Alpha-adrenergic blockers for prostatic disorders
ATC code: G04CA02 (Tamsulosin)
Selective alpha-1A adrenergic receptor antagonist. Relaxes smooth muscle in the prostate and bladder neck, improving urine flow. Minimal action on vascular alpha-1B receptors, so orthostatic hypotension is less frequent than with non-selective alpha-blockers such as doxazosin and terazosin.
First line
First-line medical therapy for BPH per EAU 2023 and AUA guidelines. Dose is 0.4 mg once daily. Effect begins within 1-2 weeks. Improves Qmax (peak urinary flow rate) by 1-3 mL/s and reduces IPSS score by 3-5 points. Does not reduce prostate volume – a 5-alpha-reductase inhibitor (finasteride, dutasteride) is added when prostate volume exceeds 40 mL.
Adjunct
Adjunctive therapy to facilitate passage of distal ureteral stones 5-10 mm in size. Meta-analyses show tamsulosin accelerates stone passage and reduces analgesic requirements. EAU 2023 guidelines permit tamsulosin 0.4 mg for distal ureteral stones. No proven benefit for stones under 5 mm.
This drug is intended for men. Not used in women.
tamsulosin is evaluated for the following indications with varying evidence strength: Benign prostatic hyperplasia (evidence tier A), Medical expulsive therapy for ureteral stones (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of tamsulosin (≥ 1 in 100): Retrograde ejaculation (most common side effect – up to 10%), Dizziness, Rhinitis, nasal congestion, Asthenia. See the Safety section for uncommon and serious reactions.
This drug is intended for men. Not used in women.
tamsulosin is contraindicated in: Hypersensitivity to tamsulosin; History of orthostatic hypotension; Severe hepatic impairment. Full list in the Safety section.