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Alfuzosin: Side Effects and Dosage

Mechanism of Action of Alfuzosin

Alfuzosin is a nonselective α₁-blocker with a short elimination half-life; but a sustained-release formulation is available. The chemical properties of alfuzosin lead to a certain degree of uroselectivity and a favorable side effect profile. Please see section general pharmacology of alpha blocker.

**Structural formula of alfuzosin**

Indications for Alfuzosin

Treatment of lower urinary tract symptoms due to benign prostatic hyperplasia.
Off-label treatment of female LUTS due to neurogenic bladder neck obstruction.
Off-label treatment: improve the spontaneous passage of distal ureteral stones.

Pharmacokinetics of Alfuzosin

Well absorbed taken after the meals, high protein binding, hepatic metabolism (CYP3A4)
Elimination half-life is 5 hours. As a sustained-release formulation, the apparent half-life is 9 hours.

Side Effects

Alfuzosin has a favorable side effect profile despite being a nonselective α1 blocker.

Initial hypotension, orthostatic collapse, reflex tachycardia, usually transient.
Increased risk (HR 1,2) of cardiac failure in patients with cardiac comorbidity (Lusty et al., 2021).
Stuffy nose
Retrograde ejaculation
Dizziness, weakness.
Rare side effects: priapism (alpha blockers inhibit sympathetic mechanisms for detumescence), intraoperative floppy iris syndrome during cataract surgery.

Contraindications of Alfuzosin

Urological Contraindications:

Conservative treatment of BPH is not indicated if surgical treatment is imperative: chronic urinary retention with renal failure, recurrent hematuria due to prostatic enlargement, recurrent infections, and bladder stones.

Cardiac Contraindications:

Hypotension, mechanical heart failure (valvular, pulmonary embolism, pericarditis), congestive heart failure.

Other contraindications:

Alfuzosin should be paused for cataract surgery to prevent an intraoperative floppy iris syndrome.

Dosage of Alfuzosin

10 mg in retarded galenic formulation orally once daily or 5 mg 1–0–1. The initial or single dose should be given before bedtime in the evening to reduce side effects.

Doxazosin

Index

Silodosin

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

References

Chapple 2004 CHAPPLE, C. R.: Pharmacological therapy of benign prostatic hyperplasia/lower urinary tract symptoms: an overview for the practising clinician.
In: BJU Int
94 (2004), Nr. 5, S. 738–44

Fusco et al., “Alpha-Blockers Improve Benign Prostatic Obstruction in Men with Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Urodynamic Studies.,” Eur Urol., vol. 69, no. 6, pp. 1091–1101, 2016, doi: 10.1016/j.eururo.2015.12.034.

C. de Mey, “alpha(1)-blockers for BPH: are there differences?,” Eur Urol, vol. 36 Suppl 3, pp. 52–63, 1999.

J. Nordling, “Efficacy and safety of two doses (10 and 15 mg) of alfuzosin or tamsulosin (0.4 mg) once daily for treating symptomatic benign prostatic hyperplasia,” BJU Int, vol. 95, no. 7, pp. 1006–12, 2005.

Deutsche Version: Alfuzosin