Tamsulosin: current clinical experience

During the past decade, our understanding of the epidemiology and natural history of benign prostatic hyperplasia (BPH) has improved considerably. Population-based studies confirm that lower urinary tract symptoms (LUTS) are very common among aging men. These studies have confirmed that men with moderate-to-severe symptoms have 4 to 6 times more trouble and interference with activities of daily living and twice the level of worry as those with mild symptoms. The realization by patients and their physicians that most men >50 years of age will develop LUTS, has resulted in increased awareness of pharmacologic agents, principally alpha-adrenergic antagonists, as a first line of therapy for this condition. Alpha blockers were introduced >30 years ago to treat LUTS and today are the mainstay in pharmacologic therapy. Among the alpha blockers, tamsulosin more selectively targets the alpha(1A)-adrenergic receptor subtype and is as effective as conventional alpha(1) blockers in treating LUTS caused by BPH. Its subselectivity and pharmacodynamic properties may provide advantages in safety, tolerability, and administration compared with other alpha blockers, such as terazosin and doxazosin. Unlike other alpha blockers, tamsulosin does not require titration to be efficacious. Because of its rapid onset of action and lack of clinically significant effect on blood pressure in normotensive and hypertensive patients, a therapeutic dose is delivered at the onset of treatment. Studies have documented that tamsulosin produces rapid improvements in LUTS and peak urinary flow rates, and these responses have been found to be durable.