As men age, the prostate enlarges which creates difficulty urinating. Although the prostate itself does not shrink with Flomax, the smooth muscle component of the gland relaxes. This effect on the involuntary muscle allows easier passage or urine with less hesitation and dribbling. Benefits appear extraordinarily rapidly. Also know as tamsulosin, the drug improves the symptoms of BPH rather than curing the condition. Lightheadedness frequently occurs on arising from a seated position. A recent evaluation of 500,000 men unexpectedly revealed those taking tamsulosin might face an increased risk of dementia. Studies to confirm or refute this possible association must be undertaken.
Hello i’m dr. ken latha thanks for watching let’s talk about flomax or tamsulosin this is a drug for treatment of symptoms related to benign enlargement of the prostate difficulty urinating if you happen to be a man and it was approved by the food and drug administration in 1997 so basically all of the drugs in the family now are generic and they’re all extended
Released so you only have to take one a day it was originally developed by a company in japan yamaguchi pharmaceuticals and they sort of to astellas but right now since its generic lots of drug manufacturers make the drug so the drug itself is for relief of symptoms of benign enlargement of the prostate benign enlargement of the prostate is going to occur in
About half of all men by age 50 and 90% of all men by age 90 symptoms tend to be mild to moderate but half of the men are going to take medicines in order to gain some relief in 2008 flomax was one of the top 20 medicines prescribed brought in over a billion dollars a year it was made very popular by catchy advertising not because the drug worked any better than
Any other drug in the same family symptoms associated with benign enlargement of the prostate have to do with irritation or storage problems those would be nocturia getting up at night to urinate urgency or frequency and then another series related to bladder emptying or to the obstruction that’s hesitancy incomplete emptying of the bladder may be the stream
Starts and stops maybe it’s a weak stream or you dribble maybe you have to strain to urinate well the american urology association came up with a symptom score a checklist so that when you’re in the doctor’s office you just fill out a very simple page form and ask questions about the symptoms that i just mentioned and then if you have a score of 1 to 7 you’ve
Got no symptoms of mild symptoms moderate symptoms if your score is between 8 and 19 and if it’s more than 20 you have severe symptoms now it’s important to realize that we can get the same thing just by asking you some simple questions can you empty your bladder completely do you have to go again within two hours where you stop and start your stream do you
Have difficulty postponing the stream how about the strength of the stream those sort of questions well it’s important to realize that the symptoms can get worse or better very quickly they seem to vary depending on the weather worse than the cold weather or if there’s stress physical or mental stress if you happen to be taking a decongestant antihistamine or
Even a nose spray and there isn’t all that much correlation with the size of the prostate and the symptoms that you have yes indeed as the prostate enlarges the symptoms tend to get worse but but there are two components to the prostate there’s one the prostate gland themselves and the other is smooth muscle well the medicine doesn’t have anything to do with
The prostate glands but it does have an awful lot to do with the muscles and just like any other kind of muscle it can relax or it can contract well when we talk about obstruction due to the prostate we talked about static obstruction that’s due to the glandular cells cells and then we talked about the dynamic component the component that can change and we know
That the muscles are controlled by those alpha-adrenergic nerves from the sympathetic nervous system and they tend to be clustered in the prostate in the prostatic urethra and in the bladder neck well it seems that if you take these kind of drugs flomax in particular of course that it relaxes the muscle and as it relaxes the so it allows less obstruction to the
Stream and causes a decrease symptom now fortunately most of the fibers of the nerve happened to be in the bladder itself or in the prostate but some of them are elsewhere and it’s the elsewhere that causes some kind of problems for some gentleman well it’s important to realize that when you take this kind of a drug you have to start at a relatively low dose so
You start at zero point four milligrams a day that’s one pill a day are you thinking about half hour after some meal same meal each day often times after breakfast so you take it and then you keep doing that for about two three four weeks and see if you’re okay if you’re okay then that’s fine if not then you can increase after the two three or four weeks to 0.8
Milligrams a day that’s the highest dose that you would want to take now if you happen to stop taking the drug for any reason you forget it you go out of town and you forget to bring your pills along then you have to start at the zero point four milligrams again well how well does it work let’s say we have a gentleman whose score on that symptom score from the
American urology association happens to be twenty so right the dividing line between moderate to severe symptoms if you take the drug you’re going to drop it by about five to ten points if you take up to sibo you drop the score by only about four to six points now it’s important to realize that when you take the flomax the benefits begin within the first week so
It’s a very rapidly acting medicine it’s not one of these things that you have to take for a month or two months to see if it’s going to be effective so we have a significant improvement that the symptoms go away completely no they don’t do that but they improve quite dramatically and in the process the amount of urine that comes out per second seems to increase by
About ten percent so that’s pretty good the drug stays in your body for most of the day so that’s okay so you we have to take one pill a day it’s extensively metabolized in the liver so if you have liver problems this isn’t for you seventy-five percent goes out in the urine so again if you have kidney disease of moderate to spear intensity this drug isn’t for you
Now there’s another problem and the problem is remember i said about 70 percent of all the receptors happen to be in the prostate or in the bladder well some of them aren’t just there some of them are in the brain and it might have an effect on cognition or cognitive function certainly we know that’s true in the mice and in other animal models and there’s question
About what happens in people who have dementia who take this kind of a drug well it seems that if a person continues to take this drug it continues to be effective and it can reduce your symptoms by about 30 35 40 percent within the first week and it maintains that for the whole year so it doesn’t get weaker as time goes on now some of the men who take this drug
