Many of your patients may secretly be living with BPH.1 But you won't know unless you ask them; research shows that men seldom bring BPH symptoms to their physician's attention.2 Men may avoid discussing BPH because:
- they may mistakenly consider BPH symptoms to be a normal part of aging1,2
- they are embarrassed to discuss the topic
- they are in denial that they're having a problem
- they fear a diagnosis of prostate cancer
- they have a fear of surgery2,3
Most men also do not realize that symptoms of BPH may be easily treated, so they believe it will be more convenient to just deal with them.2 All of these factors add up to a large number of men suffering in silence needlessly.
Alleviating patient concerns
Once you have initiated a conversation and actually diagnosed a patient as a BPH sufferer, your patient may have a new set of concerns. He or his loved one may worry that:
- BPH is serious or a precursor to prostate cancer
- BPH will affect his sex life
- treatment will be painful or inconvenient
- surgery will be necessary
- medication will be costly
Being proactive is the best way to help anticipate and ease some of the most common concerns men have but may hesitate to express to you. Download this helpful list of common concerns to give to your patients and their loved ones. It provides answers to common patient concerns and can serve as a good conversation starter when treatment becomes necessary.
Discuss treatment options with your patients
For some patients, watchful waiting may be the most appropriate option. If so, it is recommended that the option of treatment be reexamined within 6 months, since BPH symptoms tend to worsen over time.4,5 In many cases, medication may be used to relieve symptoms. However, in the event that medication alone is not effective, there are several minimally invasive surgical options. Your patients will be relieved to know that surgery is often a last-line treatment option, and that several changes in behavior can help some patients avoid surgery. For instance, reducing fluid intake at night can help relieve symptoms.
Promoting adherence
As with any chronic condition that may require daily medication, adherence to the prescribed BPH therapy can be a challenge for some patients. This may be especially true in the case of BPH, because the patient may:
- be in denial of his condition
- forget that he has a medical condition because his symptoms aren't always bothersome
- be resistant to taking any medication daily
- have cognitive impairments (dementia, Alzheimer's, etc)
- already be taking several medications and may be confused by multiple regimens
Studies show that adherence to daily medication improves if patients incorporate their regimen into their daily routine. FLOMAX capsules 0.4 mg once daily is recommended as the dose for the treatment of the signs and symptoms of BPH. It should be administered approximately one-half hour following the same meal each day.
Important Safety Information
Flomax® (tamsulosin HCl) capsules are indicated to treat the signs and symptoms of benign prostatic hyperplasia (BPH). FLOMAX is not indicated to treat hypertension.
FLOMAX is contraindicated in patients who are hypersensitive to tamsulosin HCl or any of its components.
As with other alpha-adrenergic blocking agents, there is a potential risk of syncope. When beginning treatment, or increasing the dose of FLOMAX, patients should be cautioned to avoid driving or performing hazardous tasks where injury could result should syncope occur.
FLOMAX capsules 0.4 mg should not be used in combination with strong inhibitors of CYP3A4 (e.g., ketoconazole).
Rarely (probably less than 1 in 50,000 patients) FLOMAX, like other alpha-1 antagonists, has been associated with priapism. Because this condition can lead to permanent impotence if not properly treated, patients must be advised about the seriousness of the condition.
Carcinoma of the prostate and BPH cause many of the same symptoms. Patients should be evaluated prior to the start of FLOMAX capsules therapy to rule out the presence of carcinoma of the prostate.
Intraoperative Floppy Iris Syndrome (IFIS) has been observed during cataract surgery in some patients treated with alpha-1 blockers, including FLOMAX capsules. Patients should be advised that if they are considering cataract surgery, to tell their ophthalmologist that they have taken FLOMAX capsules.
In patients with sulfa allergy, allergic reaction to FLOMAX capsules has been rarely reported. If a patient reports a serious or life-threatening sulfa allergy, caution is warranted.
FLOMAX capsules should NOT be used in combination with other alpha-adrenergic blocking agents. Caution is advised when alpha-adrenergic blocking agents, including FLOMAX, are co-administered with PDE 5 inhibitors, as this can potentially cause symptomatic hypotension.
FLOMAX capsules (particularly at a dose higher than 0.4 mg) should be used with caution in combination with moderate inhibitors of CYP3A4 (e.g., erythromycin), strong (e.g., paroxetine) or moderate (e.g., terbinafine) inhibitors of CYP2D6, or in patients known to be CYP2D6 poor metabolizers.
Caution should be exercised with concomitant administration of warfarin and FLOMAX and should be used with caution in combination with cimetidine, particularly at doses higher than 0.4 mg.
The most common side effects are dizziness, abnormal ejaculation, and rhinitis.
Before prescribing FLOMAX, please see the Full Prescribing Information.
1. Daly MP. Quality of life in sexually active men with symptomatic benign prostatic hyperplasia. Clin Drug Invest. 2005;25:219-230.
2. Garraway WM, Russell EBAW, Lee RJ, et al. Impact of previously unrecognized benign prostatic hyperplasia on the daily activities of middle-aged and elderly men. Br J Gen Pract. 1993;43:318-321.
3. Walsh PC. Benign prostatic hyperplasia. In: Walsh PC, ed. Campbells' Urology. 6th ed. Philadelphia, Pa: WB Saunders Co; 1996:1009-1027.
4. Jiménez-Cruz F. Identifying patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) at risk for progression. Eur Urol Suppl. 2003;2(7):6-12.
5. Dobrovits M, Chaudry A, Anagnostou T, et al. A longitudinal prospective study of men with mild symptoms of BOO treated with watchful waiting over 4 years. Eur Urol Suppl. 2003;2(1):26.
