Cardiovascular and ocular safety of α1-adrenoceptor antagonists in the treatment of male lower urinary tract symptoms

Introduction: alpha(1)-Adrenoceptor antagonists (alpha-blockers) represent first-line drug treatment for male lower urinary tract symptoms. Their adverse events (AEs) include asthenia, dizziness, nasal congestion, arterial (orthostatic) hypotension and intraoperative floppy iris syndrome (IFIS). Areas covered: This report focuses on cardiovascular and ocular AEs of alpha-blockers as related to their mechanism of action and subtype selectivity. Expert opinion: The incidence of hypotension differs between alpha-blockers. It is greatest with doxazosin or terazosin, but others including tamsulosin can also lead to hypotension especially upon treatment initiation. Concomitant antihypertensive medication increases the incidence of hypotension with some alpha-blockers. Use of alpha(1A)-selective blockers, evening dosing and drug intake after a meal can reduce the risk of hypotension. IFIS can occur with all drugs exerting alpha(1)-adrenoceptor antagonist properties and has especially been reported for tamsulosin. It makes cataract surgery more challenging but does not constitute a health risk to patients. IFIS seems to result from inhibition of iris dilator muscle contraction and occurs in men or women, even after alpha-blockers have been discontinued. To reduce the risk of IFIS, the authors suggest taking a careful drug history, postponing alpha-blocker treatment for patients with scheduled cataract surgery and careful counseling of patients taking alpha-blockers.