure (duh…used for hypertension). What this leads to clinically, and especially in the elderly is the risk for falls. The highest risk time for orthostatic hypotension is when the medication is first started or increased. Another situation to keep a close eye on is when another antihypertensive is added.
- Alpha blockers work quickly: In a patient with worsening retention due to BPH, alpha blockers provide relief quickly compared to the 5 alpha reductase inhibitors (finasteride, dutasteride) which can take up to months to start providing relief.
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