Are alpha-blockers involved in lower urinary tract dysfunction in multiple system atrophy? A comparison of prazosin and moxisylyte.
Lower urinary tract dysfunction is a major cause of morbidity in patients with multiple system atrophy (MSA). alpha1-Adrenergic receptors are present in the proximal urethra where impaired relaxation may be responsible for voiding difficulty and a large amount of residual urine. An open study was designed to evaluate whether the blockade of these receptors by prazosin (a nonselective alpha1 blocker) and moxisylyte (an alpha1A-selective blocker) would improve bladder emptying in patients with MSA. Post-micturition residual volumes and clinical symptoms of 49 patients with MSA were evaluated at trial entry and after 4 weeks (prazosin; n=21 and moxisylyte; n=28). The respective means for the prazosin and moxisylyte groups were 38.1% and 35.2% reductions in residual urine volume (P<0.05), and there was lessening of urinary symptoms. Side effects due to orthostatic hypotension were seen in 23.8% of the prazosin group but in only 10.7% of the moxisylyte group. These effects were common in patients with postural hypotension of more than -30 mmHg at trial entry (P<0.05). Modulation of alpha1-receptors may function in the management of lower urinary tract dysfunction in MSA.
Sakakibara
R
R
Department of Neurology, Chiba University 1-8-1 Inohana Chuo-ku, Chiba, Japan. sakaki@med.mchiba-u.ac.jp
Hattori
T
T
Uchiyama
T
T
Suenaga
T
T
Takahashi
H
H
Yamanishi
T
T
Egoshi
K
K
Sekita
N
N
D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013948:Moxisylyte / Q000009:adverse effects / Q000627:therapeutic use*; D019578:Multiple System Atrophy / Q000188:drug therapy* / Q000503:physiopathology*; D011224:Prazosin / Q000009:adverse effects / Q000627:therapeutic use*; D001743:Urinary Bladder / Q000187:drug effects / Q000503:physiopathology; D014551:Urinary Tract / Q000503:physiopathology*; D014554:Urination / Q000187:drug effects
D000317:Adrenergic alpha-Antagonists; D013948:Moxisylyte; D011224:Prazosin