Doctor Answers: Switching from Tamsulosin to Alfuzosin

Tamsulosin (brand name Flomax) and Alfuzosin (brand name Uroxatral) are medications used to treat symptoms of an enlarged prostate and lower urinary tract symptoms (LUTS) in men. Both medications work similarly by relaxing the muscles around the bladder and prostate gland to ease symptoms.

BPH (Benign Prostatic Hyperplasia) affects approximately 50% of men aged 51 to 60, and up to 90% of men over 80 years old, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

If you’re currently using Tamsulosin and are considering switching to Alfuzosin, you might have questions about the process, conversion doses, and safety considerations. We spoke with Diana Gariglio-Clelland, a urologist specializing in prostate health, to get answers to important questions on switching from Tamsulosin to Alfuzosin.

Diana Gariglio-Clelland, a Registered Dietitian and medical education specialist, has provided valuable insight and expertise to ensure you have all the information you need. The content has been thoroughly reviewed by a medical professional to ensure its accuracy and reliability.

Q: Can You Switch from Tamsulosin to Alfuzosin?

Diana Gariglio-Clelland, RD answers: Yes, it is possible to switch from Tamsulosin to Alfuzosin because both medications are alpha-blockers that work in a similar way. They help relieve symptoms of BPH by relaxing the muscles in the prostate and bladder. However, it’s essential to consult with your healthcare provider before making the switch to ensure that Alfuzosin is a good fit for you. Switching should only be done under medical supervision.

Q: What Is The Tamsulosin To Alfuzosin Conversion Dose?

Diana Gariglio-Clelland, RD answers: The typical starting dose for tamsulosin is 0.4 milligrams, taken 30 minutes after the same meal each day. If this dosage isn’t effective, it may be increased to 0.8 milligrams per day (the tablets are considered “modified release”). On the other hand, alfuzosin is only available as an extended-release tablet, with the recommended dose being 10 milligrams per day, taken immediately after a meal.When switching from tamsulosin to alfuzosin, your healthcare provider will help guide you on adjusting the doses. It’s essential to follow their advice because alfuzosin can have a greater impact on blood pressure, especially in elderly patients, and should be closely monitored.

Q: Why Do People Change From Tamsulosin To Alfuzosin?

Diana Gariglio-Clelland, RD answers: There are several reasons why patients may switch from Tamsulosin to Alfuzosin:

Side Effects

Both medications share similar side effects, but as the study suggests, Alfuzosin has been noted to cause fewer sexual side effects, particularly ejaculation issues, making it a preferred option for more sexually active men. Common side effects of both drugs include dizziness, headache, and fainting. Alfuzosin may be less likely to cause these issues compared to Tamsulosin.

Drug Allergies

Though rare, some patients may be allergic to Tamsulosin. In such cases, a healthcare provider may recommend switching to Alfuzosin as an alternative.

Efficacy

Research indicates that Tamsulosin and Alfuzosin are similarly effective at treating BPH symptoms. However, Alfuzosin may be better for patients who are concerned about sexual side effects.

Cost/Insurance Coverage

Costs for both medications can vary depending on your pharmacy and insurance. At the time of writing, Tamsulosin can cost between $12 and $22 for a 30-day supply, while Alfuzosin ranges from $12 to $36. Your insurance may favor one over the other, which can make the preferred drug more affordable.

Blood Pressure Considerations

Alfuzosin is more likely to impact blood pressure levels than tamsulosin, especially in elderly patients. According to a small study, alfuzosin doesn’t affect blood pressure levels among young, healthy men.

If you have a history of low blood pressure (especially if you’re older), then alfuzosin might not be the ideal medication for you. On the other hand, if you suffer from high blood pressure (hypertension), then it could be a benefit to take alfuzosin vs tamsulosin. 

One study concluded that taking alfuzosin alone or combined with a blood pressure medication lowered blood pressure among patients with uncontrolled hypertension. That means that if you’re already taking blood pressure medication, then adding alfuzosin can lower your blood pressure even more. For that reason, it’s important to monitor your blood pressure upon adding alfuzosin to your medication regimen. If you have any symptoms of low blood pressure (hypotension), then reach out to your healthcare provider for guidance. Some common symptoms of low blood pressure can include lightheadedness, blurred vision, confusion, fainting, and nausea.

Q: What Things Should You Consider When Switching From Tamsulosin To Alfuzosin?

Diana Gariglio-Clelland, RD answers: When switching medications, several factors should be considered:

• Cost: Alfuzosin may be more expensive than tamsulosin depending on your pharmacy and insurance.
• Side Effects: Alfuzosin may have a lower risk of sexual side effects, but it could impact your blood pressure more than tamsulosin, which can be positive or negative depending on your typical blood pressure levels.
• Efficacy: While both medications effectively treat BPH, you might find that one works better for you than the other.

