Issues for surgery
For treatment of hypertension – loss of blood pressure (BP) control if omitted.
For benign prostatic hyperplasia – risk of acute urinary retention if omitted.
Risk of hypotension when continued, particularly with alfuzosin (see Interactions with common anaesthetic agents)
Risk of Intraoperative Floppy Iris Syndrome (IFIS) in patients undergoing cataract surgery when continued (see Further information).
Combination product containing solifenacin – risk of QT-interval prolongation if continued.
Advice in the perioperative period
Elective and emergency surgery
Continue, including combination product – monitor BP.
Combination products:
- Tamsulosin with dutasteride
- Tamsulosin with solifenacin
Patients undergoing cataract surgery
Ensure the ophthalmologist/cataract surgeon is aware the patient is taking an alpha-adrenoceptor blocker (see Further information).
Post-operative advice
Patients undergoing transurethral resection of prostate (TURP)
If indicated for the treatment of benign prostatic hyperplasia (BPH), alpha-adrenoceptor blockers may be stopped following an effectual TURP, subject to a successful trial without catheter (TWOC).
Interactions with common anaesthetic agents
Hypotension
Alpha-adrenoceptor blockers can increase the risk of hypotension when used concomitantly with inhalational or intravenous anaesthetics.
The manufacturer of alfuzosin advises withhold 24 hours prior to surgery. However, in practice alfuzosin is continued – monitor BP.
For combination product containing solifenacin
See Solifenacin monograph.
Interactions with other common medicines used in the perioperative period
Hypotension
Alpha-adrenoceptor blockers can increase the risk of hypotension when used concomitantly with droperidol or prochlorperazine.
For combination product containing solifenacin
See Solifenacin monograph.
Further information
Intraoperative Floppy Iris Syndrome (IFIS)
IFIS has been observed during cataract surgery in some patients on or previously treated with tamsulosin. As IFIS may lead to increased procedural complications during the cataract operation current or past use of tamsulosin should be made known to the Ophthalmic Surgeon in advance of surgery.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 18th March 2019]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 18th March 2019]
Summary of Product Characteristics – Contiflo® XL (tamsulosin) 400 micrograms prolonged release capsules. Ranbaxy (UK) Limited a Sun Pharmaceutical Company. Accessed via www.medicines.org.uk 18/03/2019 [date of revision of the text April 2017]