تامسولوسین
Tamsulosin Hydrochloride (Flomax)
تامسولوسین

نام ژنریک

Tamsulosin

شکل دارویی

اشكال دارويي:


Tablet, Extended Release: 0.4 mg


Capsule, Extended Release, Pellets: 0.4 mg

موارد مصرف

موارد و مقدار مصرف


هيپرتروفي خوش‌خيم پروستات :


مردان : mg 0.4 خوراكي يك بار در روز پس از غذا (در زمان يكسان) مصرف شود. در افرادي كه پس از 4-2 هفته پاسخ درماني مشاهده نمي‌شود مي‌توان ميزان دارو را به mg 0.8 يك بار در روز افزايش داد. در صورت قطع هر يك از اين رژيم‌هاي درماني به مدت چند روز، دارو مجدداً با mg/d 0.4 آغاز گردد.


مكانيسم اثر


اثر ضد هيپرتروفي خوش‌خيم پروستات: دارو به طور اختصاصي گيرنده‌هاي آلفا يك در پروستات را مهار مي‌نمايد و باعث شلي عضلات نرم در گردن مثانه و پروستات و در نتيجه بهبود جريان ادرار و علائم BPH‌ مي‌گردد.

موارد منع مصرف

تداخل دارويي


مصرف همزمان ساير آلفابلاكرها باعث تداخل مي‌گردد. مصرف همزمان سايميتيدين باعث كاهش كليرانس تامسولوسين مي‌گردد.


اثر بر آزمايشهاي تشخيصي


گزارشي موجود نيست.

موارد قابل توجه

-

تداخل دارویی

عوارض جانبي


اعصاب مركزي: آستنيا، گيجي، سردرد، بيخوابي، خواب‌آلودگي.


قلبي - عروقي : درد قفسه سينه، سنكوپ.


چشم، گوش، حلق و بيني: ambylopia ، فارنژيت، آب‌ريزش بيني، سينوزيت.


دستگاه گوارش: اسهال، تهوع.


ادراري ـ تناسلي: اختلال در انزال.


عضلاني - اسكلتي : درد كمر.


تنفسي: افزايش سرفه.


ساير عوارض: واكنش‌هاي حساسيتي (راش، بثورات جلدي، urticaria، آنژيوادم)، كاهش ميل جنسي، عفونت، اختلالات دندان.


مسموميت و درمان


مصرف بيش از حد دارو مي‌تواند به افت فشار منجر گردد. درمان آن حمايتي است، بيمار به حالت درازكش قرار داده شود و در صورت لزوم مايعات وريدي و وازوپرسورها تجويز گردد. عملكرد كليه ارزيابي گردد. دياليز اثرات مثبتي در اين رابطه ندارد.

مکانیزم اثر

عوارض جانبي


اعصاب مركزي: آستنيا، گيجي، سردرد، بيخوابي، خواب‌آلودگي.


قلبي - عروقي : درد قفسه سينه، سنكوپ.


چشم، گوش، حلق و بيني: ambylopia ، فارنژيت، آب‌ريزش بيني، سينوزيت.


دستگاه گوارش: اسهال، تهوع.


ادراري ـ تناسلي: اختلال در انزال.


عضلاني - اسكلتي : درد كمر.


تنفسي: افزايش سرفه.


ساير عوارض: واكنش‌هاي حساسيتي (راش، بثورات جلدي، urticaria، آنژيوادم)، كاهش ميل جنسي، عفونت، اختلالات دندان.


مسموميت و درمان


مصرف بيش از حد دارو مي‌تواند به افت فشار منجر گردد. درمان آن حمايتي است، بيمار به حالت درازكش قرار داده شود و در صورت لزوم مايعات وريدي و وازوپرسورها تجويز گردد. عملكرد كليه ارزيابي گردد. دياليز اثرات مثبتي در اين رابطه ندارد.

فارماكوكینتیك

موارد منع مصرف و احتياط


موارد منع مصرف: حساسيت به دارو.

سایر اطلاعات

طبقه‌بندي فارماكولوژيك: آلفا بلاكر.


طبقه‌بندي درماني: درمان هيپرتروفي خوش‌خيم پروستات (BPH).


طبقه‌بندي مصرف در بارداري: رده B


نام‌هاي تجاري: Tamsulosin Hexal, Omnic


ملاحظات اختصاصي


قبل از شروع درمان از عدم وجود كارسينوم پروستات اطلاع حاصل شود.


نكات قابل توصيه به بيمار


1ـ دارو 30 دقيقه پس از غذا مصرف شود.


2ـ در شروع درمان به بيمار توصيه مي‌شود به آهستگي برخيزد تا احتمال زمين خوردن وي برطرف شود.


3ـ در صورت انجام عمل جراحي كاتاراكت مصرف اين دارو به جراح اطلاع داده شود.


4ـ در شروع درماني از انجام فعاليتهاي خطرناك و تا 12 ساعت پس از دوز اوليه و يا تغيير دوز خودداري شود تا بتوان پاسخ بيمار را ارزيابي نمود.


مصرف در سالمندان


نيمه عمر دارو با افزايش سن افزايش مي‌يابد.

Tamsulosin Hydrochloride (Flomax)

Flomax®
(tamsulosin hydrochloride)

DRUG DESCRIPTION

Tamsulosin hydrochloride is an antagonist of alpha1A adrenoceptors in the prostate.

Tamsulosin hydrochloride is (-)-(R)-5-[2-[[2-(o-Ethoxyphenoxy) ethyl]amino]propyl]-2-methoxybenzenesulfonamide, monohydrochloride. Tamsulosin hydrochloride is a white crystalline powder that melts with decomposition at approximately 230°C. It is sparingly soluble in water and methanol, slightly soluble in glacial acetic acid and ethanol, and practically insoluble in ether.

The empirical formula of tamsulosin hydrochloride is C20H28N2O5S• HCl. The molecular weight of tamsulosin hydrochloride is 444.98. Its structural formula is:

Flomax® (tamsulosin hydrochloride) Structural Formula Illustration

Each FLOMAX capsule for oral administration contains tamsulosin hydrochloride 0.4 mg, and the following inactive ingredients: methacrylic acid copolymer dispersion, NF; microcrystalline cellulose, NF; triacetin, USP; calcium stearate, NF; talc, USP; FD&C blue No. 2; titanium dioxide; ferric oxide; gelatin, and trace amounts of black edible ink.

What are the possible side effects of tamsulosin (Flomax)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using tamsulosin and call your doctor at once if you have any of these serious side effects:

  • feeling like you might pass out;
  • chest pain;
  • fever, chills, body aches, or flu symptoms; or
  • penis erection that is painful or lasts 4 hours or longer.

Less serious side effects may include:

  • mild dizziness;
  • weakness, drowsiness;
  • headache;
  • nausea,...

Read All Potential Side Effects and See Pictures of Flomax »

What are the precautions when taking tamsulosin hydrochloride (Flomax)?

Before taking tamsulosin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history.

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

To reduce the risk of dizziness, lightheadedness, or fainting, get up slowly when rising from a sitting or lying position, especially when you first start taking this drug or if your doctor changes your dose. If dizziness occurs,...

Read All Potential Precautions of Flomax »

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

INDICATIONS

Flomax® (tamsulosin hydrochloride) capsules are indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH) [see Clinical Studies]. FLOMAX capsules are not indicated for the treatment of hypertension.

DOSAGE AND ADMINISTRATION

FLOMAX capsules 0.4 mg once daily is recommended as the dose for the treatment of the signs and symptoms of BPH. It should be administered approximately one-half hour following the same meal each day.

For those patients who fail to respond to the 0.4 mg dose after 2 to 4 weeks of dosing, the dose of FLOMAX capsules can be increased to 0.8 mg once daily. FLOMAX capsules 0.4 mg should not be used in combination with strong inhibitors of CYP3A4 (e.g., ketoconazole) [see WARNINGS AND PRECAUTIONS].

If FLOMAX capsules administration is discontinued or interrupted for several days at either the 0.4 mg or 0.8 mg dose, therapy should be started again with the 0.4 mg once-daily dose.

HOW SUPPLIED

Dosage Forms And Strengths

Capsule: 0.4 mg, olive green and orange hard gelatin, imprinted on one side with Flomax 0.4 mg and on the other side with BI 58

Storage And Handling

FLOMAX capsules 0.4 mg are supplied in high density polyethylene bottles containing 100 hard gelatin capsules with olive green opaque cap and orange opaque body. The capsules are imprinted on one side with Flomax 0.4 mg and on the other side with BI 58.

FLOMAX capsules 0.4 mg, 100 capsules (NDC 0597-0058-01)

Store at 25°C (77°F); excursions permitted to 15°C–30°C (59°F–86°F) [see USP Controlled Room Temperature].

Keep FLOMAX capsules and all medicines out of reach of children.

Distributed by: Boehringer Ingelheim Pharmaceuticals, Inc. Ridgefield, CT 06877 USA. Revised: 7/2011

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

SIDE EFFECTS

Clinical Trials Experience

Because clinical studies are conducted under widely varying conditions, adverse reactions rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.

