Alfuzosin

How it works

It selectively blocks alpha-1 adrenoceptors in the smooth muscle of the prostate, prostatic capsule and bladder neck, reducing urethral tone and outflow resistance to improve urinary flow and symptoms.

Prescribing in practice

• Patients due to have cataract or other eye surgery must tell the ophthalmologist they take, or have taken, this medicine, as it is associated with intraoperative floppy iris syndrome.
• It can cause postural hypotension and a first-dose effect, with dizziness, light-headedness and rarely syncope, particularly on initiation or dose increase.
• Use with caution in patients with cardiovascular disease and those taking other blood-pressure-lowering or QT-affecting drugs; consult the SPC for detail.

Monitoring

Monitor blood pressure, particularly after the first dose and on dose changes, and review for dizziness or postural symptoms. Ensure planned ophthalmic surgery is flagged so the surgeon can anticipate floppy iris syndrome.

Counselling the patient

• If you are going to have eye surgery for cataracts, tell the eye surgeon you take this medicine, even if you stopped it some time ago.
• The first dose may make you feel dizzy or faint — take it as advised, ideally at bedtime, and get up slowly from sitting or lying.
• Take care when driving or using machinery until you know how it affects you.

Evidence & guidelines

An established alpha-blocker recommended in UK guidance (NICE) for moderate-to-severe lower urinary tract symptoms due to benign prostatic hyperplasia.