Really have symptoms from other causes so we have to make sure that you’re not suffering from prostatitis or prostate cancer diabetes or heart disease or sexual dysfunction or maybe you have a bladder irritant that you’re taking could be caffeine could be a stone in your bladder oh those things should be ruled out and then of course there are certain medicines
That you might be taking you might be taking some of the medicines for runny nose or an antidepressant that can make the situation worse so you should avoid the antihistamine you avoid the benadryl if you’re obese you try to reduce some weight you don’t drink before you go to bed you limit your alcohol you limit your caffeine when you empty your bladder you wait
A couple minutes and try to empty it again because we know that a normal person can have up to a hundred cc’s or about three ounces left in the bladder even after you’ve completely emptied it or thought you completely emptied it and you gradually increase the amount of time between your urinations to sort of train your bladder all of those good ideas when you
Take flomax tamsulosin you could have some side effects side effects relatively common headache get some dizziness or runny nose maybe just feel blah blah some people get some diarrhea some chest pain or some insomnia but what’s scary to some men is they get some ejaculatory failure you can have retrograde ejaculation so it goes into the bladders that have outside
Some men find that’s quite problematic it’s due to the relaxation of one of the sphincters that normally closes down during ejaculation but because of the medicine because of the way the medicine works it doesn’t do what it’s supposed to do and then ejaculation is what we call retrograde the major problem with this drug is it when you stand up about 15-20 percent
Of the men going to get a little light-headed the blood pressure is going to go down by more than 20 millimeters the heart rate is going to go up by about 20 beats a minute and some men are gonna feel fade or lightheaded or dizzy feel that you’re spinning around the room the room is spinning about you vertigo and actually could even get worse if you take viagra
It suggested that before you take this kind of a drug that you should be checked for a prostate cancer and it’s also suggested that if you’re taking certain other kind of medicines that might interfere with particular enzymes that degrade the flomax if you’re taking to benefit if you’re taking the risk from ice and if you’re taking clarithromycin you’ve got to
Be real careful about taking this drug because it will decrease it won’t be metabolized normally now there are certain warnings in cautions of course you have to be careful if you’re taking it with warfarin you have to beware the possibility of priapism prolonged erection for more than four hours you shouldn’t take it with any other kind of alpha blocker and
If you happen to have a cataract and you’re gonna have surgery it can cause what we call the floppy iris syndrome so you have to tell your ophthalmologist if he or she doesn’t ask that you’re taking this drug because otherwise it can cause some problems during cataract surgery and again if you have advanced disease of your kidneys or your liver this drug probably
Isn’t for you you gotta be careful if you’re taking it with a medicine like tagamet and then the food and drug administration issued a safety warning for different kind of medicine pross carr and avid art and it is a warning for high-grade prostate cancer now there’s argument whether that’s true or not but tamsulosin comes in combination in certain kind of pill
Called jalen with avid art so for people who are concerned about cancer and prostate this might be something of concern now potentially more worrisome in january of 2018 pharmaco epidemiology and drug safety from the university of connecticut looking at about 500,000 men on medicare followed for about 20 months compared men taking tamsulosin two men on either
No therapy or men taking other drugs in the family and they found that there was a 17% increase in the number of diagnosis of dementia of alzheimer’s type dementia and that at a higher dose that rose to about 40% and it happened most in men between the ages of 65 and 74 so the question is is that really that’s not necessarily cause-and-effect that’s men who were
Taking it had those kind of symptoms had the dementia and we don’t know if it’s related or not but we do know that it’s statistically potentially important and another thing at least in the animal studies the animals who were given this drug had a higher incidence of fibroadenomas of the breast and adenocarcinoma x’ now how does that play out in humans again we
Don’t know and part of the reason we don’t know is that over three-quarters of the drug studies that involve tamsulosin have not been published if you overdose on the medicine what’s gonna happen blood pressure’s gonna fall down a whole lot what other conditions has it been used for off-label interestingly if you happen to have a very small kidney stone a kidney
Stone that measures between maybe say about four millimeters and ten millimeters so certainly less than half an inch the quarter inch say well it relaxes the to relaxes the ureter and maybe allows some of the passage of the stone if it happens to be small and also if you happen to be catheterized and you’ve had the catheter in for a while well if you take the
Drug it might reduce the likelihood of needing recategorize ation or having another instruction are there other drugs in the family sure there’s your exit role and card or a– there’s rapa flow there’s hytrin and then you can have a medicine that actually will work on the size of the prostate gland itself those are the medicines finasteride you notice pross car or
Avodart doot asteroid well consumer report looked at the medicines that were available and said you know at that time this goes back to 2009 car dora seemed to be the best bang for the buck now that most of the drugs are available as generics it doesn’t really make all that much difference how much does the drug cost well that all depends the answer is too much
The drug costs if you go by the drug at the drug store with cash the generic is gonna cost between 90 and $100 at most places but for whatever reason at smith’s pharmacy it’s only twenty four dollars with a coupon at most pharmacies it’s between ten and thirty dollars you could buy the brand name the flomax itself for two hundred forty dollars cash and remember we
Have two different strengths the strengths the point for the point eight and interestingly the company flomax they price it so if you need the higher dose you’re gonna have to take two and that means double the price so anyway now you know about part of the treatment for benign enlargement of the prostate with flomax were pam’s allison thanks for watching i’m dr. ken landon you you
Transcribed from video
Flomax By wellnowdoctor