The incidence of treatment-emergent adverse events has been ascertained from six short-term U.S. and European placebo-controlled clinical trials in which daily doses of 0.1 to 0.8 mg FLOMAX capsules were used. These studies evaluated safety in 1783 patients treated with FLOMAX capsules and 798 patients administered placebo. Table 1 summarizes the treatment-emergent adverse events that occurred in ≥ 2% of patients receiving either FLOMAX capsules 0.4 mg or 0.8 mg and at an incidence numerically higher than that in the placebo group during two 13-week U.S. trials (US92-03A and US93-01) conducted in 1487 men.

Table 1 Treatment-Emergent1 Adverse Events Occurring in ≥ 2% of FLOMAX Capsules or Placebo Patients in Two U.S. Short-Term Placebo-Controlled Clinical Studies

BODY SYSTEM/ ADVERSE EVENT FLOMAX CAPSULES GROUPS PLACEBO
n=493
0.4 mg
n=502
0.8 mg
n=492
BODY AS WHOLE
Headache 97 (19.3%) 104 (21.1%) 99 (20.1%)
Infection2 45 (9.0%) 53 (10.8%) 37 (7.5%)
Asthenia 39 (7.8%) 42 (8.5%) 27 (5.5%)
Back pain 35 (7.0%) 41 (8.3%) 27 (5.5%)
Chest pain 20 (4.0%) 20 (4.1%) 18 (3.7%)
NERVOUS SYSTEM
Dizziness 75 (14.9%) 84 (17.1%) 50 (10.1%)
Somnolence 15 (3.0%) 21 (4.3%) 8 (1.6%)
Insomnia 12 (2.4%) 7 (1.4%) 3 (0.6%)
Libido decreased 5 (1.0%) 10 (2.0%) 6 (1.2%)
RESPIRATORY SYSTEM
Rhinitis3 66 (13.1%) 88 (17.9%) 41 (8.3%)
Pharyngitis 29 (5.8%) 25 (5.1%) 23 (4.7%)
Cough increased 17 (3.4%) 22 (4.5%) 12 (2.4%)
Sinusitis 11 (2.2%) 18 (3.7%) 8 (1.6%)
DIGESTIVE SYSTEM
Diarrhea 31 (6.2%) 21 (4.3%) 22 (4.5%)
Nausea 13 (2.6%) 19 (3.9%) 16 (3.2%)
Tooth disorder 6 (1.2%) 10 (2.0%) 7 (1.4%)
UROGENITAL SYSTEM
Abnormal ejaculation 42 (8.4%) 89 (18.1%) 1 (0.2%)
SPECIAL SENSES
Blurred vision 1 (0.2%) 10 (2.0%) 2 (0.4%)
1 A treatment-emergent adverse event was defined as any event satisfying one of the following criteria:
The adverse event occurred for the first time after initial dosing with double-blind study medication.
The adverse event was present prior to or at the time of initial dosing with double-blind study medication and subsequently increased in severity during double-blind treatment; or The adverse event was present prior to or at the time of initial dosing with double-blind study medication, disappeared completely, and then reappeared during double-blind treatment.
2 Coding preferred terms also include cold, common cold, head cold, flu, and flu-like symptoms.
3 Coding preferred terms also include nasal congestion, stuffy nose, runny nose, sinus congestion, and hay fever.

Signs and Symptoms of Orthostasis

In the two U.S. studies, symptomatic postural hypotension was reported by 0.2% of patients (1 of 502) in the 0.4 mg group, 0.4% of patients (2 of 492) in the 0.8 mg group, and by no patients in the placebo group. Syncope was reported by 0.2% of patients (1 of 502) in the 0.4 mg group, 0.4% of patients (2 of 492) in the 0.8 mg group, and 0.6% of patients (3 of 493) in the placebo group. Dizziness was reported by 15% of patients (75 of 502) in the 0.4 mg group, 17% of patients (84 of 492) in the 0.8 mg group, and 10% of patients (50 of 493) in the placebo group. Vertigo was reported by 0.6% of patients (3 of 502) in the 0.4 mg group, 1% of patients (5 of 492) in the 0.8 mg group, and by 0.6% of patients (3 of 493) in the placebo group.

Multiple testing for orthostatic hypotension was conducted in a number of studies. Such a test was considered positive if it met one or more of the following criteria: (1) a decrease in systolic blood pressure of ≥ 20 mmHg upon standing from the supine position during the orthostatic tests; (2) a decrease in diastolic blood pressure ≥ 10 mmHg upon standing, with the standing diastolic blood pressure < 65 mmHg during the orthostatic test; (3) an increase in pulse rate of ≥ 20 bpm upon standing with a standing pulse rate ≥ 100 bpm during the orthostatic test; and (4) the presence of clinical symptoms (faintness, lightheadedness/lightheaded, dizziness, spinning sensation, vertigo, or postural hypotension) upon standing during the orthostatic test.

Following the first dose of double-blind medication in Study 1, a positive orthostatic test result at 4 hours post-dose was observed in 7% of patients (37 of 498) who received FLOMAX capsules 0.4 mg once daily and in 3% of the patients (8 of 253) who received placebo. At 8 hours post-dose, a positive orthostatic test result was observed for 6% of the patients (31 of 498) who received FLOMAX capsules 0.4 mg once daily and 4% (9 of 250) who received placebo (Note: patients in the 0.8 mg group received 0.4 mg once daily for the first week of Study 1).

In Studies 1 and 2, at least one positive orthostatic test result was observed during the course of these studies for 81 of the 502 patients (16%) in the FLOMAX capsules 0.4 mg once-daily group, 92 of the 491 patients (19%) in the FLOMAX capsules 0.8 mg once-daily group, and 54 of the 493 patients (11%) in the placebo group.

Because orthostasis was detected more frequently in FLOMAX capsule-treated patients than in placebo recipients, there is a potential risk of syncope [see WARNINGS AND PRECAUTIONS].

Abnormal Ejaculation

Abnormal ejaculation includes ejaculation failure, ejaculation disorder, retrograde ejaculation, and ejaculation decrease. As shown in Table 1, abnormal ejaculation was associated with FLOMAX capsules administration and was dose-related in the U.S. studies. Withdrawal from these clinical studies of FLOMAX capsules because of abnormal ejaculation was also dose-dependent, with 8 of 492 patients (1.6%) in the 0.8 mg group and no patients in the 0.4 mg or placebo groups discontinuing treatment due to abnormal ejaculation.

Laboratory Tests

No laboratory test interactions with FLOMAX capsules are known. Treatment with FLOMAX capsules for up to 12 months had no significant effect on prostate-specific antigen (PSA).

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of FLOMAX capsules. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Decisions to include these reactions in labeling are typically based on one or more of the following factors: (1) seriousness of the reaction, (2) frequency of reporting, or (3) strength of causal connection to FLOMAX capsules.

Allergic-type reactions such as skin rash, urticaria, pruritus, angioedema, and respiratory symptoms have been reported with positive rechallenge in some cases. Priapism has been reported rarely. Infrequent reports of dyspnea, palpitations, hypotension, atrial fibrillation, arrhythmia, tachycardia, skin desquamation including reports of Stevens-Johnson syndrome, constipation, and vomiting have been received during the postmarketing period.

During cataract surgery, a variant of small pupil syndrome known as Intraoperative Floppy Iris Syndrome (IFIS) has been reported in association with alpha1 blocker therapy [see WARNINGS AND PRECAUTIONS].

Read the Flomax (tamsulosin hydrochloride) Side Effects Center for a complete guide to possible side effects »

DRUG INTERACTIONS

Cytochrome P450 Inhibition

Strong and Moderate Inhibitors of CYP3A4 or CYP2D6

Tamsulosin is extensively metabolized, mainly by CYP3A4 and CYP2D6.