Q: How Do You Safely Titrate From Tamsulosin To Alfuzosin?

Diana Gariglio-Clelland, RD answers: When switching medications, it’s important to safely adjust the dose under your healthcare provider’s supervision. This process is known as titration. Your doctor will guide you on how to gradually transition from tamsulosin to alfuzosin, ensuring that the switch doesn’t cause any sudden changes in your symptoms or health.

Q: Does Alfuzosin Work Better Than Tamsulosin?

Diana Gariglio-Clelland, RD answers: Alfuzosin and tamsulosin are both effective medications for treating BPH symptoms, and their efficacy is quite similar. However, alfuzosin may have a lower risk of causing sexual side effects and has a greater impact on blood pressure levels. Depending on your specific symptoms and health history, your healthcare provider may recommend one over the other.

Q: Can You Take Tamsulosin And Alfuzosin On The Same Day?

Diana Gariglio-Clelland, RD answers: It is not recommended to take both tamsulosin and alfuzosin on the same day. Since they act in similar ways, taking both could increase your risk of side effects, including dangerously low blood pressure. If you are switching medications, your healthcare provider will likely recommend stopping tamsulosin and starting alfuzosin the next day or after a short waiting period.

Ben’s Natural Flomax Alternative: Total Health

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It has a complete spectrum of 21 vitamins, 69 trace minerals, and natural herbs developed for the nutritional demands of men.

Clinical trials and meta-studies show that the active ingredients in Total Health for The Prostate have a positive impact on prostate volume, improve lower urinary tract symptoms, increase peak urinary flow, and decrease the risk of acute urinary retention.

Total Health contains 825mg of beta-sitosterol, the most effective and clinically proven natural Flomax substitute for men with prostate problems. Beta-sitosterol has been shown in studies to improve urinary symptoms and acts as a natural inhibitor of the 5 alpha-reductase enzyme to shrink the prostate.

Another important ingredient in Total Health is quercetin, a type of antioxidant proven to have anticancer benefits. Considering that prolonged urinary retention from BPH can increase bladder cancer risk, taking steps to reduce cancer risk is another important aspect of promoting bladder health.

Top Questions About Switching from Tamsulosin to Alfuzosin

Q: What are the potential interactions between Alfuzosin and other common medications?

Diana Gariglio-Clelland, RD answers:  According to the Cleveland Clinic, you should avoid taking other alpha-blockers if you’re taking Alfuzosin. Medications in this class include:

• Doxazosin (Cardura)
• Prazosin (Minipress)
• Silodosin (Rapaflo)
• Tamsulosin (Flomax)
• Terazosin 

In addition, the Cleveland Clinic recommends avoiding certain antifungal medications due to the potential interaction between them and Alfuzosin. Examples of such antifungal medications include:

• Fluconazole (Diflucan)
• Itraconazole (Sporanox)
• Ketoconazole (Nizoral)
• Posaconazole (Noxafil)
• Voriconazole (Vfend)

Other medications that aren’t recommended while taking Alfuzosin are:

• Cisapride (a medication used to treat acid reflux that isn’t used often because of potential side effects)
• Dronedarone (treats heart rhythm abnormalities)
• Droperidol (treats nausea and vomiting)
• Pimozide (medication for treating Tourette’s syndrome)
• Ritonavir (antiviral used to treat AIDS)
• Thioridazine (antipsychotic used to treat schizophrenia)

The above medications are suggested to be avoided altogether while taking Alfuzosin. The following medications may also interact with Alfuzosin – to be sure, check with your healthcare provider or pharmacist.

• Avanafil (used to treat erectile dysfunction)
• Cimetidine (antacid used to treat acid reflux and stomach ulcers)
• Medications for chest pain or blood pressure (they may cause low blood pressure when taken alongside Alfuzosin)
• Dofetilide (treats abnormal heart rhythm)
• Grapefruit juice (known to interact with many medications)
• Sildenafil (Viagra; used to treat erectile dysfunction)
• Tadalafil (Cialis – similar to Viagra)
• Vardenafil (Levitra – similar to Viagra)
• Ziprasidone (antipsychotic)

Some supplements can interact with certain prescription medications. For this reason, be sure to tell your healthcare provider if you’re taking any dietary supplements, herbs, tinctures, etc.

Q: Are there any notable differences in how Tamsulosin and Alfuzosin affect sexual function?

Diana Gariglio-Clelland, RD answers:  A study lists a decrease in libido, a decrease in erectile function, adverse effects in ejaculation, priapism (prolonged erection), and deterioration in sexual function as potential side effects of Tamsulosin. For Alfuzosin, potential sexual side effects include impotence, a decrease in erectile function.

