19C Erectile dysfunction
UROGENITAL SYSTEM
and need for prostate surgery; or in combination with
tamsulosin.
Adults: Swallow whole. Monotherapy: 0.5mg once
daily. Combination therapy: 0.5mg once daily with
tamsulosin 0.4mg once daily.
Children: Not applicable.
Contraindications: Not for use in children or
women. Pregnant women and those of childbearing
potential should avoid handling capsules.
Warnings/Precautions: Not for use in preventing
prostate cancer. Increased risk of high-grade prostate
cancer. Monitor prostate specific antigen (PSA) values
(establish new baseline PSA after 3–6 months of
treatment); double PSA levels to compare with normal
values. Rule out prostate cancer and other urological
disorders prior to treatment. Hepatic dysfunction. Avoid
donating blood until at least six months after last dose.
Interactions: May be potentiated by CYP3A4/5
inhibitors (eg, ritonavir, ketoconazole, verapamil,
diltiazem, cimetidine, troleandomycin, ciprofloxacin);
caution.
Adverse reactions: Impotence, decreased libido,
ejaculation disorder, gynecomastia, dizziness (with
tamsulosin).
How supplied: Caps– 30, 90
;FINASTERIDE
PROSCAR Merck
Type II 5;-reductase inhibitor. Finasteride 5mg; tabs.
Indications: BPH, to improve symptoms and reduce
risks of acute urinary retention and need for prostate
surgery. To reduce risk of symptomatic progression of
BPH, with doxazosin.
Adults: 5mg once daily. Reevaluate at 6 months,
then periodically.
Children: Not applicable.
Contraindications: Not for use in children or
women. Pregnant women and those of childbearing
potential should avoid handling crushed or broken
tablets.
Warnings/Precautions: Not for use in preventing
prostate cancer. Increased risk of high-grade prostate
cancer. Monitor prostate specific antigen (PSA)
values; double PSA levels for comparison with normal
ranges. Rule out prostate cancer and other urological
disorders prior to treatment. Monitor for obstructive
uropathy. Hepatic dysfunction.
Adverse reactions: Impotence, decreased libido or
ejaculate volume, mastodynia.
How supplied: Tabs– 30, 100, 1000
;TAMSULOSIN
FLOMAX Boehringer Ingelheim
;1A-blocker. Tamsulosin HCl 0.4mg; caps.
Indications: BPH.
Adults: Swallow whole. Take ½ hr after same meal
of each day. Initially 0.4mg once daily; may increase
to 0.8mg once daily after 2–4 weeks if response
is inadequate. If therapy is interrupted, resume at
0.4mg once daily and retitrate.
Children: Not applicable.
Warnings/Precautions: Rule out prostate cancer.
Sulfa allergy. Syncope. End-stage renal disease. Cataract
surgery (intraoperative floppy iris syndrome possible).
Interactions: Do not use with other ;-blockers.
Caution with cimetidine (esp. with tamsulosin
;0.4mg/day), warfarin.
Adverse reactions: Abnormal ejaculation, postural
hypotension, dizziness, rhinitis, cough, somnolence,
sinusitis, amblyopia, decreased libido, insomnia,
syncope; rare: priapism.
How supplied: Caps– 100
;TERAZOSIN
HYTRIN Abbott
;1-blocker (quinazoline). Terazosin (as HCl) 1mg,
2mg, 5mg, 10mg; caps.
Indications: BPH.
Adults: See literature. Initially 1mg at bedtime.
Titrate to 10mg once daily; usual max 20mg/day.
Reevaluate if no response after 6 weeks.
Children: Not applicable.
Warnings/Precautions: Rule out prostate cancer.
Syncope.
Interactions: Caution with verapamil, other
antihypertensives.
Adverse reactions: Syncope (esp. 1st dose),
dizziness, somnolence, asthenia, nausea, nasal
congestion, palpitations, impotence, orthostatic
hypotension, blurred vision, peripheral edema;
priapism (rare).
How supplied: Caps– 100
;SILDENAFIL
VIAGRA Pfizer
Phosphodiesterase type 5 inhibitor (cGMP-specific).
Sildenafil citrate 25mg, 50mg, 100mg; tabs.
Indications: Erectile dysfunction.
Adults: Take 1 dose as needed about 1 hr (½– 4 hrs)
before sexual activity at frequency of up to once daily.
Initially 50mg. May reduce dose to 25mg or increase
to max of 100mg. Elderly, hepatic impairment, severe
renal impairment, or concomitant potent CYP3A4
inhibitors (eg, erythromycin, ketoconazole, itraconazole,
saquinavir): consider initial dose of 25mg. Concomitant
ritonavir, indinavir, or atazanavir: max single sildenafil
dose of 25mg in 48 hrs. Concomitant ;-blockers (eg,
doxazosin): do not take ;25mg dose of sildenafil
within 4 hours of an ;-blocker.
Children: Not recommended.
Contraindications: Concomitant organic nitrates
or nitric oxide donors (eg, sodium nitroprusside).
Warnings/Precautions: Confirm diagnosis.
Cardiovascular disease (eg, MI, stroke, or life-threatening arrhythmia within 6 months; BP ;90/50
or ;170/110; unstable angina, LV outflow obstruction,
impaired autonomic regulation of BP). Anatomical penile
deformation. Predisposition to priapism. Patients for
whom sexual activity is inadvisable or contraindicated.