Concomitant treatment with ketoconazole (a strong inhibitor of CYP3A4) resulted in an increase in the Cmax and AUC of tamsulosin by a factor of 2.2 and 2.8, respectively [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY]. The effects of concomitant administration of a moderate CYP3A4 inhibitor (e.g., erythromycin) on the pharmacokinetics of FLOMAX have not been evaluated [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

Concomitant treatment with paroxetine (a strong inhibitor of CYP2D6) resulted in an increase in the Cmax and AUC of tamsulosin by a factor of 1.3 and 1.6, respectively [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY]. A similar increase in exposure is expected in CYP2D6 poor metabolizers (PM) as compared to extensive metabolizers (EM). Since CYP2D6 PMs cannot be readily identified and the potential for significant increase in tamsulosin exposure exists when FLOMAX 0.4 mg is co-administered with strong CYP3A4 inhibitors in CYP2D6 PMs, FLOMAX 0.4 mg capsules should not be used in combination with strong inhibitors of CYP3A4 (e.g., ketoconazole) [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

The effects of concomitant administration of a moderate CYP2D6 inhibitor (e.g., terbinafine) on the pharmacokinetics of FLOMAX have not been evaluated [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

The effects of co-administration of both a CYP3A4 and a CYP2D6 inhibitor with FLOMAX capsules have not been evaluated. However, there is a potential for significant increase in tamsulosin exposure when FLOMAX 0.4 mg is co-administered with a combination of both CYP3A4 and CYP2D6 inhibitors [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

Cimetidine

Treatment with cimetidine resulted in a significant decrease (26%) in the clearance of tamsulosin hydrochloride, which resulted in a moderate increase in tamsulosin hydrochloride AUC (44%) [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

Other Alpha Adrenergic Blocking Agents

The pharmacokinetic and pharmacodynamic interactions between FLOMAX capsules and other alpha adrenergic blocking agents have not been determined; however, interactions between FLOMAX capsules and other alpha adrenergic blocking agents may be expected [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

PDE5 Inhibitors

Caution is advised when alpha adrenergic blocking agents including FLOMAX are co-administered with PDE5 inhibitors. Alpha-adrenergic blockers and PDE5 inhibitors are both vasodilators that can lower blood pressure. Concomitant use of these two drug classes can potentially cause symptomatic hypotension [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

Warfarin

A definitive drug-drug interaction study between tamsulosin hydrochloride and warfarin was not conducted. Results from limited in vitro and in vivo studies are inconclusive. Caution should be exercised with concomitant administration of warfarin and FLOMAX capsules [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].

Nifedipine, Atenolol, Enalapril

Dosage adjustments are not necessary when FLOMAX capsules are administered concomitantly with nifedipine, atenolol, or enalapril [see CLINICAL PHARMACOLOGY].

Digoxin and Theophylline

Dosage adjustments are not necessary when a FLOMAX capsule is administered concomitantly with digoxin or theophylline [see CLINICAL PHARMACOLOGY].

Furosemide

FLOMAX capsules had no effect on the pharmacodynamics (excretion of electrolytes) of furosemide. While furosemide produced an 11% to 12% reduction in tamsulosin hydrochloride Cmax and AUC, these changes are expected to be clinically insignificant and do not require adjustment of the FLOMAX capsules dosage [see CLINICAL PHARMACOLOGY].

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

WARNINGS

Included as part of the PRECAUTIONS section.

PRECAUTIONS

Orthostasis

The signs and symptoms of orthostasis (postural hypotension, dizziness, and vertigo) were detected more frequently in FLOMAX capsule-treated patients than in placebo recipients. As with other alpha adrenergic blocking agents there is a potential risk of syncope [see ADVERSE REACTIONS]. Patients beginning treatment with FLOMAX capsules should be cautioned to avoid situations in which injury could result should syncope occur [see PATIENT INFORMATION].

Drug Interactions

Tamsulosin is extensively metabolized, mainly by CYP3A4 and CYP2D6. FLOMAX capsules 0.4 mg should not be used in combination with strong inhibitors of CYP3A4 (e.g., ketoconazole) [see DRUG INTERACTIONS and CLINICAL PHARMACOLOGY]. FLOMAX capsules should be used with caution in combination with moderate inhibitors of CYP3A4 (e.g., erythromycin), in combination with strong (e.g., paroxetine) or moderate (e.g., terbinafine) inhibitors of CYP2D6, in patients known to be CYP2D6 poor metabolizers particularly at a dose higher than 0.4 mg (e.g., 0.8 mg) [see DRUG INTERACTIONS and CLINICAL PHARMACOLOGY].

FLOMAX capsules should be used with caution in combination with cimetidine, particularly at a dose higher than 0.4 mg (e.g., 0.8 mg) [see DRUG INTERACTIONS and CLINICAL PHARMACOLOGY].

FLOMAX capsules should not be used in combination with other alpha adrenergic blocking agents [see DRUG INTERACTIONS and CLINICAL PHARMACOLOGY].

Caution is advised when alpha adrenergic blocking agents including FLOMAX are co-administered with PDE5 inhibitors. Alpha-adrenergic blockers and PDE5 inhibitors are both vasodilators that can lower blood pressure. Concomitant use of these two drug classes can potentially cause symptomatic hypotension [see DRUG INTERACTIONS and CLINICAL PHARMACOLOGY].

Caution should be exercised with concomitant administration of warfarin and FLOMAX capsules [see DRUG INTERACTIONS and CLINICAL PHARMACOLOGY].

Priapism

Rarely (probably less than 1 in 50,000 patients), tamsulosin, like other alpha1 antagonists, has been associated with priapism (persistent painful penile erection unrelated to sexual activity). Because this condition can lead to permanent impotence if not properly treated, patients must be advised about the seriousness of the condition [see PATIENT INFORMATION].

Screening for Prostate Cancer

Prostate cancer and BPH frequently co-exist; therefore, patients should be screened for the presence of prostate cancer prior to treatment with FLOMAX capsules and at regular intervals afterwards [see PATIENT INFORMATION].

Intraoperative Floppy Iris Syndrome

Intraoperative Floppy Iris Syndrome (IFIS) has been observed during cataract surgery in some patients on or previously treated with alpha1 blockers, including FLOMAX capsules [see ADVERSE REACTIONS].

Most reports were in patients taking the alpha1 blocker when IFIS occurred, but in some cases, the alpha1 blocker had been stopped prior to surgery. In most of these cases, the alpha1 blocker had been stopped recently prior to surgery (2 to 14 days), but in a few cases, IFIS was reported after the patient had been off the alpha1 blocker for a longer period (5 weeks to 9 months). IFIS is a variant of small pupil syndrome and is characterized by the combination of a flaccid iris that billows in response to intraoperative irrigation currents, progressive intraoperative miosis despite preoperative dilation with standard mydriatic drugs and potential prolapse of the iris toward the phacoemulsification incisions. The patient's ophthalmologist should be prepared for possible modifications to their surgical technique, such as the utilization of iris hooks, iris dilator rings, or viscoelastic substances.

IFIS may increase the risk of eye complications during and after the operation. The benefit of stopping alpha1 blocker therapy prior to cataract surgery has not been established. The initiation of therapy with tamsulosin in patients for whom cataract surgery is scheduled is not recommended.

Sulfa Allergy

In patients with sulfa allergy, allergic reaction to FLOMAX capsules has been rarely reported. If a patient reports a serious or life-threatening sulfa allergy, caution is warranted when administering FLOMAX capsules.

Patient Counseling Information

See FDA-Approved Patient Labeling

Hypotension

Patients should be told about the possible occurrence of symptoms related to postural hypotension, such as dizziness, when taking FLOMAX capsules, and they should be cautioned about driving, operating machinery, or performing hazardous tasks [see WARNINGS AND PRECAUTIONS].

Priapism

Patients should be advised about the possibility of priapism as a result of treatment with FLOMAX capsules and other similar medications. Patients should be informed that this reaction is extremely rare, but if not brought to immediate medical attention, can lead to permanent erectile dysfunction (impotence) [see WARNINGS AND PRECAUTIONS].

Screening for Prostate Cancer

Prostate cancer and BPH frequently co-exist; therefore, patients should be screened for the presence of prostate cancer prior to treatment with FLOMAX capsules and at regular intervals afterwards [see WARNINGS AND PRECAUTIONS].

Intraoperative Floppy Iris Syndrome

Patients considering cataract surgery should be advised to tell their ophthalmologist that they have taken FLOMAX capsules [see WARNINGS AND PRECAUTIONS].

Administration

Patients should be advised not to crush or chew the FLOMAX capsules.

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

Rats administered doses up to 43 mg/kg/day in males and 52 mg/kg/day in females had no increases in tumor incidence, with the exception of a modest increase in the frequency of mammary gland fibroadenomas in female rats receiving doses ≥ 5.4 mg/kg (P < 0.015). The highest doses of tamsulosin hydrochloride evaluated in the rat carcinogenicity study produced systemic exposures (AUC) in rats 3 times the exposures in men receiving the maximum therapeutic dose of 0.8 mg/day.

Mice were administered doses up to 127 mg/kg/day in males and 158 mg/kg/day in females. There were no significant tumor findings in male mice. Female mice treated for 2 years with the two highest doses of 45 and 158 mg/kg/day had statistically significant increases in the incidence of mammary gland fibroadenomas (P < 0.0001) and adenocarcinomas (P < 0.0075). The highest dose levels of tamsulosin hydrochloride evaluated in the mice carcinogenicity study produced systemic exposures (AUC) in mice 8 times the exposures in men receiving the maximum therapeutic dose of 0.8 mg/day.

The increased incidences of mammary gland neoplasms in female rats and mice were considered secondary to tamsulosin hydrochloride-induced hyperprolactinemia. It is not known if FLOMAX capsules elevate prolactin in humans. The relevance for human risk of the findings of prolactin-mediated endocrine tumors in rodents is not known.

Tamsulosin hydrochloride produced no evidence of mutagenic potential in vitro in the Ames reverse mutation test, mouse lymphoma thymidine kinase assay, unscheduled DNA repair synthesis assay, and chromosomal aberration assays in Chinese hamster ovary cells or human lymphocytes. There were no mutagenic effects in the in vivo sister chromatid exchange and mouse micronucleus assay.

