title: Cardiovascular and ocular safety of α1-adrenoceptor antagonists in the treatment of male lower urinary tract symptoms.
abstract: BACKGROUND
  α1-Adrenoceptor antagonists (α-blockers) represent first-line drug treatment for male lower urinary tract symptoms. Their adverse events (AEs) include asthenia, dizziness, nasal congestion, arterial (orthostatic) hypotension and intraoperative floppy iris syndrome (IFIS).
  
  
  METHODS
  This report focuses on cardiovascular and ocular AEs of α-blockers as related to their mechanism of action and subtype selectivity.
  
  
  CONCLUSIONS
  The incidence of hypotension differs between α-blockers. It is greatest with doxazosin or terazosin, but others including tamsulosin can also lead to hypotension especially upon treatment initiation. Concomitant antihypertensive medication increases the incidence of hypotension with some α-blockers. Use of α(1A)-selective blockers, evening dosing and drug intake after a meal can reduce the risk of hypotension. IFIS can occur with all drugs exerting α(1)-adrenoceptor antagonist properties and has especially been reported for tamsulosin. It makes cataract surgery more challenging but does not constitute a health risk to patients. IFIS seems to result from inhibition of iris dilator muscle contraction and occurs in men or women, even after α-blockers have been discontinued. To reduce the risk of IFIS, the authors suggest taking a careful drug history, postponing α-blocker treatment for patients with scheduled cataract surgery and careful counseling of patients taking α-blockers.
authors: Hannover Medical School, Department of Urology , Hannover , Germany.
authors: Matthias
authors: M
authors: Oelke
authors: Adrian
authors: A
authors: Gericke
authors: Martin C
authors: MC
authors: Michel
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000818:Animals; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000503:physiopathology; D002387:Cataract Extraction / Q000379:methods; D005128:Eye Diseases / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy; D008297:Male; D010353:Patient Education as Topic
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists
keywords: adverse drug event; alfuzosin; blood pressure; doxazosin; hypotension; intraoperative floppy iris syndrome; silodosin; tamsulosin; terazosin; α1-adrenoceptor antagonist