There is no evidence that there is a difference in efficacy between the alpha blockers and the choice of agent depends upon tolerability and cost. In the frail elderly, alfuzosin or tamsulosin may be considered first line choices.

Drugs also used for urinary retention not listed here:

• Doxazosin (see section 2.5.4 Alpha-adrenoceptor blocking drugs)
• Finasteride (see section 6.4.2 Male sex hormones and antagonists)

Tamsulosin hydrochloride

• Modified-release capsules 400micrograms (£1.49 = 400micrograms daily)

Indications

• Lower urinary tract symptoms (LUTS) in men

Notes

1. Tamsulosin has been associated with floppy iris syndrome (an intraoperative complication during cataract surgery). The possibility of a class effect with other alpha blockers cannot be excluded. Tamsulosin is best avoided in those who may need cataract surgery in the future and should be withheld in those scheduled for cataract surgery for 4 weeks prior to surgery (during which time their urological symptoms may deteriorate). Current or past use of any alpha blocker should be made known to the ophthalmic surgeon in advance of surgery since such patients have an increased risk of intraoperative complications during cataract surgery and will require an experienced cataract surgeon rather than routine listing.
2. Tamsulosin is now available to buy over the counter (OTC) from community pharmacies for men aged 45 to 75 years for the treatment of the functional symptoms of benign prostatic hyperplasia (BPH), according to a defined protocol.

Alfuzosin hydrochloride

• Tablets 2.5mg (£1.82 = 2.5mg three times a day)
• Modified-release tablets 10mg (£11.68 = 10mg daily)

Indications

• Lower urinary tract symptoms (LUTS) in men