Studies in rats revealed significantly reduced fertility in males dosed with single or multiple daily doses of 300 mg/kg/day of tamsulosin hydrochloride (AUC exposure in rats about 50 times the human exposure with the maximum therapeutic dose). The mechanism of decreased fertility in male rats is considered to be an effect of the compound on the vaginal plug formation possibly due to changes of semen content or impairment of ejaculation. The effects on fertility were reversible, showing improvement by 3 days after a single dose and 4 weeks after multiple dosing. Effects on fertility in males were completely reversed within nine weeks of discontinuation of multiple dosing. Multiple doses of 10 and 100 mg/kg/day tamsulosin hydrochloride (1/5 and 16 times the anticipated human AUC exposure) did not significantly alter fertility in male rats. Effects of tamsulosin hydrochloride on sperm counts or sperm function have not been evaluated.

Studies in female rats revealed significant reductions in fertility after single or multiple dosing with 300 mg/kg/day of the R-isomer or racemic mixture of tamsulosin hydrochloride, respectively. In female rats, the reductions in fertility after single doses were considered to be associated with impairments in fertilization. Multiple dosing with 10 or 100 mg/kg/day of the racemic mixture did not significantly alter fertility in female rats.

Use In Specific Populations

Pregnancy

Teratogenic Effects - Pregnancy Category B

Administration of tamsulosin hydrochloride to pregnant female rats at dose levels up to approximately 50 times the human therapeutic AUC exposure (300 mg/kg/day) revealed no evidence of harm to the fetus. Administration of tamsulosin hydrochloride to pregnant rabbits at dose levels up to 50 mg/kg/day produced no evidence of fetal harm. FLOMAX capsules are not indicated for use in women.

Nursing Mothers

FLOMAX capsules are not indicated for use in women.

Pediatric Use

FLOMAX capsules are not indicated for use in pediatric populations.

Efficacy and positive benefit/risk of tamsulosin hydrochloride was not demonstrated in two studies conducted in patients 2 years to 16 years of age with elevated detrusor leak point pressure ( > 40 cm H2O) associated with known neurological disorder (e.g., spina bifida). Patients in both studies were treated on a weight-based mg/kg schema (0.025 mg, 0.05 mg, 0.1 mg, 0.2 mg, or 0.4 mg tamsulosin hydrochloride) for the reduction in detrusor leak point pressure below 40 cm H2O. In a randomized, double-blind, placebo-controlled, 14-week, pharmacokinetic, safety and efficacy study in 161 patients, no statistically significant difference in the proportion of responders was observed between groups receiving tamsulosin hydrochloride and placebo. In an open-label, 12-month safety study, 87 patients were treated with tamsulosin hydrochloride. The most frequently reported adverse events ( ≥ 5%) from the pooled data of both studies were urinary tract infection, vomiting, pyrexia, headache, nasopharyngitis, cough, pharyngitis, influenza, diarrhea, abdominal pain, and constipation.

Geriatric Use

Of the total number of subjects (1783) in clinical studies of tamsulosin, 36% were 65 years of age and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and the other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out [see CLINICAL PHARMACOLOGY].

Renal Impairment

Patients with renal impairment do not require an adjustment in FLOMAX capsules dosing. However, patients with end-stage renal disease (CLcr < 10 mL/min/1.73 m²) have not been studied [see CLINICAL PHARMACOLOGY].

Hepatic Impairment

Patients with moderate hepatic impairment do not require an adjustment in FLOMAX capsules dosage. FLOMAX has not been studied in patients with severe hepatic impairment [see CLINICAL PHARMACOLOGY].

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

OVERDOSE

Should overdosage of FLOMAX capsules lead to hypotension [see WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS], support of the cardiovascular system is of first importance. Restoration of blood pressure and normalization of heart rate may be accomplished by keeping the patient in the supine position. If this measure is inadequate, then administration of intravenous fluids should be considered. If necessary, vasopressors should then be used and renal function should be monitored and supported as needed. Laboratory data indicate that tamsulosin hydrochloride is 94% to 99% protein bound; therefore, dialysis is unlikely to be of benefit.

CONTRAINDICATIONS

FLOMAX capsules are contraindicated in patients known to be hypersensitive to tamsulosin hydrochloride or any component of FLOMAX capsules. Reactions have included skin rash, urticaria, pruritus, angioedema, and respiratory symptoms [see ADVERSE REACTIONS].

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

CLINICAL PHARMACOLOGY

Mechanism of Action

The symptoms associated with benign prostatic hyperplasia (BPH) are related to bladder outlet obstruction, which is comprised of two underlying components: static and dynamic. The static component is related to an increase in prostate size caused, in part, by a proliferation of smooth muscle cells in the prostatic stroma. However, the severity of BPH symptoms and the degree of urethral obstruction do not correlate well with the size of the prostate. The dynamic component is a function of an increase in smooth muscle tone in the prostate and bladder neck leading to constriction of the bladder outlet. Smooth muscle tone is mediated by the sympathetic nervous stimulation of alpha1 adrenoceptors, which are abundant in the prostate, prostatic capsule, prostatic urethra, and bladder neck. Blockade of these adrenoceptors can cause smooth muscles in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and a reduction in symptoms of BPH.

Tamsulosin, an alpha1 adrenoceptor blocking agent, exhibits selectivity for alpha1 receptors in the human prostate. At least three discrete alpha1 adrenoceptor subtypes have been identified: alpha1A, alpha1B, and alpha1D; their distribution differs between human organs and tissue. Approximately 70% of the alpha1 receptors in the human prostate are of the alpha1A subtype.

FLOMAX capsules are not intended for use as an antihypertensive drug.

Pharmacodynamics

Urologic pharmacodynamic effects have been evaluated in neurologically impaired pediatric patients and in adults with BPH [see Use In Specific Populations and Clinical Studies].

Pharmacokinetics

The pharmacokinetics of tamsulosin hydrochloride have been evaluated in adult healthy volunteers and patients with BPH after single and/or multiple administration with doses ranging from 0.1 mg to 1 mg.

Absorption

Absorption of tamsulosin hydrochloride from FLOMAX capsules 0.4 mg is essentially complete ( > 90%) following oral administration under fasting conditions. Tamsulosin hydrochloride exhibits linear kinetics following single and multiple dosing, with achievement of steady-state concentrations by the fifth day of once-a-day dosing.

Effect of Food

The time to maximum concentration (Tmax) is reached by 4 to 5 hours under fasting conditions and by 6 to 7 hours when FLOMAX capsules are administered with food. Taking FLOMAX capsules under fasted conditions results in a 30% increase in bioavailability (AUC) and 40% to 70% increase in peak concentrations (Cmax) compared to fed conditions (Figure 1).

Figure 1 : Mean Plasma Tamsulosin Hydrochloride Concentrations Following Single-Dose Administration of FLOMAX Capsules 0.4 mg Under Fasted and Fed Conditions (n=8)

Mean Plasma Tamsulosin Hydrochloride Concentrations Following Single-Dose Administration - Illustration

The effects of food on the pharmacokinetics of tamsulosin hydrochloride are consistent regardless of whether a FLOMAX capsule is taken with a light breakfast or a high-fat breakfast (Table 2).

Table 2 : Mean (± S.D.) Pharmacokinetic Parameters Following FLOMAX Capsules 0.4 mg Once Daily or 0.8 mg Once Daily with a Light Breakfast, High-Fat Breakfast or Fasted

Pharmacokinetic Parameter 0.4 mg QD to healthy volunteers; n=23 (age range 18-32 years) 0.8 mg QD to healthy volunteers; n=22 (age range 55-75 years)
Light Breakfast Fasted Light Breakfast High-Fat Breakfast Fasted
Cmin (ng/mL) 4.0 ± 2.6 3.8 ± 2.5 12.3 ± 6.7 13.5 ± 7.6 13.3 ± 13.3
Cmax (ng/mL) 10.1 ± 4.8 17.1 ± 17.1 29.8 ± 10.3 29.1 ± 11.0 41.6 ± 15.6
Cmax /Cmin Ratio 3.1 ± 1.0 5.3 ± 2.2 2.7 ± 0.7 2.5 ± 0.8 3.6 ± 1.1
Tmax (hours) 6.0 4.0 7.0 6.6 5.0
T½ (hours) - - - - 14.9 ± 3.9
AUC t (ng• hr/mL) 151 ± 81.5 199 ± 94.1 440 ± 195 449 ± 217 557 ± 257
Cmin = observed minimum concentration
Cmax = observed maximum tamsulosin hydrochloride plasma concentration
Tmax = median time-to-maximum concentration
T½ = observed half-life
AUCτ = area under the tamsulosin hydrochloride plasma time curve over the dosing interval

Distribution

The mean steady-state apparent volume of distribution of tamsulosin hydrochloride after intravenous administration to 10 healthy male adults was 16 L, which is suggestive of distribution into extracellular fluids in the body.

