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Tamsulosin is an active ingredient in the group of alpha blockers, also known as alpha receptor blockers. It is used as one of the most important remedies in benign prostate syndrome and helps relieve symptoms. Here you can find out more about how tamsulosin works, when it’s best to take the drug, and what side effects to expect.
How does Tamsulosin work?
Tamsulosin is a molecule that binds to and blocks the so-called α1 receptor (also alpha-1 or α1-adrenergic receptor). There are many such α1 receptors in our body, for example on the bladder. Smooth muscle fibers are controlled via these receptors. For example, if the messenger substance norepinephrine binds to the α1 receptor, the smooth muscle cells in our bladder contract. The result: we can’t urinate due to muscle resistance.
Tamsulosin now blocks the α1 receptor so that norepinephrine can no longer bind to it. This achieves the opposite effect. Smooth muscle in the lower urinary tract relaxes, making it easier to go to the bathroom.
What is tamsulosin used for?
The active substance tamsulosin is used in benign prostate syndrome (BPS). Earlier this clinical picture called benign prostatic hyperplasia (BPH). Nowadays, however, a distinction is made between several subforms, all of which are summarized under the term benign prostate syndrome. Benign enlargement of the prostate (benign prostatic hyperplasia) is included, as are urinary problems (bladder emptying disorders), which are also called lower urinary tract symptoms (LUTS).
With an increase in the size of the prostate gland (prostate), which in men is located directly under the urinary bladder, the urethra narrows. Those affected often find it difficult to empty the bladder completely against the high resistance. This is where tamsulosin helps, as it reduces bladder resistance by relaxing the associated muscles.
It is important to know that tamsulosin relieves symptoms, but does not eliminate the cause, so it has no effect on prostate enlargement itself. There is another type of drug for this, such as finasteride.
Tamsulosin is only approved for men. For women, some studies have shown a positive effect on bladder emptying disorders, but there is insufficient data on the safety of the application. This means that it will initially only be available as a so-called off-label drug for women. This means that in some cases the prescription is carried out without the corresponding approval of the agent for this application.
How should tamsulosin be taken?
Tamsulosin is taken in the form of tablets or hard capsules. Both preparations are available in a so-called delayed form. This means that the active substance is released evenly and distributed in the body over 24 hours – the extended-release tablets or extended-release capsules should be taken once a day. Tamsulosin is absorbed from the intestine. The dosage of tamsulosin is 0.4 mg.
Ideally, tamsulosin should be taken in the morning after the first meal. This way you can always guarantee the same effective level. However, there is no general answer to the question of whether tamsulosin should be taken in the morning or in the evening. For most people, it is best taken in the morning after breakfast. If you work nights, you may also benefit from taking it in the evening.
When taking tamsulosin, it should be noted that there is a more frequent urinary urgency may occur. If you also drink coffee or alcohol, this craving can be intensified.
The active ingredient is very common and is produced by many pharmaceutical companies, so most of the tablets or hard capsules have an additional company name, such as Tamsulosin BASICS®, Tamsulosin Ocas® or Tamsulosin Zentiva®. The active ingredient is the same for all drugs, as is the dosage of 0.4mg.
The active substance tamsulosin hydrochloride can be found on some packages. This is also tamsulosin. Hydrochloride is just an additional molecule found in many drugs. The hydrochloride ensures better water solubility, which leads to better absorption of the active ingredients into the blood.
What are the side effects of tamsulosin?
Possible side effects include:
How does tamsulosin affect potency?
Tamsulosin has shown good efficacy and few side effects in several large studies. The so-called retrograde ejaculation (ejaculation backwards) has been described as a possible side effect. Due to relaxed muscle fibers in the bladder, some of the ejaculate can end up in the bladder. Those affected may have problems with ejaculation, for example with delayed or non-existent ejaculation. However, impotence as a side effect has not been described in the literature.
A very rare side effect is a permanent erection caused by tamsulosin, also called priapism. This side effect occurs much more frequently, for example, with drugs of the phosphodiesterase V inhibitor class, such as sildenafil (Viagra®).
What drugs do you combine tamsulosin with?