That means that both medications have the potential to cause unwanted sexual side effects. However, while Alfuzosin is thought to cause fewer sexual side effects, one randomized controlled trial found little difference between Alfuzosin and Tamsulosin in terms of sexual side effects. 

It’s important to note that side effects from medications like Tamsulosin and Alfuzosin aren’t always negative. In a study, people taking Tamsulosin for BPH noted greater improvement in self-perceived sexual satisfaction compared to before they began taking Tamsulosin. Similarly, a study noted that Alfuzosin can help improve symptoms of sexual dysfunction. 

All-in-all, alpha-blockers (the medication class Tamsulosin and Alfuzosin belong to) are associated with “a low rate of sexual dysfunction”, according to a study. Just how prevalent is sexual dysfunction in patients taking Tamsulosin and Alfuzosin? For both medications, the prevalence was less than 3% in a randomized controlled trial. 

Whether you experience a positive or negative change in sexual function while taking medications like Tamsulosin and Alfuzosin will be an individual response. Factors like age, other health conditions, and pre-existing sexual dysfunction will play a role in how the medications affect sexual function.

If you experience significant adverse sexual side effects to the point that you’re considering discontinuing Tamsulosin or Alfuzosin, reach out to your prescribing healthcare provider for guidance.

Q: What are the benefits of Alfuzosin’s extended-release formulation over Tamsulosin’s modified-release form?

Diana Gariglio-Clelland, RD answers:  As mentioned earlier, studies show that Alfuzosin and Tamsulosin have similar effects on improving urinary symptoms. This means we can safely infer that there aren’t any notable benefits of an extended-release formulation over a modified-release formulation.

One interesting thing to note about the extended-release formulation of Alfuzosin is that it’s absorbed 50% slower if you take it in a fasted state (not eating or drinking anything besides water for at least eight hours). For that reason, it’s recommended to take Alfuzosin with a meal. On the other hand, being in a fasted state isn’t known to reduce the absorption rate of Tamsulosin, with fasted absorption rates near 100% (though it’s recommended to take it after a meal).

Tamsulosin doesn’t come in an extended-release formulation, but it’s noted to be designed to be “absorption rate controlled” (AKA modified-release), per the United States Food and Drug Administration (FDA). The FDA notes the half-life (the time it takes for only half of the dose to remain in your system) as 14-15 hours.

The half-life for Alfuzosin is 10 hours (per the FDA), so shorter than Tamsulosin. However, the dose is higher for Alfuzosin (10 mg vs. 0.4 or 0.8 mg of Tamsulosin), so after 10 hours there will still be 5 mg of Alfuzosin in your system compared to 0.2-0.4 mg of Tamsulosin after 14-15 hours.

Both medications are only taken once daily, so there aren’t any notable benefits in terms of convenience for Tamsulosin vs. Alfuzosin.

Q: Who should avoid switching from Tamsulosin to Alfuzosin?

Diana Gariglio-Clelland, RD answers: If you have issues with low blood pressure, then you might not be a candidate for switching to Alfuzosin since it’s known to have a greater impact on blood pressure. Some examples of people at greater risk of potential blood pressure problems from Tamsulosin are people over the age of 50, the elderly, and those with pre-existing blood pressure issues.

Orthostatic hypotension is when your blood pressure falls when going from lying down or sitting to standing, making you feel dizzy or woozy when you get up. This is a form of low blood pressure and is more likely in older people. If you experience orthostatic hypotension frequently, or if it’s severe when it occurs, then you might not be a good candidate for switching from Tamsulosin to Alfuzosin. 

If your symptoms are well-tolerated on Tamsulosin and you’re meeting treatment goals, then you may want to avoid switching to Alfuzosin since switching isn’t likely to result in any notable benefits. Similarly, if your health insurance covers Tamsulosin and your out-of-pocket cost would be higher for Alfuzosin, you may not be an ideal candidate to switch unless the monetary difference is worth it if you’re not meeting treatment goals on Tamsulosin.

Conclusion

If you consider switching from Tamsulosin to Alfuzosin, you should know that both are alpha-blockers, a type of medication that relaxes the muscles near the bladder and prostate gland in men. They are used to reduce symptoms of an enlarged prostate and lower urinary tract symptoms.

Tamsulosin and Alfuzosin have similar efficacy. Alfuzosin has a greater impact on blood pressure levels compared to tamsulosin and may have a slightly lower risk of causing sexual side effects.

Follow your prescribing healthcare provider’s guidance regarding switching from tamsulosin to alfuzosin. Avoid taking both medications at the same time, which can increase your risk of unwanted side effects.

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