Tamsulosin hydrochloride is extensively bound to human plasma proteins (94% to 99%), primarily alpha1 acid glycoprotein (AAG), with linear binding over a wide concentration range (20 to 600 ng/mL). The results of two-way in vitro studies indicate that the binding of tamsulosin hydrochloride to human plasma proteins is not affected by amitriptyline, diclofenac, glyburide, simvastatin plus simvastatinhydroxy acid metabolite, warfarin, diazepam, propranolol, trichlormethiazide, or chlormadinone. Likewise, tamsulosin hydrochloride had no effect on the extent of binding of these drugs.

Metabolism

There is no enantiomeric bioconversion from tamsulosin hydrochloride [R(-) isomer] to the S(+) isomer in humans. Tamsulosin hydrochloride is extensively metabolized by cytochrome P450 enzymes in the liver and less than 10% of the dose is excreted in urine unchanged. However, the pharmacokinetic profile of the metabolites in humans has not been established. Tamsulosin is extensively metabolized, mainly by CYP3A4 and CYP2D6 as well as via some minor participation of other CYP isoenzymes. Inhibition of hepatic drug-metabolizing enzymes may lead to increased exposure to tamsulosin [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS]. The metabolites of tamsulosin hydrochloride undergo extensive conjugation to glucuronide or sulfate prior to renal excretion.

Incubations with human liver microsomes showed no evidence of clinically significant metabolic interactions between tamsulosin hydrochloride and amitriptyline, albuterol (beta agonist), glyburide (glibenclamide) and finasteride (5alpha-reductase inhibitor for treatment of BPH). However, results of the in vitro testing of the tamsulosin hydrochloride interaction with diclofenac and warfarin were equivocal.

Excretion

On administration of the radiolabeled dose of tamsulosin hydrochloride to 4 healthy volunteers, 97% of the administered radioactivity was recovered, with urine (76%) representing the primary route of excretion compared to feces (21%) over 168 hours.

Following intravenous or oral administration of an immediate-release formulation, the elimination half-life of tamsulosin hydrochloride in plasma ranged from 5 to 7 hours. Because of absorption rate-controlled pharmacokinetics with FLOMAX capsules, the apparent half-life of tamsulosin hydrochloride is approximately 9 to 13 hours in healthy volunteers and 14 to 15 hours in the target population.

Tamsulosin hydrochloride undergoes restrictive clearance in humans, with a relatively low systemic clearance (2.88 L/h).

Specific Populations

Pediatric Use

FLOMAX capsules are not indicated for use in pediatric populations [see Use in Specific Populations].

Geriatric (Age) Use

Cross-study comparison of FLOMAX capsules overall exposure (AUC) and half-life indicates that the pharmacokinetic disposition of tamsulosin hydrochloride may be slightly prolonged in geriatric males compared to young, healthy male volunteers. Intrinsic clearance is independent of tamsulosin hydrochloride binding to AAG, but diminishes with age, resulting in a 40% overall higher exposure (AUC) in subjects of age 55 to 75 years compared to subjects of age 20 to 32 years [see Use In Specific Populations].

Renal Impairment

The pharmacokinetics of tamsulosin hydrochloride have been compared in 6 subjects with mild-moderate (30 ≤ CLcr < 70 mL/min/1.73 m²) or moderate-severe (10 ≤ CLcr < 30 mL/min/1.73 m²) renal impairment and 6 normal subjects (CLcr > 90 mL/min/1.73 m²). While a change in the overall plasma concentration of tamsulosin hydrochloride was observed as the result of altered binding to AAG, the unbound (active) concentration of tamsulosin hydrochloride, as well as the intrinsic clearance, remained relatively constant. Therefore, patients with renal impairment do not require an adjustment in FLOMAX capsules dosing. However, patients with end-stage renal disease (CLcr < 10 mL/min/1.73 m²) have not been studied [see Use In Specific Populations].

Hepatic Impairment

The pharmacokinetics of tamsulosin hydrochloride have been compared in 8 subjects with moderate hepatic impairment (Child-Pugh's classification: Grades A and B) and 8 normal subjects. While a change in the overall plasma concentration of tamsulosin hydrochloride was observed as the result of altered binding to AAG, the unbound (active) concentration of tamsulosin hydrochloride does not change significantly, with only a modest (32%) change in intrinsic clearance of unbound tamsulosin hydrochloride. Therefore, patients with moderate hepatic impairment do not require an adjustment in FLOMAX capsules dosage. FLOMAX has not been studied in patients with severe hepatic impairment [see Use in Specific Populations].

Drug Interactions

Cytochrome P450 Inhibition

Strong and Moderate Inhibitors of CYP3A4 or CYP2D6

The effects of ketoconazole (a strong inhibitor of CYP3A4) at 400 mg once daily for 5 days on the pharmacokinetics of a single FLOMAX capsule 0.4 mg dose was investigated in 24 healthy volunteers (age range 23 to 47 years). Concomitant treatment with ketoconazole resulted in an increase in the Cmax and AUC of tamsulosin by a factor of 2.2 and 2.8, respectively [see WARNINGS AND PRECAUTIONS]. The effects of concomitant administration of a moderate CYP3A4 inhibitor (e.g., erythromycin) on the pharmacokinetics of FLOMAX have not been evaluated [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

The effects of paroxetine (a strong inhibitor of CYP2D6) at 20 mg once daily for 9 days on the pharmacokinetics of a single FLOMAX capsule 0.4 mg dose was investigated in 24 healthy volunteers (age range 23 to 47 years). Concomitant treatment with paroxetine resulted in an increase in the Cmax and AUC of tamsulosin by a factor of 1.3 and 1.6, respectively [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS]. A similar increase in exposure is expected in CYP2D6 poor metabolizers (PM) as compared to extensive metabolizers (EM). A fraction of the population (about 7% of Caucasians and 2% of African Americans) are CYP2D6 PMs. Since CYP2D6 PMs cannot be readily identified and the potential for significant increase in tamsulosin exposure exists when FLOMAX 0.4 mg is co-administered with strong CYP3A4 inhibitors in CYP2D6 PMs, FLOMAX 0.4 mg capsules should not be used in combination with strong inhibitors of CYP3A4 (e.g., ketoconazole) [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

The effects of concomitant administration of a moderate CYP2D6 inhibitor (e.g., terbinafine) on the pharmacokinetics of FLOMAX have not been evaluated [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

The effects of co-administration of both a CYP3A4 and a CYP2D6 inhibitor with FLOMAX capsules have not been evaluated. However, there is a potential for significant increase in tamsulosin exposure when FLOMAX 0.4 mg is co-administered with a combination of both CYP3A4 and CYP2D6 inhibitors [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

Cimetidine

The effects of cimetidine at the highest recommended dose (400 mg every 6 hours for 6 days) on the pharmacokinetics of a single FLOMAX capsule 0.4 mg dose was investigated in 10 healthy volunteers (age range 21 to 38 years). Treatment with cimetidine resulted in a significant decrease (26%) in the clearance of tamsulosin hydrochloride, which resulted in a moderate increase in tamsulosin hydrochloride AUC (44%) [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

Other Alpha Adrenergic Blocking Agents

The pharmacokinetic and pharmacodynamic interactions between FLOMAX capsules and other alpha adrenergic blocking agents have not been determined; however, interactions between FLOMAX capsules and other alpha adrenergic blocking agents may be expected [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

PDE5 Inhibitors

Caution is advised when alpha adrenergic blocking agents, including FLOMAX, are co-administered with PDE5 inhibitors. Alpha-adrenergic blockers and PDE5 inhibitors are both vasodilators that can lower blood pressure. Concomitant use of these two drug classes can potentially cause symptomatic hypotension [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

Warfarin

A definitive drug-drug interaction study between tamsulosin hydrochloride and warfarin was not conducted. Results from limited in vitro and in vivo studies are inconclusive. Therefore, caution should be exercised with concomitant administration of warfarin and FLOMAX capsules [see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS].

Nifedipine, Atenolol, Enalapril

In three studies in hypertensive subjects (age range 47 to 79 years) whose blood pressure was controlled with stable doses of nifedipine, atenolol, or enalapril for at least 3 months, FLOMAX capsules 0.4 mg for 7 days followed by FLOMAX capsules 0.8 mg for another 7 days (n=8 per study) resulted in no clinically significant effects on blood pressure and pulse rate compared to placebo (n=4 per study). Therefore, dosage adjustments are not necessary when FLOMAX capsules are administered concomitantly with nifedipine, atenolol, or enalapril [see DRUG INTERACTIONS].

Digoxin and Theophylline

In two studies in healthy volunteers (n=10 per study; age range 19 to 39 years) receiving FLOMAX capsules 0.4 mg/day for 2 days, followed by FLOMAX capsules 0.8 mg/day for 5 to 8 days, single intravenous doses of digoxin 0.5 mg or theophylline 5 mg/kg resulted in no change in the pharmacokinetics of digoxin or theophylline. Therefore, dosage adjustments are not necessary when a FLOMAX capsule is administered concomitantly with digoxin or theophylline [see DRUG INTERACTIONS].

