Alpha-1 Adrenoceptor Antagonist
Alfuzosin Hydrochloride
Brand names: Xatral XL
Adult dose
Dose: 10 mg once daily
Route: Oral (modified-release tablet)
Frequency: Once daily after evening meal
Clinical pearls
- Modified-release tablets should be swallowed whole, not crushed
- Warn all patients about IFIS risk — inform ophthalmologist before any eye surgery even if drug stopped
- First-dose hypotension is less marked than with non-selective alpha-blockers but still monitor
- No significant effect on PSA levels — does not mask prostate cancer screening
- May improve IPSS (International Prostate Symptom Score) within 2–4 weeks
Contraindications
- History of postural hypotension
- Hepatic impairment
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)
- Concomitant use with other alpha-blockers
- Concomitant use with potent CYP3A4 inhibitors
Side effects
- Postural hypotension (especially with first dose)
- Dizziness
- Headache
- Asthenia
- Tachycardia
- Intraoperative floppy iris syndrome (IFIS) — warn ophthalmologist pre-cataract surgery
- Priapism (rare)
Interactions
- Antihypertensives — additive hypotension
- PDE5 inhibitors (sildenafil, tadalafil) — enhanced hypotension
- CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) — increased alfuzosin exposure; avoid
- Other alpha-blockers — additive effects; avoid
Monitoring
- Blood pressure (especially after first dose and dose increases)
- Renal function (caution if eGFR 30–60)
- Symptom score (IPSS) at 3–6 months
- Inform ophthalmologist if cataract surgery planned or undertaken
Reference: BNF; NICE NG104 (Lower urinary tract symptoms in men, 2022); EAU Guidelines on Non-neurogenic Male LUTS (2024); https://bnf.nice.org.uk/drugs/alfuzosin-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.