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

See 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) alfuzosin,

Uroxatral

(trade name),

Xatral

(trade name)

Classification

Therapeutic: urinary tract antispasmodics
Pharmacologic: peripherally acting antiadrenergics
Pregnancy Category: B

Indications

Management of symptomatic benign prostatic hyperplasia (BPH).

Action

Selectively blocks alpha₁- adrenergic receptors in the lower urinary tract to relax smooth muscle in the bladder neck and prostate.

Therapeutic effects

Increased urine flow and decreased symptoms of BPH.

Pharmacokinetics

Absorption: 49% absorbed following oral administration; food enhances absorption.Distribution: Unknown.Metabolism and Excretion: Mostly metabolized by the liver (CYP3A4 enzyme system); 11% excreted unchanged in urine.Half-life: 10 hr.

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO-ER	within hr	8 hr	24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Moderate to severe hepatic impairment;Potent inhibitors of the CYP3A4 enzyme system;Concurrent use of other alpha-adrenergic blocking agents;Severe renal impairment; Pediatric: Children.Use Cautiously in: Congenital or acquired QTc prolongation or concurrent use of other drugs known to prolong QTc;Mild hepatic impairment;Symptomatic hypotension;Concurrent use of antihypertensive agents, phosphodiesterase type 5 inhibitors, or nitrates (↑ risk of postural hypotension);Previous hypotensive episode with other medications; Geriatric: Consider age-related changes in body mass and cardiac, renal, and hepatic function when prescribing.

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

Oral (Adults) 10 mg once daily.

Availability (generic available)

Extended-release tablets: 10 mg

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.

alfuzosin

An alpha-blocker drug used in the treatment of prostate enlargement. Brand names are Xatral and Xatral XL.