Furosemide

The pharmacokinetic and pharmacodynamic interaction between FLOMAX capsules 0.8 mg/day (steady-state) and furosemide 20 mg intravenously (single dose) was evaluated in 10 healthy volunteers (age range 21 to 40 years). FLOMAX capsules had no effect on the pharmacodynamics (excretion of electrolytes) of furosemide. While furosemide produced an 11% to 12% reduction in tamsulosin hydrochloride Cmax and AUC, these changes are expected to be clinically insignificant and do not require adjustment of the FLOMAX capsules dosage [see DRUG INTERACTIONS].

Clinical Studies

Four placebo-controlled clinical studies and one active-controlled clinical study enrolled a total of 2296 patients (1003 received FLOMAX capsules 0.4 mg once daily, 491 received FLOMAX capsules 0.8 mg once daily, and 802 were control patients) in the U.S. and Europe.

In the two U.S. placebo-controlled, double-blind, 13-week, multicenter studies [Study 1 (US92-03A) and Study 2 (US93-01)], 1486 men with the signs and symptoms of BPH were enrolled. In both studies, patients were randomized to either placebo, FLOMAX capsules 0.4 mg once daily, or FLOMAX capsules 0.8 mg once daily. Patients in FLOMAX capsules 0.8 mg once-daily treatment groups received a dose of 0.4 mg once daily for one week before increasing to the 0.8 mg once-daily dose. The primary efficacy assessments included: 1) total American Urological Association (AUA) Symptom Score questionnaire, which evaluated irritative (frequency, urgency, and nocturia), and obstructive (hesitancy, incomplete emptying, intermittency, and weak stream) symptoms, where a decrease in score is consistent with improvement in symptoms; and 2) peak urine flow rate, where an increased peak urine flow rate value over baseline is consistent with decreased urinary obstruction.

Mean changes from baseline to Week 13 in total AUA Symptom Score were significantly greater for groups treated with FLOMAX capsules 0.4 mg and 0.8 mg once daily compared to placebo in both U.S. studies (Table 3, Figures 2A and 2B). The changes from baseline to Week 13 in peak urine flow rate were also significantly greater for the FLOMAX capsules 0.4 mg and 0.8 mg once-daily groups compared to placebo in Study 1, and for the FLOMAX capsules 0.8 mg once-daily group in Study 2 (Table 3, Figures 3A and 3B). Overall there were no significant differences in improvement observed in total AUA Symptom Scores or peak urine flow rates between the 0.4 mg and the 0.8 mg dose groups with the exception that the 0.8 mg dose in Study 1 had a significantly greater improvement in total AUA Symptom Score compared to the 0.4 mg dose.

Table 3 : Mean (±S.D.) Changes from Baseline to Week 13 in Total AUA Symptom Score** and Peak Urine Flow Rate (mL/sec)

  Total AUA Symptom Score Peak Urine Flow Rate
Mean Baseline Value Mean Change Mean Baseline Value Mean Change
Study 1†
FLOMAX capsules 19.9 ± 4.9 -9.6* ± 6.7 9.57 ± 2.51 1.78* ± 3.35
0.8 mg once daily n=247 n=237 n=247 n=247
FLOMAX capsules 19.8 ± 5.0 -8.3* ± 6.5 9.46 ± 2.49 1.75* ± 3.57
0.4 mg once daily n=254 n=246 n=254 n=254
Placebo 19.6 ± 4.9 -5.5 ± 6.6 9.75 ± 2.54 0.52 ± 3.39
n=254 n=246 n=254 n=253
Study 2‡
FLOMAX capsules 18.2 ± 5.6 -5.8* ± 6.4 9.96 ± 3.16 1.79* ± 3.36
0.8 mg once daily n=244 n=238 n=244 n=237
FLOMAX capsules 17.9 ± 5.8 -5.1* ± 6.4 9.94 ± 3.14 1.52 ± 3.64
0.4 mg once daily n=248 n=244 n=248 n=244
Placebo 19.2 ± 6.0 -3.6 ± 5.7 9.95 ± 3.12 0.93 ± 3.28
n=239 n=235 n=239 n=235
* Statistically significant difference from placebo (p-value ≤ 0.050; Bonferroni-Holm multiple test procedure).
** Total AUA Symptom Scores ranged from 0 to 35.
† Peak urine flow rate measured 4 to 8 hours post dose at Week 13.
‡ Peak urine flow rate measured 24 to 27 hours post dose at Week 13. Week 13: For patients not completing the 13-week study, the last observation was carried forward.

Mean total AUA Symptom Scores for both FLOMAX capsules 0.4 mg and 0.8 mg once-daily groups showed a rapid decrease starting at 1 week after dosing and remained decreased through 13 weeks in both studies (Figures 2A and 2B).

In Study 1, 400 patients (53% of the originally randomized group) elected to continue in their originally assigned treatment groups in a double-blind, placebo-controlled, 40-week extension trial (138 patients on 0.4 mg, 135 patients on 0.8 mg, and 127 patients on placebo). Three hundred twenty-three patients (43% of the originally randomized group) completed one year. Of these, 81% (97 patients) on 0.4 mg, 74% (75 patients) on 0.8 mg, and 56% (57 patients) on placebo had a response ≥ 25% above baseline in total AUA Symptom Score at one year.

Figure 2A : Mean Change from Baseline in Total AUA Symptom Score (0-35) Study 1

Mean Change from Baseline in Total AUA Symptom Score - Illustration

* indicates significant difference from placebo (p-value ≤ 0.050).
B = Baseline determined approximately one week prior to the initial dose of double-blind medication at Week 0. Subsequent values are observed cases.
LOCF = Last observation carried forward for patients not completing the 13-week study.
Note: Patients in the 0.8 mg treatment group received 0.4 mg for the first week.
Note: Total AUA Symptom Scores range from 0 to 35.

Figure 2B : Mean Change from Baseline in Total AUA Symptom Score (0-35) Study 2

Mean Change from Baseline in Total AUA Symptom Score (0-35) Study 2 - Illustration

* indicates significant difference from placebo (p-value ≤ 0.050).
Baseline measurement was taken Week 0. Subsequent values are observed cases.
LOCF = Last observation carried forward for patients not completing the 13-week study.
Note: Patients in the 0.8 mg treatment group received 0.4 mg for the first week.
Note: Total AUA Symptom Scores range from 0 to 35.

Figure 3A : Mean Increase in Peak Urine Flow Rate (mL/Sec) Study 1

Mean Increase in Peak Urine Flow Rate (mL/Sec) Study 1 - Illustration

* indicates significant difference from placebo (p-value ≤ 0.050).
B = Baseline determined approximately one week prior to the initial dose of double-blind medication at Week 0. Subsequent values are observed cases.
LOCF = Last observation carried forward for patients not completing the 13-week study.
Note: The uroflowmetry assessments at Week 0 were recorded 4 to 8 hours after patients received the first dose of double-blind medication. Measurements at each visit were scheduled 4 to 8 hours after dosing (approximate peak plasma tamsulosin concentration).
Note: Patients in the 0.8 mg treatment groups received 0.4 mg for the first week.

Figure 3B : Mean Increase in Peak Urine Flow Rate (mL/Sec) Study 2

Mean Increase in Peak Urine Flow Rate (mL/Sec) Study 2 - Illustration

* indicates significant difference from placebo (p-value ≤ 0.050).
Baseline measurement was taken Week 0. Subsequent values are observed cases.
LOCF = Last observation carried forward for patients not completing the 13-week study.
Note: Patients in the 0.8 mg treatment group received 0.4 mg for the first week.
Note: Week 1 and Week 2 measurements were scheduled 4 to 8 hours after dosing (approximate peak plasma tamsulosin concentration).

All other visits were scheduled 24 to 27 hours after dosing (approximate trough tamsulosin concentration).

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

PATIENT INFORMATION

Flomax®
(Flo-max)
(tamsulosin hydrochloride) Capsules, 0.4 mg

Read the Patient Information that comes with FLOMAX capsules before you start taking it and each time you refill your prescription. The information may have changed. This leaflet does not take the place of discussions with your doctor about your medical condition or your treatment.

What is FLOMAX?

FLOMAX is a prescription alpha-blocker medicine used to treat the signs and symptoms of benign prostatic hyperplasia (BPH), a condition your doctor may refer to as an enlarged prostate.

  • FLOMAX is not for women.
  • FLOMAX is not for children.

Who should not take FLOMAX?

Do not take FLOMAX capsules if you are allergic to any of its ingredients. See the end of this leaflet for a complete list of ingredients in FLOMAX capsules.

What should I tell my doctor before using FLOMAX?

Before taking FLOMAX capsules, tell your doctor about all your medical conditions, including:

Tell your doctor about all the medicines you take, including:

  • any prescription medicines, including blood pressure medicines.
  • any non-prescription medicines, including vitamins and herbal supplements.

Some of your other medicines may affect the way FLOMAX capsules work. Especially tell your doctor if you take a medicine for high blood pressure. You should not take FLOMAX if you are already taking certain blood pressure medicines.

Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.

How should I take FLOMAX?

