alfuzosin

General

Pronunciation
al-FYOO-zo-sin [Pronunciation]

Trade Name(s)

• Uroxatral

• Xatral [Canada]

Pregnancy Category
Category B

Ther. class.
urinary tract antispasmodics

Pharm. class.
peripherally acting antiadrenergics

Indications

Management of symptomatic benign prostatic hyperplasia (BPH).

Action

Selectively blocks alpha₁- adrenergic receptors in the lower urinary tract to relax smooth muscle in the bladder neck and prostate.

Therapeutic Effect(s):
Increased urine flow and decreased symptoms of BPH.

Pharmacokinetics

Absorption: 49% absorbed following oral administration; food enhances absorption.

Distribution: Unknown.

Metabolism and Excretion: Mostly metabolized by the liver (CYP3A4 enzyme system); 11% excreted unchanged in urine.

Half-life: 10 hr.

TIME/ACTION PROFILE

ROUTE	ONSET	PEAK	DURATION
PO-ER	within hr	8 hr	24 hr

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;

• Moderate to severe hepatic impairment;

• Potent inhibitors of the CYP3A4 enzyme system;

• Concurrent use of other alpha-adrenergic blocking agents;

• Severe renal impairment;

• Pedi: Children.

Use Cautiously in:

• Congenital or acquired QTc prolongation or concurrent use of other drugs known to prolong QTc;

• Mild hepatic impairment;

• Symptomatic hypotension;

• Concurrent use of antihypertensive agents, phosphodiesterase type 5 inhibitors, or nitrates (↑ risk of postural hypotension);

• Previous hypotensive episode with other medications;

• Geri: Consider age-related changes in body mass and cardiac, renal, and hepatic function when prescribing.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache.

EENT: intraoperative floppy iris syndrome.

Resp: bronchitis, sinusitis, pharyngitis.

CV: postural hypotension.

GI: abdominal pain, constipation, dyspepsia, nausea.

GU: erectile dysfunction, priapism.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• Ketoconazole , itraconazole , and ritonavir ↓ metabolism and significantly ↑ levels and effects (concurrent use contraindicated).

• Levels are ↑ by cimetidine , atenolol , and diltiazem .

• May ↑ levels and effects of atenolol and diltiazem (monitor BP and heart rate).

• ↑ risk of hypotension with antihypertensives , nitrates , phosphodiesterase type 5 inhibitors (including sildenafil , tadalafil , and vardenafil ) and acute ingestion of alcohol .

Route/Dosage

• PO (Adults): 10 mg once daily..

Availability

• Extended-release tablets: 10 mg

Assessment

• Assess for symptoms of benign prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, interruption of urinary stream, impairment of size and force of urinary stream, terminal urinary dribbling, straining to start flow, dysuria, urgency) before and periodically during therapy.

» Assess for orthostatic reaction and syncope. Monitor BP (lying and standing) and pulse frequently during initial dose adjustment and periodically thereafter. May occur within a few hr after initial doses and occasionally thereafter.

» Rule out prostatic carcinoma before therapy; symptoms are similar.

Potential Nursing Diagnoses

• Risk for injury (Side Effects)

• Noncompliance (Patient/Family Teaching)

Implementation

PO: Administer with food at the same meal each day. Tablets must be swallowed whole; do not crush, break, or chew.

Patient/Family Teaching

Instruct patient to take medication with the same meal each day. Take missed doses as soon as remembered. If not remembered until next day, omit; do not double doses.

» May cause dizziness or drowsiness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.

» Caution patient to avoid sudden changes in position to decrease orthostatic hypotension.

» Advise patient to consult health care professional before taking any cough, cold, or allergy remedies.

» Instruct patient to notify health care professional of medication regimen before any surgery, especially cataract surgery.

» Advise patient to notify health care professional if priapism, angina, frequent dizziness, or fainting occurs.

» Emphasize the importance of follow-up exams to evaluate effectiveness of medication.

» Geri: Assess risk for falls; implement fall prevention program and instruct patient and family in preventing falls at home.

Evaluation/Desired Outcomes

Decreased symptoms of benign prostatic hyperplasia.