Using Taulosin

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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