  • Take FLOMAX exactly as prescribed by your doctor.
  • Do not crush, chew, or open FLOMAX capsules.
  • Take FLOMAX one time each day, about 30 minutes after the same meal each day. For example, you may take FLOMAX 30 minutes after dinner each day.
  • If you miss a dose of FLOMAX, take it as soon as you remember. If you miss your dose for the whole day, continue with your next dose on your regular schedule. Do not take two doses at the same time.
  • If you stop or forget to take FLOMAX for several days, talk with your doctor before starting again.
  • If you take more FLOMAX capsules than prescribed, call your doctor right away.

What are the possible side effects of FLOMAX capsules?

Possible side effects of FLOMAX may include:

  • Decreased blood pressure when changing positions. FLOMAX capsules may cause a sudden drop in blood pressure upon standing, especially after the first dose or when changing doses.
    Symptoms may include:

Change positions slowly from lying down to sitting up or from a sitting to a standing position until you learn how you react to FLOMAX capsules. If you begin to feel dizzy, sit or lie down until you feel better. If the symptoms are severe or do not improve, call your doctor.

  • Allergic reactions. Make your doctor aware of any allergic reactions you may experience while taking FLOMAX.
    Allergic reactions may include:
    • rash
    • itching
    • hives
      Rare and more serious allergic reactions may also occur. Get medical help right away if you have any of the following reactions:
    • swelling of face, tongue, or throat
    • difficulty breathing
    • blistering of the skin
  • A painful erection that will not go away. FLOMAX capsules can cause a painful erection (priapism), which cannot be relieved by having sex. If this happens, get medical help right away. If priapism is not treated, you may not be able to get an erection in the future.
  • Eye problems during cataract surgery. During cataract surgery, a condition called intraoperative floppy iris syndrome (IFIS) can happen if you take or have taken FLOMAX capsules. If you need to have cataract surgery, be sure to tell your surgeon if you take or have taken FLOMAX capsules.

Common side effects of FLOMAX capsules may include:

These are not all the possible side effects with FLOMAX capsules. Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088, or by visiting www.fda.gov/medwatch.

What should I avoid while taking FLOMAX capsules?

Avoid driving, operating machinery, or other dangerous activities, until you know how FLOMAX affects you. FLOMAX capsules may cause a sudden drop in blood pressure upon standing, especially after the first dose or when changing doses. See “What are the possible side effects of FLOMAX capsules?”

How do I store FLOMAX capsules?

Store FLOMAX capsules at Room Temperature [77°F (25°C)]. Short-term exposure to higher or lower temperatures [from 59°F (15°C) to 86°F (30°C)] is acceptable. Ask your doctor or pharmacist if you have any questions about storing your capsules.

Keep FLOMAX capsules and all medicines out of the reach of children.

General information

This medicine was prescribed for you by your doctor for your condition. Do not use it for another condition. Do not give FLOMAX to other people, even if they have the same symptoms that you have. It may harm them.

While taking FLOMAX, you must have regular checkups. Follow your doctor's advice about when to have these checkups.

BPH can occur with other more serious conditions, including prostate cancer. Therefore, ask your doctor about screening for prostate cancer prior to treatment with FLOMAX capsules and at regular intervals afterwards.

This patient information leaflet summarizes the most important information about FLOMAX. If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about FLOMAX that is written for health professionals. For more information call Boehringer Ingelheim Pharmaceuticals, Inc. at 1-800-542-6257, or (TTY) 1-800-459-9906.

What are the ingredients in FLOMAX capsules?

  • Active Ingredient: tamsulosin hydrochloride
  • Inactive Ingredients: methacrylic acid copolymer dispersion, NF; microcrystalline cellulose, NF; triacetin, USP; calcium stearate, NF; talc, USP; FD&C blue No. 2; titanium dioxide; ferric oxide; gelatin, and trace amounts of black edible ink.

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

>

PATIENT INFORMATION

Flomax®
(Flo-max)
(tamsulosin hydrochloride) Capsules, 0.4 mg

Read the Patient Information that comes with FLOMAX capsules before you start taking it and each time you refill your prescription. The information may have changed. This leaflet does not take the place of discussions with your doctor about your medical condition or your treatment.

What is FLOMAX?

FLOMAX is a prescription alpha-blocker medicine used to treat the signs and symptoms of benign prostatic hyperplasia (BPH), a condition your doctor may refer to as an enlarged prostate.

  • FLOMAX is not for women.
  • FLOMAX is not for children.

Who should not take FLOMAX?

Do not take FLOMAX capsules if you are allergic to any of its ingredients. See the end of this leaflet for a complete list of ingredients in FLOMAX capsules.

What should I tell my doctor before using FLOMAX?

Before taking FLOMAX capsules, tell your doctor about all your medical conditions, including:

Tell your doctor about all the medicines you take, including:

  • any prescription medicines, including blood pressure medicines.
  • any non-prescription medicines, including vitamins and herbal supplements.

Some of your other medicines may affect the way FLOMAX capsules work. Especially tell your doctor if you take a medicine for high blood pressure. You should not take FLOMAX if you are already taking certain blood pressure medicines.

Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.

How should I take FLOMAX?

  • Take FLOMAX exactly as prescribed by your doctor.
  • Do not crush, chew, or open FLOMAX capsules.
  • Take FLOMAX one time each day, about 30 minutes after the same meal each day. For example, you may take FLOMAX 30 minutes after dinner each day.
  • If you miss a dose of FLOMAX, take it as soon as you remember. If you miss your dose for the whole day, continue with your next dose on your regular schedule. Do not take two doses at the same time.
  • If you stop or forget to take FLOMAX for several days, talk with your doctor before starting again.
  • If you take more FLOMAX capsules than prescribed, call your doctor right away.

What are the possible side effects of FLOMAX capsules?

Possible side effects of FLOMAX may include:

  • Decreased blood pressure when changing positions. FLOMAX capsules may cause a sudden drop in blood pressure upon standing, especially after the first dose or when changing doses.
    Symptoms may include:

Change positions slowly from lying down to sitting up or from a sitting to a standing position until you learn how you react to FLOMAX capsules. If you begin to feel dizzy, sit or lie down until you feel better. If the symptoms are severe or do not improve, call your doctor.

  • Allergic reactions. Make your doctor aware of any allergic reactions you may experience while taking FLOMAX.
    Allergic reactions may include:
    • rash
    • itching
    • hives
      Rare and more serious allergic reactions may also occur. Get medical help right away if you have any of the following reactions:
    • swelling of face, tongue, or throat
    • difficulty breathing
    • blistering of the skin
  • A painful erection that will not go away. FLOMAX capsules can cause a painful erection (priapism), which cannot be relieved by having sex. If this happens, get medical help right away. If priapism is not treated, you may not be able to get an erection in the future.
  • Eye problems during cataract surgery. During cataract surgery, a condition called intraoperative floppy iris syndrome (IFIS) can happen if you take or have taken FLOMAX capsules. If you need to have cataract surgery, be sure to tell your surgeon if you take or have taken FLOMAX capsules.

Common side effects of FLOMAX capsules may include:

These are not all the possible side effects with FLOMAX capsules. Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088, or by visiting www.fda.gov/medwatch.

What should I avoid while taking FLOMAX capsules?

Avoid driving, operating machinery, or other dangerous activities, until you know how FLOMAX affects you. FLOMAX capsules may cause a sudden drop in blood pressure upon standing, especially after the first dose or when changing doses. See “What are the possible side effects of FLOMAX capsules?”

How do I store FLOMAX capsules?

Store FLOMAX capsules at Room Temperature [77°F (25°C)]. Short-term exposure to higher or lower temperatures [from 59°F (15°C) to 86°F (30°C)] is acceptable. Ask your doctor or pharmacist if you have any questions about storing your capsules.

Keep FLOMAX capsules and all medicines out of the reach of children.

General information

This medicine was prescribed for you by your doctor for your condition. Do not use it for another condition. Do not give FLOMAX to other people, even if they have the same symptoms that you have. It may harm them.

While taking FLOMAX, you must have regular checkups. Follow your doctor's advice about when to have these checkups.

BPH can occur with other more serious conditions, including prostate cancer. Therefore, ask your doctor about screening for prostate cancer prior to treatment with FLOMAX capsules and at regular intervals afterwards.

This patient information leaflet summarizes the most important information about FLOMAX. If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about FLOMAX that is written for health professionals. For more information call Boehringer Ingelheim Pharmaceuticals, Inc. at 1-800-542-6257, or (TTY) 1-800-459-9906.

What are the ingredients in FLOMAX capsules?

  • Active Ingredient: tamsulosin hydrochloride
  • Inactive Ingredients: methacrylic acid copolymer dispersion, NF; microcrystalline cellulose, NF; triacetin, USP; calcium stearate, NF; talc, USP; FD&C blue No. 2; titanium dioxide; ferric oxide; gelatin, and trace amounts of black edible ink.

Last reviewed on RxList: 8/8/2011
This monograph has been modified to include the generic and brand name in many instances.

