Alpha-1 blocker

Alpha-1 blockers (also called alpha-adrenergic blocking agents) constitute a variety of drugs which block α1-adrenergic receptors in arteries and smooth muscles.

Indications

These drugs may be used to treat:
* benign prostatic hyperplasia (BPH)cite journal |author=Höfner K |title=alpha(1)-Blocker therapy in the nineties: focus on the disease |journal=Prostate Cancer Prostatic Dis. |volume=2 |issue=S4 |pages=S9–S15 |year=1999 |month=December |pmid=12496768 |doi=10.1038/sj.pcan.4500368 |url=]
**Lower urinary tract symptoms
**Post Transurethral microwave thermotherapy (TUMT) and Transurethral needle ablation of the prostate (TUNA) procedures
* high blood pressure (hypertension). This is not typically the drug of choice unless the patient also has BPH.
* symptoms of [http://health.yahoo.com/ency/healthwise/hw72762 non inflammatory chronic pelvic pain syndrome] , a type of prostatitis. As a side effect they may reduce blood pressure and result in lightheadedness.

Examples of alpha blockers

Selective Alpha-1 blockers include:
* Doxazosincite journal |author=Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H |title=The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones |journal=J. Urol. |volume=173 |issue=6 |pages=2010–2 |year=2005 |month=June |pmid=15879806 |doi=10.1097/01.ju.0000158453.60029.0a |url=] (Cardura)
* Prazosin (Minipress)
* Trimazosin (Minipress)
* Tamsulosin (Flomaxtra/Flomax)
* Alfuzosin (Uroxatral)
* Terazosin (Hytrin)

Non-selective Adrenergic blockers:

* Phenoxybenzamine
* Phentolamine (Regitine)

Tamsulosin is relatively selective for α1a-adrenergic receptors, which are mainly present in the prostate. Hence, it may have a more selective action in BPH with minimal effects on blood pressure.

Adverse effects and interactions

By reducing α1-adrenergic activity of the blood vessels, these drugs may cause hypotension (low blood pressure) and interrupt the baroreflex response. In doing so, they may cause dizziness, lightheadedness, or fainting when rising from a lying or sitting posture (known as orthostatic hypotension or postural hypotension). For this reason, it is generally recommended that alpha blockers should be taken at bedtime. Additionally, the risk of first dose phenomenon may be reduced by starting at a low dose and titrating upwards as needed.

Because these medications may cause orthostatic hypotension, as well as hypotension in general, these agents may interact with other medications that increase risk for hypotension, such as other antihypertensives and vasodilators.

As discussed above, tamsulosin may have less risk for hypotension and orthostatic hypotension due to its selectivity for α1a-adrenergic receptors. On the other hand, the drug (a) elevates risk for floppy iris syndrome, and (b) might show ADRs characteristic of the sulfa related drugs.

References

External links

* [http://www.drugdigest.org/DD/Comparison/NewComparison/0,10621,5-17,00.html DrugDigest] - Alpha blockers
* [http://www.rxlist.com/cgi/generic2/tamsul_cp.htm RxList.com] - Tamsulosin
*


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