Using Taulosin

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Tamsulosin Could be dangerous and cause dementia. Below is a commentary to a study which showed that tamsulosin can cause dementia.

Written by Steven A Kaplan MD, FACS

There have been a host of reports suggesting that chronic and long-term use of certain medications may be associated with changes in mental cognitive function, including dementia. Even stalwarts such as statins have been investigated for this phenomenon. In this cohort study using Medicare data from 2006 to 2012, the authors examined the potential association between selective a–adrenoreceptor antagonists, such as tamsulosin, versus other BPH drugs, including doxazosin, terazosin, alfuzosin, dutasteride, and finasteride as well a no–BPH medication group. The authors used a propensity score–matching analysis, which in part corrects for confounding variables, and the data suggest that the tamsulosin cohort had higher rates of dementia than the BPH no-medication group as well as the other BPH medication groups.

Although the data correct for the incidence of hypertension, dyslipidemia, and diabetes, they does not account for who prescribed medications (BPH may be defined differently by different specialties), use of combination therapies, types of concomitant medications, prostate size, and obesity (which may be associated with higher degree of systemic inflammation and a potential precursor to dementia). In other words, although some confounding variables may have been statistically corrected for, we have little idea about the role of multiple drug interaction and downstream changes in cognitive function. Moreover, while the authors only selected men >66 years, we don’t know how long men were on said medications prior to their analysis. Therefore, one should be cautious in attributing cause and effect to tamsulosin. Of interest, the number of tamsulosin patients was 10 times more than the number on the other drugs, so this may have been driven by propensity of drug utilization rather than the drug itself.

That being said, the urologic community needs to explore whether we are doing our patients a disservice by using long-term medications for what is essentially a quality-of-life disorder. Although we can rationalize prescribing a daily drug for many years for dyslipidemia, hypertension, diabetes, etc, can we really justify taking a medication (and often multiple drugs) for bothersome voiding symptoms, particularly now, in an era where we have numerous minimally invasive alternative therapies as well as safer and more effective surgical procedures? It seems reasonable to begin to rethink how we define success and more importantly failure with medication use. A little less LUTS may not justify the long-term use, cost, and potential consequences such as dementia. We need to do better in the LUTS world; urologists will need to lead!

Neal Pros

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6 Replies

  • Posted

    Neal,

    Can you provide a link to the study you referenced?

    Thanks,

    Henry

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  • Posted

    Hi guys moving slightly from the post I have an enlarged prostate I am taking Tamsulosin and Finasteride on a daily basis.Still get sexually arroused but the errection is semi hard and the ejaculation is normally silent . Is there any medication anyone can recommend to increase errection strength . This was obviously explained to me when I started but am feeling immensely frustrated now as is my wife .... I understood maybe incorrectly that viagra would no t work with both these drugs ?
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  • Posted

    What other drugs are currently available besides Tamulsin that are effective?
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    • Posted

      I have heard that Cialis, also called Tadalafil, once per day can be effective at reducing urinary retention.  I have not taken it myself so do not know the recommended dose for BPH, but others on this web site can recommend a dose rate. Of course it also has the effect of reducing Erectial Dysfunction. ED.

      Thomas

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    • Posted

      I started self catheterization 3 months ago and have been able to stop Tamsulosin, Flomax.  I was taking 0.4 mg twice a day.  However now I need to be careful to always have the cath supplies with me and a place to cath or could end up in an emergency situation.

      Thomas

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  • Posted

    Thanks for sharing this.  I never liked the short-term side affects of Tamsulosin, including dizziness and a mild sense of disorientation.  Because I'm up on roofs several times a year (6 stories up, at the ridge level of our Victorian pile), I am keenly aware of my sense of balance, which felt compromised by this drug.  I stopped taking it after my Urolift in Dec of 2015, and haven't missed it.  I am now taking spironolactone for reasons unrelated to BPH, and have found that, as a pleasant side effect, it appears to have reduced the severe restriction I had been feeling while cathing.  And none of the dizziness associated with the other drug!

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