Disclaimer

Flomax Consumer

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

TAMSULOSIN CAPSULE - ORAL

(tam-sull-OH-sin)

COMMON BRAND NAME(S): Flomax

USES: This medication is used in men to treat the symptoms of an enlarged prostate (benign prostatic hyperplasia-BPH). Tamsulosin is known as an alpha-blocker and works by relaxing muscles in the bladder and prostate. Relaxing these muscles helps to relieve symptoms of BPH such as difficulty in beginning the flow of urine, weak stream, and the need to urinate frequently or urgently (including during the middle of the night).

This medication should not be used to treat high blood pressure.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Tamsulosin may also be used to help your body "pass," or get rid of, kidney stones through urination. It has also been used to help treat bladder problems in women.

HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking this medication and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually once daily, 30 minutes after the same meal each day. Swallow this medication whole. Do not crush, chew, or open the capsules.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

If you have not taken this drug for several days, contact your doctor to see if you need to be restarted at a lower dose.

It may take up to 4 weeks to notice an improvement in symptoms. Tell your doctor if your symptoms do not improve after 4 weeks or if they worsen.

Disclaimer

Flomax Consumer (continued)

SIDE EFFECTS: Dizziness, lightheadedness, drowsiness, runny/stuffy nose, or ejaculation problems may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if this rare but serious side effect occurs: fainting.

Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the Flomax (tamsulosin hydrochloride) Side Effects Center for a complete guide to possible side effects »

PRECAUTIONS: Before taking tamsulosin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history.

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

To reduce the risk of dizziness, lightheadedness, or fainting, get up slowly when rising from a sitting or lying position, especially when you first start taking this drug or if your doctor changes your dose. If dizziness occurs, sit or lie down until you feel better. Also, when you first start taking this drug, avoid situations where you may be injured if you faint.

Before having surgery (including cataract eye surgery), tell your doctor or dentist that you are taking this medication and about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. Before using tamsulosin, talk with your doctor about the risks and benefits.

It is unknown if tamsulosin passes into breast milk. Consult your doctor before breast-feeding.

Disclaimer

Flomax Consumer (continued)

DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.

Some products that may interact with this drug include: other alpha-blockers (such as prazosin, terazosin), drugs to treat erectile problems/pulmonary hypertension (such as sildenafil, tadalafil, vardenafil).

Other medications can affect the removal of this product from your body, which may affect how this product works. Examples include azole antifungals (such as ketoconazole), macrolide antibiotics (such as clarithromycin), nefazodone, HIV protease inhibitors (such as ritonavir), telithromycin, among others.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This document does not contain all possible interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting.

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (such as prostate exams, prostate-specific antigen-PSA) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised August 2011. Copyright(c) 2011 First Databank, Inc.

Flomax Patient Information Including Side Effects

Brand Names: Flomax

Generic Name: tamsulosin (Pronunciation: tam soo LOE sin)

What is tamsulosin (Flomax)?

Tamsulosin is in a group of drugs called alpha-adrenergic (AL-fa ad-ren-ER-jik) blockers. Tamsulosin relaxes the muscles in the prostate and bladder neck, making it easier to urinate.

Tamsulosin is used to improve urination in men with benign prostatic hyperplasia (enlarged prostate).

Tamsulosin may also be used for other purposes not listed in this medication guide.

Flomax 0.4 mg

green/orange, imprinted with Flomax 0.4 mg, BI 58

Tamsulosin 0.4 mg-TEV

oblong, brown/white, imprinted with 93 7338

What are the possible side effects of tamsulosin (Flomax)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using tamsulosin and call your doctor at once if you have any of these serious side effects:

  • feeling like you might pass out;
  • chest pain;
  • fever, chills, body aches, or flu symptoms; or
  • penis erection that is painful or lasts 4 hours or longer.

Less serious side effects may include:

  • mild dizziness;
  • weakness, drowsiness;
  • headache;
  • nausea, diarrhea;
  • back pain;
  • blurred vision;
  • dental problems;
  • sleep problems (insomnia);
  • abnormal ejaculation, decreased sex drive; or
  • runny nose, sore throat, cough.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Read the Flomax (tamsulosin hydrochloride) Side Effects Center for a complete guide to possible side effects »

What is the most important information I should know about tamsulosin (Flomax)?

You should not use this medication if you are allergic to tamsulosin. Do not take tamsulosin with other similar medicines such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), or terazosin (Hytrin).

Tamsulosin may cause dizziness or fainting, especially when you first start taking it or when you start taking it again. Be careful if you drive or do anything that requires you to be alert. Avoid standing for long periods of time or becoming overheated during exercise and in hot weather. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

If you stop taking tamsulosin for any reason, call your doctor before you start taking it again. You may need a dose adjustment.

Tamsulosin can affect your pupils during cataract surgery. Tell your eye surgeon ahead of time that you are using this medication. Do not stop using tamsulosin before surgery unless your surgeon tells you to.

Side Effects Centers

Flomax Patient Information including How Should I Take

What should I discuss with my healthcare provider before taking tamsulosin (Flomax)?

You should not use this medication if you are allergic to tamsulosin. Do not take tamsulosin with other similar medicines such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), or terazosin (Hytrin).

If you have a history of prostate cancer, you may need a dose adjustment or special tests to safely take this tamsulosin.

Tamsulosin can affect your pupils during cataract surgery. Tell your eye surgeon ahead of time that you are using this medication. Do not stop using tamsulosin before surgery unless your surgeon tells you to.

Although this medication is not for use in women, tamsulosin is not expected to harm an unborn baby. If you are a woman using this medication, tell your doctor if you are pregnant or breast-feeding.

Tamsulosin is not for use in children.

How should I take tamsulosin (Flomax)?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results.

Tamsulosin is usually taken once a day, approximately 30 minutes after a meal. Try to take this medication at the same time each day.

Do not crush, chew, or open a tamsulosin capsule. Swallow it whole.

Tamsulosin lowers blood pressure and may cause dizziness or fainting, especially when you first start taking it, or when you start taking it again. Call your doctor if you have severe dizziness or feel like you might pass out.

You may feel very dizzy when you first wake up. Be careful when standing or sitting up from a lying position.

If you stop taking tamsulosin for any reason, call your doctor before you start taking it again. You may need a dose adjustment.

Your blood pressure and prostate will need to be checked often. Visit your doctor regularly.

Some things can cause your blood pressure to get too low. This includes vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low-salt diet, or taking diuretics (water pills). Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Store at room temperature away from moisture and heat.

Side Effects Centers

Flomax Patient Information including If I Miss a Dose

What happens if I miss a dose (Flomax)?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

If you miss your doses for several days in a row, contact your doctor before restarting the medication. You may need a lower dose.

What happens if I overdose (Flomax)?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include extreme dizziness or fainting.

What should I avoid while taking tamsulosin (Flomax)?

Tamsulosin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

To prevent dizziness, avoid standing for long periods of time or becoming overheated during exercise and in hot weather.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Drinking alcohol can increase certain side effects of tamsulosin.

What other drugs will affect tamsulosin (Flomax)?

Tell your doctor about all other medications you use, especially:

  • cimetidine (Tagamet);
  • conivaptan (Vaprisol);
  • cyclosporine (Gengraf, Neoral, Sandimmune);
  • imatinib (Gleevec);
  • isoniazid (for treating tuberculosis);
  • methimazole (Tapazole);
  • pioglitazone (Actos);
  • ropinirole (Requip);
  • ticlopidine (Ticlid);
  • warfarin (Coumadin);
  • an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), metronidazole (Flagyl, Protostat), telithromycin (Ketek), or terbinafine (Lamisil);
  • an antidepressant such as citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nefazodone, paroxetine (Paxil), sertraline (Zoloft), or tranylcypromine (Parnate);
  • antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Extina, Ketozole, Nizoral, Xolegal), or voriconazole (Vfend);
  • anti-malaria medication such as chloroquine (Arelan) or pyrimethamine (Daraprim), or quinine (Qualaquin);
  • erectile dysfunction medicine such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra);
  • heart or blood pressure medication such as diltiazem (Cartia, Cardizem), felodipine (Plendil), nicardipine (Cardene), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others;
  • a heart rhythm medication such as amiodarone (Cordarone, Pacerone) or quinidine (Quin-G);
  • HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir); or
  • medicine to treat psychiatric disorders, such as aripiprazole (Abilify), chlorpromazine (Thorazine), clozapine (Clozaril, FazaClo), fluphenazine (Permitil, Prolixin), haloperidol (Haldol), perphenazine (Trilafon), or thioridazine (Mellaril).

Where can I get more information?

Your pharmacist can provide more information about tamsulosin.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 7.02. Revision date: 12/15/2010.

Your use of the content provided in this service indicates that you have read,understood and agree to the End-User License Agreement,which can be accessed by clicking on this link.

Healthwise

Side Effects Centers

توزیع کنندگان این دارو
شرکت های تولید کننده یا وارد کننده دارو

دارونـــما
نوآوری برای سلامت

طراحی و اجرا M.Ramezani
ارتباط با ما Info@darunama.com