Depending on the underlying disease, tamsulosin is also combined with other active ingredients, which is why Drugs with appropriate combinations of active ingredients are available. The most common combination used to treat benign prostate syndrome is tamsulosin with finasteride. Finasteride intervenes in the hormonal cycle and thus prevents the prostate from overgrowing. Dutasteride comes from the same group of drugs and is also often combined with tamsulosin to reduce prostate enlargement and also to improve urine flow.
However, finasteride and dutasteride can lead to erectile dysfunction, which is why another possible combination is tamsulosin with tadalafil. Like sildenafil (Viagra®), tadalafil belongs to the group of phosphodiesterase V inhibitors. These also have a relaxing effect on the smooth muscles of the bladder, but have no effect on an enlarged prostate.
Interactions with other drugs
Tamsulosin is broken down by the liver. Drugs that are metabolised in the liver by the same system may interact with tamsulosin. For example, the level of tamsulosin increases with the simultaneous administration of the antihistamine cimetidine.
In contrast, the antihypertensive drugs ramipril or amlodipine have no effect on tamsulosin levels.
Contraindications: who shouldn’t take tamsulosin?
Caution should be exercised in individuals subject to orthostatic hypotension. This is a clinical picture in which there is a sudden drop in blood pressure. Tamsulosin is not suitable for these people as low blood pressure is one of the possible side effects.
Tamsulosin should also not be given to people with severe hepatic impairment.
There have also been increasing reports in recent years that tamsulosin may contribute to what is known as “floppy iris syndrome.” This is a complication of Cataract surgery. For this reason, people with eye conditions are advised to replace tamsulosin with alfuzosin, as this does not appear to have any effect on the eye muscles.
How long can you take tamsulosin?
Tamsulosin is initially taken for four weeks to evaluate the effect of the drug. If there is a positive effect, Tamsulosin can be taken for life. The study data provides enough evidence to classify long-term use as safe.
If the desired effect is not achieved, tamsulosin should be discontinued after consulting the treating physician. If your symptoms subside as a result of using the drug, you shouldn’t stop it yourself, or your symptoms may come back.
Alternatives to tamsulosin
There are some herbal alternatives to tamsulosin. To evaluate the effectiveness of these substances, the HMPC (Committee for Herbal Medicinal Products) exists in Europe. The HMPC gives the title of ‘established use’ to herbal medicines which have been in use in Europe for at least ten years and for which there are studies suggesting a positive influence.
In the treatment of benign prostate syndrome, there are over-the-counter alternatives made from saw palmetto, pumpkin seeds, or nettles. There is only sufficient data for the saw palmetto fruit to which the HMPC has hereby given the title of ‘well established use’. For example, saw palmetto fruits are contained in the Prostagutt® product. Prostagutt® can also be taken simultaneously with tamsulosin. For a more precise treatment plan, it is necessary to consult an expert in the field of urology.
Other alternatives are, for example, the active ingredients alfuzosin or silodosin, which also belong to the group of alpha blockers. Unlike tamsulosin, however, alfuzosin has a stronger effect on blood pressure, while silodosin has more unwanted sexual side effects.
Sources
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Zhang, H.L. et al. (2017): Tamsulosin for the treatment of lower urinary tract symptoms in women: a systematic review and meta-analysis. In: International Journal of Impotence Research, Vol. 29(4), pp.
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Jung, HJ et al. / Cochrane Database of Systematic Reviews (2017): Silodosin for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia.
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Miernik, A., Gratzke, C. (2020): Current therapy of benign prostate syndrome. In: Deutsches Ärzteblatt, Vol. 117, pp.
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AMBOSS Podcast (2022): Phytotherapy – tradition and evidence. (Access: 05/2023)
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Online information from the European Medicines Agency: Herbal Medicines Committee (HMPC). (Access: 05/2023)
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Moll, D. / Deutsche ApothekerZeitung (2020): Before cataract surgery: Stop tamsulosin early! (Access: 05/2023)
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Kahle, C. / Yellow List (2018): Tamsulosin. (Access: 05/2023)
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Information for Heumann professionals: Tamsulosin Heumann 0.4 mg modified-release hard capsules. (Status: 11/2022)
Updated: 05/15/2023
Author: Yannis Diener, human medicine student
